Introducing the 'P-E-T' Guidelines for Diabetic Foot Care

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Podiatry Expert Dr. Alan Berman Outlines Easy-to-Follow Advice for Preventing Complications

Nearly 26 million Americans have diabetes, according to new estimates from the Centers for Disease Control and Prevention (CDC). And 60-70% of them suffer from nerve damage (neuropathy) that can affect many parts of the body but most commonly involves the hands and feet (peripheral neuropathy). “Nerve damage typically shows up first in the feet and is the primary cause of foot problems for people with diabetes,” says Dr. Alan Berman, Podiatrist of Somers Orthopaedic Surgery & Sports Medicine Group. “The American Diabetes Association estimates that one in five people with diabetes who seek hospital care do so for foot problems. By taking proper care of the feet, many of the most serious complications of diabetes can be prevented. That’s why we are introducing the P-E-T guidelines for diabetic foot care.”    

Diabetic neuropathy, caused by high blood glucose levels over time, often causes pain at first. But as the condition progresses to loss of feeling and numbness, the ability to feel pain, heat and cold is lost and even the slightest burn, sore or cut may become infected and ulcerated. Diabetes also causes blood vessels of the foot and leg to narrow and harden, resulting in poor circulation (blood flow) that can make the foot less able to fight infection and heal. The danger is that the patient, due to loss of feeling, may not even be aware of the problem and the untreated ulcer may cause serious damage to tissue and bone.

“Our P-E-T guidelines give the patient three primary things to remember in caring for their feet,” says Dr. Berman, “PROTECT your feet, EXAMINE them daily, and TELL your doctor immediately if you detect any irregularity. These steps will help prevent the serious consequences of diabetes-related foot problems.”

PROTECT YOUR FEET
Wash your feet in lukewarm water every day. Test the water temperature with your elbow or a thermometer, 98°-100° generally is ok. Do not soak your feet. Pat them thoroughly dry (do not rub), especially between the toes. Use a moisturizing cream or lotion only on the tops and bottoms of your feet – not between the toes – to keep the skin soft. Cut toenails after bathing, when they are soft; cut straight across and smooth with an emery board. (If you cannot cut your toenails easily, ask your healthcare provider to do it.)

Always wear shoes and socks. Never walk barefoot. Choose shoes with closed toes and heels, stiff outer material and soft, seamless insides. Avoid high heels and pointy toes. Make sure there is 1/2” of extra room beyond your longest toe and make sure the shoes don't pinch or rub anywhere. (Your doctor may recommend special shoes.) Keep your feet warm year round by wearing clean, dry socks made of natural fibers that wick moisture away from the skin; avoid socks that are too tight.

EXAMINE YOUR FEET EVERY DAY
Look at your feet every day to check for cuts, sores, blisters, redness, corns, calluses, ingrown nails, cracks in the skin, or other problems. While many of these irregularities are little more than an annoyance for most people, they can be potentially dangerous for diabetics because of the higher risk of infection, especially when nerve damage causes loss of feeling. If you cannot see the bottoms of your feet, use a mirror or ask someone for help. Also check for changes in the shape of your feet and toes. Diabetic nerve damage can weaken the foot muscle, shortening the tendons in the foot and making the toes curl under the feet (hammertoes).

TELL YOUR DOCTOR
Notify your healthcare provider immediately if you detect any of the changes noted above or if you have increasing numbness or pain in your feet. Don't self-treat any foot problems. Don't use a nail file, nail clipper, scissors or chemical wart removers. Your doctor should also examine your feet, test for nerve damage and check blood circulation to your legs and feet at every checkup.

“Beyond meticulous foot care, the best strategy for preventing the complications of diabetes — including foot problems –- is proper diabetes management with a healthy diet, regular exercise, blood sugar monitoring and adherence to a prescribed medication regimen,” Dr. Berman says. A major study by the American Diabetes Association showed that strict blood glucose control with intensive insulin therapy lowered the chances of having symptoms of peripheral neuropathy - tingling, burning, and pain - by 64%. Patients can also control some of the factors that cause poor blood flow, especially smoking, which is one of the biggest threats to the feet. Smoking affects small blood vessels, causing decreased blood flow to the feet and making wounds heal slowly. Keeping blood pressure and cholesterol under control also improves circulation, as does exercise, which stimulates blood flow in the legs and feet.

“Foot problems are common in people with diabetes,” Dr. Berman concludes. “But with proper medical management and active patient involvement in following the P-E-T guidelines for foot care, many of the serious complications can be prevented.”

Somers Orthopaedic Surgery and Sports Medicine Group, founded in 1988, is one of the most comprehensive and specialized practices in the region. Highly trained physicians specialize in diagnosing and treating all orthopaedic, rheumatological, and pain management problems in adults and children. All surgeons are board certified and experienced, having completed rigorous training at the finest medical institutions in the country. The staff includes fifteen physicians, five physicians' assistants, three physical therapists and a supporting staff of over 100. The group's physicians perform all types of arthroscopic surgery, ACL reconstruction, minimally invasive joint replacement, computer navigation, revision joint replacement, sports care, spine surgery, fracture care, hand, ankle, and foot surgery. State-of-the-art facilities include digital radiology, MRI and ultrasound. http://www.somersortho.com

Alan N. Berman, D.P.M, D.A.B.P.S. earned his PODIATRY degree in 1984 from the New York College of Podiatric Medicine and has been serving Putnam County residents in his private podiatric practice for over 25 years. He is Board Certified by The American Board of Podiatric Surgery and The American Board of Podiatric Orthopedics & Primary Podiatric Medicine. This dual board certification has allowed Dr Berman's patients to comfortably choose either surgical care or state-of-the-art non-surgical care. Dr. Berman is the author of numerous articles for local newspapers and magazines on foot related health issues. He was the founding Director of Podiatry at the Monsey family health center from 1992-1994. Dr. Berman is a member of the American Podiatric Medical Association and a past member of The American Academy of Podiatric Practice Management. He has hospital privileges at both Putnam Hospital Center and Hudson Valley Hospital Center.

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MELISSA CHEFEC
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