Alfred A. Garofalo, DPM
Director of Podiatry
Bellevue Hospital Center
Gouverneur Healthcare Services
Q. Why is foot care so important when I've been diagnosed with diabetes?
A. Diabetes can have very serious effects on lower extremities. One of the reasons is that, over time, excess glucose in the blood stream can injure the walls of the tiny blood vessels that feed your nerves, especially in the lower extremities. This can lead to nerve damage. With reduced nerve function, you may have less feeling in your feet and may not notice a foot injury until it becomes infected. Even ordinary problems can eventually lead to serious complications. Diabetes can also lead to reduced blood circulation to legs and feet.
Q. How will I know if I have nerve damage?
A. Numbness, tingling or burning in the feet are the most common symptoms of nerve damage, also called diabetic peripheral neuropathy. It can, in fact, be the first symptom that signals to a patient the presence of diabetes. If you are a diabetic patient who develops neuropathy, you should visit your podiatrist on a more regular basis. Infections are also common. Since you may lack sensation on your feet, you will also have the absence of pain, and won't become aware of the infection until other problems arise. An unattended infection can lead to the amputation of a limb.
Q. What should I do to protect against the effects of neuropathy?
A. You should check your feet -- especially the bottoms of your feet -- each evening before you go to bed for any signs of redness, irritation or skin change. You should check your shoes before putting them on each day to insure there's no debris that can act as an irritant. To avoid burns, never place your feet near a radiator or heater if they feel cold, and always check water temperature with your hands before placing your feet in the tub. You shouldn't walk barefoot so you can avoid bruises or abrasions. If you notice a change in color or any swelling, see a doctor right away -- delay could allow the problem to escalate. Finally, you should see your doctor and care team regularly, and get foot exams at least once a year.
Q. What about poor circulation?
A. Some signs of poor circulation, also called peripheral arterial disease, are the inability to walk a few blocks without resting, pain in the limbs during sleep, changes in the skin texture or color, frequent bruises that develop into skin ulcers and a wound that does not heal. One out of every three people with diabetes over the age of 50 are estimated to have this condition. It increases their risk for heart attack and stroke. To help limit or reduce the effects of peripheral arterial disease, quit smoking, keep blood sugar, cholesterol and blood pressure under control, and do regular exercise, like walking. You should also be sure to wear appropriate shoes that fit comfortably and offer the proper support. As long as you check their feet after each exercise session, your feet are not at risk and you can and should exercise regularly.
Q. Can I get a pedicure if I'm a diabetic patient?
A. I'm frequently asked this question. Yes, you can get a pedicure, but keep a few things in mind. Don't put your feet in a whirlpool bath. Without proper sterilization, fungus, yeast and bacteria thrive in those environments. Bring your own sterilized instruments to ensure no micro-organisms are unknowingly transferred to your feet. If you don't have your own instruments, make sure they come from a sterile package and are disposable single-use only. If you need to trim your nails, be sure the nail is cut straight across and not into the nail fold or cuticle. Do not allow the technician to remove dry skin or callous with a sharp instrument.
Q. Can I use over-the-counter medication for my feet?
A. I strongly caution against using over-the-counter medications to relieve foot problems like corns and calluses. These products often contain a chemical that can cause severe skin irritation or even ulcer burns, which can be difficult to detect due to decreased sensation, and not found until after the damage is done. Always see your podiatrist to treat any foot problems.