Diabetes and the Benefit of Arch Supports

Can a simple shoe insert to support the arch be of any benefit to a diabetic?  The answer is, quite simply, yes, it's likely there is a benefit.

As a diabetic lives longer with the disease, an eventual change forms in how nerves function with small blood vessels that feed nutrients to tissue all over the body.  This is even in spite of good glucose control.   One complication associated with this is a gradual destructive change that occurs in the joints of the feet, particularly in the middle of the foot.  This is different than arthritis or more traditional joint disease.  The changes are subtle, and go about unfelt and unknown.  As time progresses, some diabetics will take that joint destruction to the next phase, developing a condition called Charcot neuroarthropathy.  In this serious condition, the foot will undergo a three month long fracturing process on its own, and if not treated immediately can result in serious foot deformity that can lead to wounds, infection, and amputation.

The use of a simple quality arch support can help stabilize one's foot structure, and if used for a long period of time can help reduce the risk of this joint damage by decreasing joint strain.  While a prescription orthotic is the best option, an over the counter product may also be helpful if one does not already use a diabetic insert.  Powerstep insert are arguably probably the best of these types of inserts, which is why my Indianapolis podiatry practice carries them.  A few other niche manufacturers carry products of near equal quality, but unfortunately the most widely available products in pharmacies that the general public sees are usually sub-standard for this purpose.  As for plastic inserts from so-called orthotic stores, my advice is to avoid these over-priced items.  They are mass produced and not custom fit, so the hard plastic can potentially cause skin irritation in a diabetic.  The support they provide is decent, but the risks associated with the material and fit in a diabetic should give one cause for concern.

By reducing small amounts of daily and gradual joint strain, an insert can potentially reduce one's risk of the serious joint disease associated with Charcot neuroarthropathy.  Talk to you podiatrist about your risk factors for this disease, and how some form of an insert in your shoes can help to reduce this risk.

Attend A Diabetes Fair and Learn!

For those of you in the Indianapolis area, I will be attending a diabetes health fair at Riverview Hospital in Noblesville on Saturday morning, March 10th.  If you happen to be in the area and would like to ask me questions, please feel free to swing by and visit.  You may need to RSVP with Riverview Hospital before arriving or attending some of the morning's other activities.  However, my booth will be open for anyone who wants to chat. I will be discussing all aspects of diabetic foot care and diabetes foot complications, and will be displaying examples of diabetic inserts and diabetic shoes.  Details can be found by calling Riverview Hospital at 317-770-5835.

Hospitals all over the country hold diabetic health fairs on a semi-regular basis, especially if there is a diabetes education department attached to the hospital.  At these health fairs, one can usually have their glucose checked, receive diabetes care and diet advice, and often have foot screenings as well if it is staffed by a podiatrist.  For diabetics, this is a great way to mingle with others who are diabetic, and to receive valuable information all in one location.  For some diabetics, these health fairs are the only source of diabetes education outside of their primary care doctor's office, and can be instrumental in helping those diabetics learn about all facets of their condition.

If you are diabetic and have the opportunity to attend a diabetic health fair, I absolutely recommend it.  It can be a great opportunity to learn more about diabetes, and if there is a podiatrist available for a diabetic foot screening exam, there is a great opportunity to see if you have any risk factors for diabetic foot complications.

Maggots and Honey...Wound Care Gets Wild!

The world of wound care products is ever expanding, fueled by research into the best and most novel techniques to get tissue to heal, and skin to grow.  Sometimes this research takes a peek backward into either ancient wound care or nature for guidance forward.  Today I would like to talk about two such techniques, both of which are used daily on diabetic foot wounds.

Honey has been used for centuries as a treatment for wounds.  A modern dressing has been created from the honey created by bees using a single pollen source in New Zealand.  This medical grade honey has properties that keep wound tissue moist, help improve fluid transfer across the tissue, and keep wound pH down.  It lacks the bacteria and contaminants found in supermarket honey, and is built into a dressing that won't allow the honey to flow out of the wound.  It can be useful in the treatment of diabetic wounds (and others) when healing has stalled.

