Diabetics should get their feet checked

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Take a step towards better footcare

You might find people wishing they had diabetes with news that it’s doctor recommended for diabetics to have their feet tended to every two or three months. That’s right, according to podiatrist Natalie Bennett, diabetics, especially those with diabetic neuropathy (nerve damage which normally affects the toes and feet) need to have all their basic foot care handled by a podiatrist.
“We recommend they form a relationship with a podiatrist for all their foot care and see them as often as necessary, every two or three months is common,” she said. “Foot care includes cutting and filing nails as well as tending to any corns and callouses,” she added.
“We don’t want diabetic patients with neuropathy using any instruments on their feet themselves. This is a recipe for serious problems as they may accidentally cut or nip themselves and not realise it.”
So what about going to the spa or salon for a pedicure? Absolutely not, according to Ms Bennett.
“We’ve had a lot of horrific episodes with people going to spas and having pedicures. They may not tell the therapist that they have neuropathy. We’ve had a client who had her feet burned having them soak in hot oil — and she didn’t feel it,” she said.
“At spas all sorts of things can go wrong so once someone has been diagnosed with neuropathy, they should not risk having pedicures from anyone other than a podiatrist.”

Get your feet checked at least every year if you have diabetes. If you have diabetes and other foot-related problems or other health issues, you may need to see your podiatrist even more often.

One of the most frequent results of diabetes is a condition called diabetic neuropathy. It happens when too much glucose in the blood causes nerve damage. The nerves affected are those that branch from the brain and spinal cord to the rest of the body.

On the even of World Diabetes Day, local podiatrist Natalie Bennett said the condition is very common in Bermuda. She estimated that about 65 percent of her patients with diabetes develop diabetic neuropathy.

Typically it affects the toes and feet where nerves are the farthest away from the brain and spine. There may be a loss of feeling or sensation so that those affected are unable to detect problems as they arise. This often leads to infection and in the most severe cases, amputation.

For example, people with diabetic neuropathy may go for weeks walking on a pebble stuck in their shoe. Unable to feel it, they don’t remove it and a pressure wound can develop. Unable to feel that wound, it too may go unattended until an ulcer forms. The ulcer can progress to an infection, which, if still left untreated can become gangrenous. At this stage amputation may be required to save the rest of the body from becoming infected.

According to Ms Bennett it’s imperative that diabetics are tested regularly for the condition. And simply knowing that you can feel your feet doesn’t mean you don’t have the problem.

“Many of my clients say: ‘I can feel my feet!’ But when I test them they actually have lost protective sensation,” she said.

Protective sensation is what is compromised in the previous example of the pebble in the shoe. It can also happen in an ill fitting shoe, where those with neuropathy don’t realise the shoe is too tight or has been rubbing their skin causing it to blister or a callous to form.

“They can’t gauge sensation and they can’t gauge vibration,” said Ms Bennett. This can easily lead to serious problems.

And she pointed out that diabetic neuropathy can take different forms. “Motor neuropathy affects stability and there’s a type of neuropathy where pain receptors are damaged and the patient suffers constant pain in the feet and legs. This is an awful, very painful condition,” she added.

“We recommend diabetic patients get their feet checked annually for neuropathy. If we find there is neuropathy or any other underlying problems we do a full vascular neurology and mechanical foot check and we see those patients every two to three months for their basic foot care.”

Ms Bennett and local endocrinologist Dr Annabel Fountain give many free foot screenings each year.

“If you go to a health fair one or both of us is usually there,” said Ms Bennett who is passionate about the importance of diagnosing neuropathy.

“In Bermuda we have a very high rate of amputations, which means there’s a lot of undiagnosed neuropathy out there,” she said. “It’s easy not to know you have it and once you know you can manage it and avoid having an amputation.”

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Published Nov 13, 2012 at 8:00 am (Updated Nov 12, 2012 at 8:42 pm)

Diabetics should get their feet checked

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