With the peak of summer (and the heat) now upon us, many of us will take time to kick off the shoes and take a walk on the beach or maybe on a grassy field in the local park. Some may even hop into a river or creek to cool off. No worries, right?
Well, for some people, relaxing barefoot comes with some concern. Specifically, those with diabetes need to pay close attention to their feet.
According to Ralph Schmeltz, MD, an endocrinologist and president of the Pennsylvania Medical Society, diabetes can damage nerves and reduce blood flow in feet.
"Sometimes a diabetic will not feel a cut or blister on the bottom of their foot that can develop into a serious infection," he said. "But with some diligence, these can be recognized and the infection prevented. Prevention is best, which starts with wearing well fitting shoes at all times."
Mary Korytkowski, MD, professor of medicine and a member of the American Diabetes Association Board of Directors, agrees and adds, "Foot care is a crucial component in managing diabetes."
"By checking your feet on a daily basis and working with your health care provider, you can help prevent future complications," she says.
Proactive steps through a medical home
Gus Geraci, MD, vice president of health care quality and value at the Pennsylvania Medical Society, has seen how something that starts off minor, like a cut, can turn into a disaster for patients with diabetes if they don't pay close attention. And, it's something that he worries about.
But, he also believes that today's health care team has the tools to make a difference.
"Today, we have the ability through information technology to work with populations within a medical home," he says. "It's very possible to set up electronic systems to work with those who could be at risk by keeping an eye on preventive steps they may or may not be taking."
Dr. Geraci says that within a medical home, the right information technology in combination with good communications efforts can remind patients to take care of key exams, such as examining the feet, both on their own and with the help of their medical team.
"A medical home might notice through its data that its diabetic patients have a high rate of problems with their feet," says Dr. Geraci. "If that's the case, the medical team can add at home and in office foot checks into the mutually agreed upon management plan they create with each of their patients.
Dr. Geraci adds that studies show that diabetes patients who are successfully contacted and reminded of certain tests were more likely to follow through. One landmark study suggests that patients in general receive about 55 percent of treatments they need.
Caring for feet
Through his career, Dr. Schmeltz has treated thousands of diabetes patients. He and the Pennsylvania Medical Society offer the following foot care tips for diabetes patients:
•Wash your feet every day. Room temperature water and soap is best option.
•After washing, make sure you dry your feet, especially between the toes.
•Check your feet every day. Either use a mirror to check the bottoms, or ask for help. Look for deformities, spots, cuts, blisters, and swelling.
•Use skin lotion to keep your feet smooth and soft.
•To avoid ingrown toenails, trim your toenails straight and not curved. If you have vascular disease, poor eyesight, or difficulties using a scissors, see a podiatrist to have your nails trimmed.
•Don't rely on your feet to determine if a surface is hot or cold. The sand on the beach may be hotter than your feet can sense, leaving you with a burn.
•Realize that going barefoot can present problems. Wearing shoes with socks might be your safest option.
•Check the inside of your shoes periodically to be sure there aren't any pieces of gravel or shoe parts that could rub against your foot and cause a blister.
•When visiting your physician, take off your shoes and socks and be sure to discuss foot care.
•Avoid tobacco: Smoking increases the chances of developing foot problems.
Dr. Schmeltz also reminds diabetes patients to always keep your blood glucose, blood pressure, and lipids within their target range.
Pennsylvania Medical Society