First, a disclaimer: I want you to know I love my diabetic patients. If I sound demeaning at any point discussing this, it’s not the diabetic patient making me angry. My anger stems from the medical profession’s poor treatment of the diabetic foot, especially the lack of preventative care, which includes effective, relevant education about what can develop.
This is the sum total of primary care docs’ foot care advice to their diabetic patients: “Remember to check your feet everyday.” You might as well ask them to set the clock on their remote.
They might also tell them to not go barefoot and wear “good” shoes. We, the medical profession, are so archaic when it comes to diabetic foot care, it borders on embarrassing. We need to be more specific and proactively inform our patients as much as possible.
Diabetics get advice about their feet that’s a collection of myths. I’m going to take a look at a few of these over the next few weeks… and both doctors and patients should listen up.
“Diabetic foot problems are caused by poor control of glucose and bad blood supply.”
Wow, I have to take a deep breath on that one. If you believe this BS, then you also might believe in unicorns! (Or, for that matter, “Uni-bunions.”) What leads to foot problems in diabetics is a loss of protective sensation, otherwise known as “peripheral neuropathy.” It all stems from that.
If you’re not familiar with the concept, here’s how I like to explain it:
Think of two cars. Now, my car isn’t diabetic, but your car is.
Say, on my car, an engine hose breaks. My warning light flickers, telling me that there’s a problem with the engine. I pull over and get the hose fixed before the car overheats and the engine dies.
Now, on your car, when the hose breaks, no warning light comes on. You drive merrily along until the engine overheats, and there has been serious damage to the engine. Well, without that protective sensation, you don’t know you’ve done the damage until it’s often too late.
Going hand-in-hand with the numbness is the development of calluses and ulcers. Unlike on a hand, where a callus just grows outward, a callus on a foot grows slightly out of the skin, but mostly inward. In some cases, it can eventually reach the bone. When it eventually breaks open or sloughs off, it becomes an open, malperforans ulcer. People think these ulcers just kind of appear. Put simply: calluses get deeper, and if they get deep enough, they become an ulcer.
So my guidelines for inspecting your feet are to do it daily — but know what you’re looking for — checking for any calluses and potential malperforans ulcers.
The ADA and others lead you to believe that strict daily blood glucose monitoring and/or good A1C numbers will keep you all safe and cozy. While I don’t disagree with strict control of diabetes, I definitely disagree with letting your guard down. How can you possibly have your guard up if you don’t even know what you are looking for? In my experience, the non-insulin dependent diabetics generally develop the worst foot and ankle problems because they’re not warned. This is why the subject makes me angry.
I can’t tell you how many times while trying to knock some sense into a diabetic patient’s head they argumentatively come out with “but my A1C’s are good.”
Yes, and that ulcer on your foot is just a spot on my eyeglasses.