A Rather Pedestrian Topic

Some people find feet fascinating. I, however, have never found feet — mine, or anyone else’s, for that matter — very interesting. In college, I ran track and cross country, so for a number of years I became accustomed to the occasional warped toenail and the constant callusing of many different parts of my foot (tops and sides of toes, mostly). But I was young, and really, unless you’re prone to some type of foot fetish, there’s little cause to pay attention to these things so far away. Such utilitarian body parts.


Then I find out I have Type 1 diabetes and learn that foot care is pretty important. In my diabetes education class, I was told things I didn’t know, such as that lotion on my feet isn’t a good idea — I can’t remember why, now (and not that I was lotioning my feet to begin with!); how important it is to thoroughly dry my feet after baths and showers; and to cut my toenails squarely rather than the rounded aesthetic I’d known my entire life.

In short, to give my feet the respect they deserve.

It was also important for me to not go barefoot, both inside the home as well as out — a rule I flaunt pretty much on a daily basis. (I’ve tried wearing slippers around the house, but my good intentions soon lead to neglected slippers by the bed.) That lawn on which I love to walk sans shoes? It harbors unseen dangers that can cut or get lodged in a diabetic foot, leading to infections. Or worse (amputations).

Of course, many of the instances of feet fearmongering are legitimate, but often it’s because those of us with diabetes who have complications from diabetes really do need to watch the feet. Observe them daily. Inspect them for discoloration, sores, calluses, blisters, and so on.

Treat the feet right.

On Tuesday, I went to the podiatrist. First time in my life I’ve been to a podiatrist. My endocrinologist recommended it last fall, and due to the popularity of the foot doctor I was to see, it was a six-month wait to get an appointment.

The reason for my visit was primarily to establish a my-feet-to-a-foot-doctor relationship. Once a year is a good routine, and so I’ve now had my inaugural foot exam. I still have calluses on my toes, so that was the main reason I wanted to talk to her about my feet. But as someone with diabetes, despite how I may be talking about foot care in a joking manner, I know that it’s of critical importance that I don’t neglect my feet. And, well, I am amassing quite a health-care team for my diabetes, so what’s adding one more to the group?

Visiting the podiatrist was pretty uneventful. I filled out a questionnaire about my medical history and about foot history. The podiatrist’s assistant asked me more questions, and then she wrapped my big toes in cloth wetted with some softening compound — so the doctor could remove the calluses on the sides of each toe — and left the examination room.

(And if you’re imagining something hideous and abhorrent on my feet right about now, don’t. The calluses weren’t bad. They weren’t discolored or even that large or ugly. Just there. Sheesh.)

I think the most important information I took away from the visit came during my discussion of diabetic complications with the doctor. Even if I maintain great blood glucose control throughout the rest of my life, as a person with diabetes I have an 80% chance of developing some form of neuropathy in my feet — be it mild, middling, or severe. Chances are it would be mild. But…the thing she said that struck me — the thing that I never really gave much thought to — was that developing neuropathy of the feet is so dangerous because diabetic complications don’t typically hit with just one punch. Thus, problems with the feet (nerve damage, for instance…not feeling a sore or a blister or something you might have stepped on) are compounded by vascular problems: poor circulation to the feet, and thus a more difficult time for the feet to heal. It can also be accompanied by retinopathy, so in addition to not feeling a problem with your feet, you also can’t see the problem with your feet. In essence, what’s going on down there becomes something going on in secret.

Unless you’re aware, observant, diligent, and careful.

And I am. It’s just that I’m going to be more careful now that I’ve had the discussion about these things with someone in the know. I passed all of the foot tests the podiatrist administered (the eyes-closed touch test; the push-this-way, that-way test) with flying colors, so for now I’m able to tell if I step on something or have a sore on my foot or some other food malady that will need attention.

I do look at my feet on a daily basis. It’s become a post-shower routine to put each foot, in turn, on the lid of the toilet and give a quick inspection for anything out of the ordinary.

For more information about taking care of your feet, check out our Foot Care articles.

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  • Peter Mead

    The 80% chance of neuropathy despite BG control sounds like a bit of a stretch. It is funny how some doctors have access to “everybody knows” data we can’t find easily on the Internet. And how some attempt to overstate the condition so that you will do what they say and not get complacent.

    I’m not doubting that foot care is important. But its like the figure posted on this site months ago about gastroparesis. 50% of all Diabetics get it. I queried that statistic and simply got back the reply that a doctor said so!


  • Peter Mead

    For a little perspective: Type 1 diabetes is an auto-immune aberration. But where are we sent? To an endo. We are immediately trained into a cope mentality. Frankly, with no cure, we gotta. But look at how much money goes into researching BETTER AND BETTER COPE as opposed to CURE. It has been known for a long time that bad T-cells turn on the beta cells, instead of themselves getting turned upon. This would seem to be the basic on the chain of consequence that leads to you and I having to wear a pump and watch our pizza. But look at all the research dedicated to restoring beta cells, pancreas etc.? Wrong target!

    My point is simply that there seems to be a prevaling professional attitude of “Do what I say, I’ve got the statistics” but I don’t see that they can prove it.


  • Peter Mead

    One last point: many statistics are skewed by including too many different types of Type 1 diabetics in the same study. I am a fit, educated and otherwise healthy diabetic who takes full responsibility for my condition (well…there was an incident of two pancakes this morning…). On the ADA message boards, I routinely hear from people with the most unimaginable non-handlings for their disease, or older people who were never properly educated and now have complications or defiant folk who “know best” and don’t keep their numbers down or people with other afflictions that limit their ability to manage D. Statistically, they are apples to my orange. And there are others like me, who developed Type 1 recently and availed themselves of modern management. For a doctor to wave around some 80% complication rate based on a catch all study is plain irresponsible.

    Please excuse the typos.
    End of rant.


  • jane

    The idea that “all dibetics have or will have foot problems” touches a nerve with me. Some well intentioned people in my life tend to give me gifts of foot care products, because they know I’m diabetic. I have type 1, diagnosed 8 years ago when I was 47. At the time of diagnosis, when sugar levels had been running high for who knows how long, I had feet I was not proud of. Calluses, rough thick skin, cracks in the skin between my toes. Today, on a pump, and well controlled, my feet are as smooth as can be with no thick skin, no cracks between the toes – no products used. Ever. I’m convinced that people who work hard to maintain good control can not only prevent, but reverse effects to their feet. I’m living proof. My eyes show absolutely no sign of diabetic damage… and with their small vessels, eyes are usually the first to see damage. Moral of the story, we can live a long a uncomplicated life by staying in good control. People need to stop throwing all of us in the same bucket.

  • Teresa

    Peter Mead, will you marry me??

  • Ephrenia

    I have been diagnosed with Neuropathy in my feet. I had the burning (like I was hanging over flames), tingling (like walking on a pile of straight pins), and nubness (like my big toes were asleep) before my diagnosis of Type 2 Diabetes. Taking 200mg of Alpha Lipoic Acid 3 times daily (as well as controlling my Blood Glucose within normal levels) practically eliminated my symptoms, barring only a bit of breakthrough burning, for which I take Gabapentin.

    My eyes (dilated exams yearly) and kidneys (microalbumin levels checked regularly) show no signs of damage. Just my feet. The podiatrist I’ve seen doesn’t think I “need” diabetic shoes, but sold me a pair because my regular Dr ordered them. I’m in the market for a new podiatrist. I suppose I’ll have to go out of town.