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Foot Care Q&A: Part 2

by Joy Pape, RN, BSN, CDE, WOCN, CFCN

Dr. Wu: Orthotics are meant to change the way someone walks. Diabetic, or what we call accommodative, inserts help take off the pressure rather than changing the way you walk.

Insoles are a generic, broad term for diabetes inserts. When you get your inserts, you need to take out the original [insole], or you will be rubbing against the top of your shoe.

Dennis Janisse: Again, this all depends on the condition of your foot. Many people will and do benefit from the “proper” insert, premade or custom. These inserts always have to be fitted with the shoe, as well as with cushioned socks, because they could alter the shoe fit and cause worse problems. Inserts can protect, cushion, keep the feet dryer, be antifungal/antibacterial, provide support, and/or control the foot.

Dr. Scheffler: A true orthotic changes the way a foot functions. This should be a prescribed item by a podiatrist or orthopedic surgeon that is made to treat your specific problem. If you have pronation [your feet roll in when you walk] or a flat foot, they can be designed to hold your foot in the right position. They can take pressure off the bone or nerve that’s causing a callus or pain. Not everybody needs these, but if you have a problem, you do. An insole is anything that goes inside your shoe for cushioning. Sometimes your insurance will pay for it. Get only the kind your doctor advises.

4. Are there any home remedies your patients have told you about that work?

Dr. Smukler: What happens is that a patient comes in with a firm belief that a particular home remedy works. If it isn’t causing the person any harm, I’m usually all right with using it.

Dennis Janisse: A lot of people think alcohol or peroxide is a cure-all, which they are not. They can harm your feet, especially if you have a wound.

Dr. Wu: I recommend to always check the remedy out with your foot doctor, especially if there is no evidence [from research] to support it. For the most part, if it is not meant to treat a serious foot problem, and if the product is not hurting you, then I am usually OK with it.

Dr. Beauchamp: I know of a few home remedies that may be of benefit. For gout, once an acute case is under control, eating cherries or drinking some of the cherry concentrate drinks on the market can help prevent future attacks. Of course, you need to be concerned about how this affects your blood glucose levels. You can always check it to find out.

In the case of mild toenail fungus, Vicks vapor rub has worked wonderfully on about 40% of cases. My thinking is that if [a remedy] cannot cause harm and patients are asking to try it, I should let them. Sometimes we’re both pleasantly surprised, and sometimes we just move to a more aggressive or conventional therapy if it doesn’t seem to be working out. I always involve patients in the decision-making process. They seem to respect that, even if the home remedy doesn’t work out. We can always say we tried, and in these days of rising drug costs, they appreciate the effort to save them some money.

5. Should people who have diabetes get a pedicure?

Dennis Janisse: Although I don’t recommend [pedicures], I know people do get them. If they do, they should go to someone that understands diabetes, someone who has some medical training.

Dr. Smukler: This is highly dependent on who does the pedicure and on the condition of the person’s feet. Some people end up happy, and some people end up with serious problems. I recommend caution and mostly discourage my patients from having pedicures.

Dr. Wu: One should be very selective about with whom and where one gets a pedicure. Tell the person you have diabetes. I hate to say an absolute “no” [to pedicures]. But when in doubt, the pleasure is not worth the risk.

Dr. Beauchamp: Pedicures are typically given in cosmetology salons. Nail care should be performed by medical professionals. Usually there is some risk involved in [getting a pedicure] when someone has a condition such as diabetes, peripheral vascular disease, antiplatelet therapy, etc. These conditions make it necessary to seek professional treatment.

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