Looking to nature, some wound care clinics have used medical grade maggot therapy to clean diseased wounds.  Yes, that sounds disgusting.  However, maggots have a purpose in nature beyond simply becoming flies.  They eat dead tissue, and kill bacteria.  Indigent people (i.e. homeless or those with very poor hygiene living in squalor) have presented to numerous emergency rooms and clinics with maggots infesting their wounds, and some have actually benefited from this in a limited way.  Historically, maggots have had a role in battlefield wound management both directly and indirectly.  Medical science has found a way to use this benefit in a safe and sterile manner.  Special breeds of fly larvae are formed under sterile conditions in a laboratory, and the maggots are applied in a surgical manner.  They are left in the wound under a special dressing, and removed after a certain period to allow the maggots to ingest the dead tissue.  The wound is cleaner, healthier, and has a better likelihood of healing.  Bacteria is also consumed by the maggot.  This technique is viable when other options are not effective, such as in cases of significant gangrene or unresponsive dead tissue.

Until next time,
Scott R. Kilberg DPM

www.inpodiatrygroup.com - foot surgeon, podiatrist in Indianapolis
myachingfoot.blogspot.com -  foot pain treatment indianapolis
YouTube videos on foot problems

A foot doctor in Indianapolis Noblesville Fishers Carmel Westfield and Fortville Indiana.

Diabetes and Orthotics....A Perfect Match

This Valentine’s Day, thoughts of companionship and the ‘perfect match’ are in the air.  Running with that theme, another perfect match is the diabetic foot and an orthotic.  These two go well together, and can have a beneficial relationship to the point that the foot is healthier for it.

The purpose of an orthotic is to realign foot that has abnormal structure, and return the foot to a more normal anatomic position during standing and walking.  It accomplishes this by forcing the arch to become more stable.  The orthotic is formed from a mold of the foot, one in which the foot is held in the corrected position.  Further external changes are made to the mold to further correct the foot, based on a doctor’s biomechanical exam of the foot and its specific position during walking and standing.  However, more important to diabetics, the orthotic has a second function.  This function is to reduce abnormal pressure points.  The orthotic accomplishes this simply through correcting the abnormal foot structure:  once the foot structure returns to a more normal position, the pressure points also normalize.

This works best for abnormal pressure on the bottom of the foot, but it can also benefit areas such as the side of the big toe where a callus often develops (and a common diabetic ulcer as well), and even the tops of the toes by reducing the downward force the toes are allowed to make on the ball of the foot.  When pressure is reduced, callus and corn formation is reduced, and subsequently the possibility of wounds and infections.  When an orthotic is combined with a top cover made of the specialty foam plastizote, the reduction of pressure top the bottom of the foot is even better, protecting the diabetic foot in its cradle.

The diabetic foot and orthotics....a Valentine’s day match indeed!

Until next time,
Scott R. Kilberg DPM

www.inpodiatrygroup.com - foot surgeon, podiatrist in Indianapolis
myachingfoot.blogspot.com -  foot pain treatment indianapolis
YouTube videos on foot problems

A foot doctor in Indianapolis Noblesville Fishers Carmel Westfield and Fortville Indiana.

Good News On Declining Diabetic Amputation Rates

Good news has been recently reported by the Centers For Disease Control in the February issue of Diabetes Care.  In the report, amputation rates in hospitalized diabetics over 40 were assessed over a time period from 1988 to 2008.  The rates in 1996 were 11.2 out of every 1000 diabetic underwent an amputation, while in 2008 this rate was about 4 of every 1000 diabetics.  The rates of nondiabetic amputations stayed about the same.  Those who were older than 75, were male, or were African-American were more likely to have an amputation, than those who were younger, female, or caucasian.

This is a significant decrease, and I suspect it is likely related to new amputation prevention strategies, better access to education and foot care, the expanding field of diabetic limb salvage and wound care, the advancing of Medicare coverage for diabetic foot care and protective shoes/inserts, and better treatment options for poor circulation and difficult to treat wounds.

With this in mind, lets work together to bring that number down even further over the next twenty years, and make diabetic limb amputations a relic of the past.  Keep your glucose under control, take care of your foot skin, wear  properly fitting shoes, and see your podiatrist regularly for foot care and wound prevention.

