Please, check your feet!!

May 28, 2011
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Diabetic neuropathy is one of the most common complications that as Podiatrist we see in our diabetic patient population. At this time of the year it is very important to review neuropathy, its causes, and the importance of daily foot checks at home to prevent complications associated with having neuropathy. 

Neuropathy by definition is disease or dysfunction of one or more peripheral nerves that typically causes numbness, weakness, or both and generally begins in the extremities, especially a patient’s feet. It is thought that a combination of factors adds to the incidence of neuropathy in diabetic patients, but it is directly related to poor sugar control. Nerves are very sensitive to changes in blood glucose levels and when consistently high, the sugar molecules tend to glycosylate (collect on) both the small blood vessels and the small nerves. This glycosylation compresses the nerve to some degree and results in the symptomatic representation of neuropathy. 

Several categories of neuropathy affect the diabetic population, but the most common type is Peripheral Neuropathy. Peripheral Neuropathy is also known as distal symmetric neuropathy, meaning symptoms present first in the toes and fingers on both the right and left sides of the body. As the neuropathy progresses it continues towards the arms and legs; centrally on the body. The sensory changes are minimal at first and may go unnoticed, but as the neuropathy progresses symptoms become more discernable. The best was to prevent and control the progression of diabetic neuropathy is to keep your blood glucose levels within normal range, thus protecting your nerves from glycosylation. 

Comprehensive foot examinations by your Podiatrist can help diagnose peripheral neuropathy in its early stages and it is important to remember that if you are experiencing any changes in sensation to your toes or feet, you see your doctor immediately. Your Podiatrist will look for changes in light and sharp touch, vibration sense, reflexes and your ulceration risk. All of these components can hold clues to an early diagnosis of peripheral neuropathy. 

Whether you’re newly diagnosed or have been dealing with neuropathy for some time, you must be doing your part at home! Checking your feet every night, identifying any open areas on your soles or between toes and any color changes that may indicate problems is imperative. The largest complication associated with having diabetic neuropathy is the patients inability to feel, thus injuries that would be painful in a non-diabetic go unnoticed in a diabetic and can lead to ulceration, infection, and loss of digits. If you notice something unusual or different from the previous day, contact your Podiatrist for an appointment. As the weather gets warmer, it’s especially important to wear closed-toed shoes only, much for the same reasons as mentioned above. Open-toed shoes open the door for more injuries, more bacteria to cultivate on your foot and larger problems. Although it might not always be ideal, it is always safer!!

What about white vs. colored socks?
This is a question we get a lot from our diabetic patients with neuropathy: why white socks over colored? The answer is non-scientific and has nothing to do with dyes in the socks that may be harmful (in fact, unless a patient has an allergy, dyes are not typically harmful). Rather, the answer lies in the fact that white socks can serve as an indicator for patients. When patients can’t feel their feet, white socks, when removed at the end of the day can be inspected for signs of staining, blood or openings that may indicate injury to the foot. They prompt the patient to explore further whether they need to be following up with their Podiatrist for problems with their feet. 

Whether you’re a diabetic patient with or without neuropathy, it is important to have occasional screenings conducted by your Podiatrist helping to catch complications early and decrease risks associated with your disease! 

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