DRHOOK- No mis-step: Diabetics must take good care of feet

the handsome doctor John Hong of Charlottesville

Open mouth, insert foot. Have you ever been in a situation where you wanted to die because you said something inappropriate?

Some friends threw a farewell party for me in LA when I finished residency. Not that I was a Chatty Cathy, but– I said to a couple of my friends across the dinner table, "Oh, yes, remember when you were–" 

As I was telling this funny story, one of them kicked me in the shin. Oops! The person sitting next to me was the "sore subject" of the story. Thank God we were in LA, because I easily changed the subject by saying, "Hey, isn't that Brad Pitt over there?"

A lot of people have phobias about feet. I know of very few people who think they have nice-looking feet. Many people refuse to look at their feet, feeling like they're parasites attached to the ends of their legs. 

But if you're diabetic, it is important to check your feet everyday.

Can your feet be more of a problem that inserting them into your mouth when you've said something stupid?

According to Drs. Heather & Brian Snyder (yes, two podiatrists who are married. Isn't that romantic? They got married under a foot arch– I assume), 15 percent of diabetics will develop an open foot wound and 20 percent of them will lead to— gulp– amputation.

Even worse for these folks, 50 percent will have a foot or leg amputation in the next three-to-five years. 

Which diabetics are at risk for foot ulcers and infections? Those with neuropathy (damaged nerves), peripheral artery disease, and high sugars are most at risk. With neuropathy, the feeling diminishes so a diabetic person might not feel pain from a cut foot or an ingrown toenail digging into the skin. According to Dr. H. Snyder, many patients don't notice a problem until they see blood in their socks or notice a foul odor coming from their foot.

Poor blood flow to the feet makes wounds heal poorly, so bypass surgery or angioplasty might be done to improve circulation. High sugars also inhibit the immune system's defense against infection, so it's vital to control the blood sugars. That means taking medicines, following a diabetic diet, hydration, and exercise.

In my diabetic patients, I check between the toes for chronic athlete's foot, look for calluses, check the nails, and search for any skin breakdown that can be a portal of entry for bacteria. I hate when my at high-risk patients wear smelly shoes without socks because they might as well just wear a "Bacteria Enter Here" sign on their feet.

For those with bunions or hammertoes, shoes often don't fit well and the pressure points can cause ulcers to develop. The problem with ulcers is if they get deeper, they approach the bones and joints. If the bones become infected, that can lead to amputation. A foot can even become gangrenous. In gangrene, gas can form in the foot to create blister-looking lesions and a crunchy feeling under the skin. The healthy foot tissue can die off (necrosis) and lead to having parts of the foot/ankle removed.

The sooner a diabetic foot ulcer/infection is treated, the better the prognosis. Surgical debridement (removal of the infected tissue), antimicrobials, and proper dressing and salves to allow healing all can save a diabetic person from losing a toe, foot, or ankle. Podiatrists are great at getting shoes to relieve pressure from ulcers.

A foot of prevention is worth a yard of cure. (I hope I am toeing the line on this one!) For more information, contact the Dr. Synders at Albemarle Family Foot & Ankle at 434-979-0728. I'm sure you can get your foot in the door if necessary.


Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.