Until next time,
Scott R. Kilberg DPM

www.inpodiatrygroup.com - foot surgeon, podiatrist in Indianapolis
myachingfoot.blogspot.com -  foot pain treatment Indianapolis
YouTube videos on foot problems

A foot doctor in Indianapolis Noblesville Fishers Carmel Westfield and Fortville Indiana.

From Ingrown Nail To Toe Amputation

Diabetes can have a profound effect on the foot, as readers of this blog have noted each week.  One of these effects can be severe injury following a simple grooming technique at home, and is entirely preventable if one exercises a little restraint.

People commonly trim their toenails at home, and often will 'dig' into a nail that seems ingrown.  This digging creates skin irritation along side the nail, and does little to address any ingrowth except for reducing nail corner pressure temporarily until the nail simply grows out again.  In most people, this skin irritation can lead to an infection if bacteria becomes trapped between the ingrown nail that was not cut out and the swollen, inflamed skin.  This infection can linger if untreated, and is what most people associate with a painful ingrown toenail.  Diabetics, unfortunately, have little tolerance for infections as the bacteria removal capability in place in one's immune system is hampered in diabetes.  This means that simple toe infections can spread quickly, and it also means that since the nail grows from tissue near one of the toe bones, an infection around the nail can spread easily to bone.  Most bone infections in the toes are doom them to amputation, since toe bone infections are difficult to treat simply with antibiotics, and the destructive changes seen in these infections renders the toe bone useless.

It is therefore very important for diabetics to resist the temptation to dig at their nail corners.  If an ingrown nail is suspected, or if one is absolutely present and is painful, a diabetic needs to see a podiatrist for care.  A safe and simple procedure for ingrown toenails can be performed, that will eliminate the problem and reduce the potential for a toe infection that could lead to amputation.

Until next time,
Scott R. Kilberg DPM

www.inpodiatrygroup.com - foot surgeon, podiatrist in Indianapolis
myachingfoot.blogspot.com -  foot pain explained
YouTube videos on foot problems

A foot doctor in Indianapolis Noblesville Fishers Carmel Westfield and Fortville Indiana.

What Part of My Foot Should I Moisturize, and What Should I Keep Dry?

Keeping a diabetic foot healthy involves keeping the skin healthy.  The winter is a crucial time in the health of the skin, as most parts of the United States see a significant enough temperature drop to affect the moisturization of the skin.  Keeping the proper level of skin moisturization is important, as dry areas of skin can form cracks and sores, and overly moist areas can lead to bacteria and fungus infections.  One simply has to know what parts of the foot need to be moisturized better, and what parts need to be drier.

The bottom of the foot is particularly at risk of developing cracks, sores, and split skin due to the pressure the thicker skin takes when bearing the weight of the body.  Dry skin makes this worse.  The skin on the bottom of the foot, and to a lesser degree, must stay well moisturized.  This is even more important during the winter, when one naturally sweats less.  When the skin cracks open, bacteria has a direct pathway into the body and can cause an infection.  Once or twice-a-day moisturizing is needed to keep the skin well hydrated, and some people may need a prescription moisturizer with lactic acid or urea to keep the skin healthy.

On the other hand, some parts of the foot need to remain dry.  The spaces between the toes are warm, dark, and generally moist on their own.  the introduction of moisturizers to these spaces can tip the moisture balance to too moist, and can lead to the overproduction of fungus and eventually bacteria, which love warm, dark, moist environments.  One should avoid placing moisturizer creams between the toes to avoid this.  Cracks and fissures can develop in the skin between the toes and do pose a problem.  In these cases, a podiatrist should be seen to properly manage these between-the-toes cracks, as significant wounds and infections have been known to develop in these spots, and medical treatment is needed to restore balance to the skin and prevent these serious complications.

Until next time,
Scott R. Kilberg DPM

www.inpodiatrygroup.com - foot surgeon, podiatrist in Indianapolis
myachingfoot.blogspot.com -  foot pain explained
YouTube videos on foot problems

A foot doctor in Indianapolis Noblesville Fishers Carmel Westfield and Fortville Indiana.