By: Daniel Trecroci
According to Richard Bernstein, MD, FACE, FACN, CWS, a diplomat at the American College of Wound Management, elevated blood sugars can injure and eventually destroy sensory nerves in the feet. Virtually all people with diabetes, who have experienced ongoing higher-than-normal blood sugars for more than five years, suffer some loss of sensitivity to pain, pressure and temperature in their feet.
Furthermore, the nerves that control the shape of the foot are likewise injured, with a resultant deformity that includes “claw” or “hammer” toes, high arch and prominent bones at the bases of the toes on the sole of the foot.
“Thus we have a deformed foot, with bony prominences [knuckles of toes, tips of toes, heels, and bases of toes at soles] that may be continually rubbed or pressed by shoes,” says Bernstein. “This foot may be unable to perceive the extent of such pressure and may not heal readily if injured.”
Feet can also be burned at temperatures as low as 92 degrees Fahrenheit.
Bernstein advises never attempting to file down, remove or shave calluses or corns. This is dangerous. Also, do not permit podiatrists, pedicurists or anyone else to do so. If any calluses or corns are present, find a shoe store or surgical supply dealer that employs a pedorthic specialist. He or she will modify your shoes, offer you new shoes, or supply you with appropriate orthotic inserts.
For people with diabetes, there are many new products now available to cope with foot problems.
Neil Scheffler, DPM, FACFAS, of the Baltimore Podiatry Group in Baltimore, Maryland, says that all patients with diabetes should have their podiatrists individualize the types of shoes they should be wearing.
“It is very important, perhaps the most important aspect of diabetic foot care, and is often overlooked,” says Scheffler. “Patients who have had ulcers and wear therapeutic shoes more than 60 percent of the time decrease the recurrence of ulcers by more than 50 percent.”
Orthoses are shoe inserts intended to adjust an irregular walking pattern and accommodate foot deformities. Orthoses perform functions that make standing, walking, and running more comfortable. They alter the angles at which the foot strikes a surface while walking or running, minimizing stresses that could cause foot deformities and/or pain.
“An orthotic device will diffuse areas of pressure and control excessive motion in the foot,” explains Arnie Davis, certified pedorthist and president of Davis Shoe Therapeutics in San Francisco.
Davis says that, upon prescription, orthotic devices are made from exact molds of the patient’s feet and are fitted into commercially made or extra-depth shoes. Davis also prescribes ankle-foot orthoses, or braces, that use the leg to stabilize the foot.
These shoes are indicated for diabetic patients with neuropathy who are at risk for developing ulcers or a skin breakdown. ProThotics are clinically proven to reduce pressure for patients with sensitive or ulcerated feet.
Davis recommends that people with diabetes wear white socks because they act as a flag for any problems that might occur.
“I accept the benefits of diabetic socks,” says Scheffler, adding that a person with diabetes should look for certain characteristics in a sock, rather than wearing any given brand for people with diabetes. He recommends getting a sock with additional cushioning that wicks perspiration away from the skin.
According to manufacturer Beiersdorf-Jobst, Inc., SensiFoot is the “first and only diabetic sock that incorporates the benefits of gradient compression.”
“SensiFoot is designed to give people with sensitive feet added comfort and protection from rubbing and pressure points that can lead to skin damage,” says Claus Wiegel, president of Beiersdorf-Jobst, Inc.
SensiFoot incorporates a padded foot and heel, and moisture-wicking fibers to keep the foot cool and dry. The sock also has an anti-microbial finish to prevent growth of fungus and bacteria.
TheraSock Double Sock System
TheraSock, manufactured by TheraFoot Technologies, is a double-layer sock that helps absorb friction between the sock layers to guard against blisters, corns, calluses and other injuries. According to a recent study released by the Academic Hospital of Mastrich, Holland, TheraSock was found to prevent foot ulcers, reduce callus formation and prevent bed sores.
Rx Comfort Socks
Manufactured by PTFE, LLC-Dx, Rx Comfort Socks are designed to help people with diabetes and other circulatory problems. The socks come with Blister Guard, which utilizes Teflon fibers that significantly reduce skin friction. This prevents blisters, abrasion, hot spots and calluses.
According to researchers at the University of Washington, there is a 2 percent incidence per year of foot ulcers in patients with types 1 and 2 diabetes. Scheffler says that the abundance of saline dressings, skin creams, ointments, antibiotics and foams are used to help diabetic foot wounds heal properly.
Available by prescription in the United States since April 1998, Regranex, a growth factor medication, was given approval by the U.S. Food and Drug Administration (FDA) in December 1997 for the treatment of diabetic foot ulcers.
“Growth factor is what allows the wound to heal,” says Scheffler. “If the body doesn’t bring about healing by itself, Regranex will give it a boost.”
Apligraf was given FDA approval in 1998 for the treatment of leg ulcers.
Results of a Harvard Medical School study on 16 patients with diabetes showed that weekly applications of Apligraf for four weeks resulted in a higher healing rate when compared to control treatment. Also, Apligraf was not associated with any significant side effects. This led researchers to conclude that it may be a “very useful adjunct for the management of chronic diabetic foot ulcers, which are resistant to the currently available standard line.”
Already available in Canada and the United Kingdom, Dermagraft is a human-based skin replacement designed to promote complete wound closure and accelerate healing. Dermagraft provides a living, metabolically active human skin tissue capable of interacting with the wound bed.
In August 2000, Dermagraft maker Advanced Tissue Sciences (ATS) of La Jolla, California, submitted a Pre-market Approval application to the FDA. According to data collected from a recent clinical trial, Dermagraft healed significantly more ulcers having a duration of greater than six weeks than control treatments did.
Diabetic foot creams can be helpful for tending to a variety of foot problems resulting from diabetes, from calluses and cracked skin to neuropathy and infections.
Diapedic Foot Cream
Produced by Diapedic Pure Skin Therapy, Diapedic Foot Cream has been proven to effectively reduce neuropathy, treat skin and nail infections and improve peripheral circulation. Its unique formula of 36 bio-active ingredients, including medicinal plant extracts, natural impids and vitamins, is identical chemically to those in human tissue and heals by penetrating the skin on a cellular level.