People with diabetes often have questions about how best to care for their feet and what to do when problems occur. To help answer these questions, Diabetes Self-Management interviewed several foot-care experts — including four podiatrists and one pedorthist — who regularly work with people with diabetes. A podiatrist is a doctor of podiatric medicine (DPM), who is qualified by his education and training to diagnose and treat conditions affecting the foot, ankle, and related structures of the leg. Podiatrists are also known as podiatric physicians or surgeons. A pedorthist is a professional trained to prevent or alleviate foot problems through the use of footwear, including shoes, orthotics, and other foot devices. The experts interviewed for this article were the following:
• Dr. Keith A. Beauchamp, DPM, a podiatrist who has a private practice in Macon, Missouri.
• Dennis Janisse, CPed, a certified pedorthist who is President and CEO of National Pedorthic Services, Inc., and is a Clinical Assistant Professor in the Department of Physical Medicine and Rehabilitation at the Medical College of Wisconsin. He teaches pedorthic courses at Northwestern Medical School and the Medical College of Wisconsin. He is a past president of the Pedorthic Footwear Association.
• Dr. Neil Scheffler, DPM, a podiatrist and coauthor of the book 101 Tips on Foot Care for People with Diabetes, published by the American Diabetes Association. He has a private practice in Baltimore, Maryland.
• Dr. Pedro Smukler, DPM, a podiatrist with private practices in Brooklyn and Manhattan, New York. Not only does he see patients in his office, but he also visits patients in their homes.
• Dr. Stephanie Wu, DPM, MSc, a podiatrist and Associate Dean of Research, Associate Professor of Surgery, Associate Professor of Stem Cell and Regenerative Medicine, and Director of the Center for Lower Extremity Ambulatory Research (CLEAR), at the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, in Chicago.
1. When a person who has diabetes comes to you for the first time, what do you teach?
Dr. Wu: I teach them the importance of keeping their blood glucose under control through diet, checking their blood glucose, and exercise, as well as the importance of regular doctor visits and getting into the habit of checking their feet before they go to bed every night.
I also show my patients gross pictures or point out the people who are in the waiting area in wheelchairs who have had amputations or other problems. It helps them understand what could happen, and it gives them a reason to take care of themselves. I don’t mean to scare them, but no one thinks anything is going to happen to him. Foot problems are like high blood pressure: There are no symptoms and no pain involved. People with high blood pressure don’t realize it’s causing a problem until they have a heart attack or stroke. Similarly, a patient of mine who works in a pizzeria stepped on a nail [but wasn't in pain]. He thought he was too busy to take care of himself until it was too late. So I tell my patients, “This can happen to you, but it doesn’t have to.”
Dr. Scheffler: I really emphasize the need for daily self-examination. People with diabetes need to look at the tops and bottoms of their feet and between their toes. Once they know what normal is for them, they will be able to pick up on changes and take care of them right away. How to address these changes depends on how severe the change is. If it’s a wound with pus, I tell them to call me or go to the ER right away; waiting even 24 hours can be too much. On the other hand, if it’s a scratch and the person has no other problems, it’s not an emergency.