Apr 09, 2008

Love Your Feet

David Spero

As a Diabetes Self-Management reader, you are probably already expert on foot care. But a short reminder course can’t hurt. Foot pain is one of the most common symptoms of diabetes. It can be a warning sign of serious circulation or nerve problems that, if ignored, could lead to loss of use of the foot. Fortunately, foot pain can almost always be prevented, improved, and usually eliminated completely. So it’s worth reviewing.

What causes foot pain in diabetes?
According to health writer Jeff Foster, there are at least three major causes of foot pain in diabetes.

• Sometimes high blood glucose levels cause nerve damage in the feet and hands. This is called peripheral neuropathy (PN). In the sensory nerves, PN can be felt as pain from a trivial cause, like putting on socks, or from no cause at all. You may also experience numbness, tingling, burning, or stabbing pains. When the nerves to the muscles become affected (motor neuropathy), your muscles may begin to hurt and lose strength.
• Circulation problems in the feet can cause severe pain directly. (Tissues experience lack of blood flow as pain.) Poor circulation also contributes to infections, which cause more pain.
• Muscle weakness or poor balance due to neuropathy can put more pressure on the feet, causing pain.

Love your feet—prevent pain
My e-mail auto-signature ends with the words, "Love your body. Love your life." Most people's feet need love, especially if they have diabetes.

Be good to your feet. Check them and wash them gently in warm (not too hot) water every day. Blot them dry and moisturize daily to keep skin from cracking. Keep the area between the toes dry.

Wear clean, dry socks and change them daily. Wear them to bed at night if your feet get cold. Don't wear tight-fitting socks.

Keep your feet warm and dry and safe. If your shoes or socks get wet, change them as soon as you can. Never walk barefoot, not even at home.

Check your shoes before you put them on. Make sure there aren't sharp edges, tight spots or pebbles.

Cut your nails very carefully. If you can't do it well (like I can't), get someone else to do it. File them instead of cutting as much as possible, and don't cut them too short.

Get a podiatrist's help with tough nails, corns, or calluses, and see one regularly to prevent complications.

Treatments for neuropathy and pain
If your feet start to hurt, pay more attention to them. Massage them often, or get someone else to do it. This can improve circulation and sometimes restore sensation. You can also use a foot roller to stimulate nerves.

You may want to try cushioned supports or shoe inserts to relieve the pressure on your feet.

Exercise (strengthening and stretching) will strengthen the foot and ankle muscles and keep them flexible, which relieves pain.

Of course, let your doctor know about your foot pain and what you are doing about it. He may be able to help. Physical therapy may help, too.

Complementary foot treatments
Anodyne therapy is a complementary method that thousands have found to be effective. It involves bathing the feet in infrared light. This warms them and releases nitric oxide, which apparently improves circulation.

Anodyne therapy was approved by the FDA in 1994. Dr. Timothy Shea, D.P.M., a Certified Wound Care Specialist at the John Muir Wound Care Center in Walnut Creek, said in the magazine Podiatry Today, "It seems to be a good, proven, acceptable modality which is useful for patients." However, a recent study has suggested that the placebo effect may play a substantial role in the therapy's success.

Warm herbal baths can also be very helpful, and there is a device called the ReBuilder that may help with at least the sensory side of neuropathy.

For serious foot circulation problems, you may want to consider hyperbaric oxygen therapy (HBOT). In HBOT, you breathe in high concentrations of oxygen under high pressure. Studies have found that HBOT can reduce amputation rates by up to 50%. It is covered by Medicare and in Canada. But you (and your doctor) may never have heard of it, since there is no drug company marketing department promoting it.

The bottom line
One of the best ways to love your feet is to keep your blood glucose under good control. Lowering blood sugar usually relieves neuropathy and prevents circulation problems. So get those numbers down and notice how much better your feet feel.

What about you? Have you had foot problems? What have you done about them? Did it work? Let us know by commenting here.

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Personal note: My book Diabetes: Sugar-coated Crisis - Who gets it, who profits, and how to stop it, is now featured on the Web site of "Unnatural Causes," the PBS series on the social causes of illness. Check it out here.

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Diabetic Complications

Self-Managing Chronic Pain (Part 1) (09/03/08)
Diabetes and Celiac Disease (Part 2) (09/02/08)
The Mysteries of Pain (08/27/08)

Foot Care

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Diabetes and Skin Care (Part 2) (03/10/08)
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