Diabetes: Pitfalls Preventing Podiatric Care

Diabetic Shoes and Your Foot from Chicago Health SMB Brands on Vimeo.

At times I see patients who are diabetics who have not been properly educated about their feet.  They seem to have been scared so much from false education as to take a “don’t touch my feet” attitude with their podiatrist, their physician and surgeon of the foot and ankle.

Myth #1: ” The podiatrist is only the one I have to see if I need an amputation.”  I heard this a lot when I practiced in South Texas.  Yes, it is true that this is a procedure that has to be performed in some people, but it is a last resort.  Podiatrists work to prevent limb loss by safely rendering treatments to the feet to keep them healthy.

Myth #2: “I was told that I couldn’t have my toenails trimmed because I’m a diabetic.  So I don’t want them done.”  The podiatrist’s job is to perform procedures such as reduction of long or thick toenails to prevent problems from developing, such as ulcers, lacerations, infections, etc., that could lead to limb loss.  It may be unsafe for a diabetic to trim their own nails or have a non-professional do it, especially if their sugars are high or if they have a condition such as poor circulation (peripheral vascular disease), where a wound that can happen if they cut the skin by mistake, or if the have peripheral neuropathy, where injuries can happen because of lack of sensation.  On the contrary, diabetics need the services that podiatrists offer, including sterile instruments and a means to stop bleeding if it occurs.

Myth #3: “I was told that I can’t have functional orthotics because I am a diabetic.”  There are standards for certain types of diabetic shoes and inserts for diabetics with peripheral vascular disease or peripheral neuropathy.  These are discussed in the video above.  However, this does not mean that other types of orthotics are contraindicated.  There are many biomechanical conditions that are treated with semi-rigid functional orthotics.  These include such painful conditions as plantar fasciitis, posterior tibial tendon syndrome, osteoarthritis, tarsal coalitions, etc.  Usually I will place a diabetic topcover constructed of a spongy foamy material, the same material used in a diabetic insole, for at-risk patients who need a functional orthotic.  Podiatrists are specialists in the fabrication of orthotics for diabetics.

Myth #4: “I can’t have surgery because I’m a diabetic.”  Post-operative wound healing and bone healing are dependent of good blood sugar control to prevent infections.  The blood circulation status and nerve status are also checked to minimize the risk of complications.  A physical exam by the primary care physician is ordered to make sure the patient is fit for anesthesia.  Patients are also instructed not to take their diabetic medications before surgery to prevent their blood sugars from going too low.  Just because a patient is diabetic is not a contraindication for surgery.  There are many conditions where surgery is indicated, and are successfully performed on diabetic patients.

The podiatrist’s job is to explain what treatments are necessary for the feet, and how those treatments can be rendered for patients with various medical conditions, including diabetes.  Dr. Hoy has special expertise in the treatment of diabetics.