If Only Toes Could Talk...
Bill came into my pharmacy several months ago, sat down, and took off his shoe and stocking to show me his toe. His middle toe was deep red and purple. He described how the strap of his sandal had rubbed a sore at the base of the toe, and said it was not painful.
He asked about a solution to soak the foot in, or an antibiotic ointment to apply to the reddened area. I told him that for a person with diabetes, this is not a time to self-medicate and advised him to see his physician immediately to obtain proper treatment.
His physician, after examining the ulcer and checking pulses in the ankle and foot, gave him a prescription for oral antibiotics.
Your toes and feet can be a barometer of the current state of your diabetes control. Have you lost the hair on your toes? Are your toenails discolored and thickened? Is the skin on your legs shiny with dark patches? Are your feet cold at night? Do they change color on elevation? Have your feet developed a burning or tingling sensation? Do they hurt or are they without any feeling? Do you experience leg or foot cramps at night?
As a person with diabetes, I am concerned about the health of my feet. I have seen too many preventable amputations of the toes, foot or lower limbs caused by Peripheral Vascular Disease (PVD). PVD means poor circulation and blood flow to the tissues in the foot. One sign of PVD may be loss of hair on the toes. Other signs such as cramping of the legs, or temperature changes in the foot may indicate PVD as well.
Healing a foot ulcer can be difficult, expensive, and may take a long time. The patient with diabetes has difficulty fighting infection for many reasons, including impaired blood supply, nerve changes, and changes in the blood itself, such as white cell and platelet abnormalities. Healthy platelets are part of your body's method of healing wounds.
Keeping your entire vascular system healthy by maintaining close- to-normal glucose control, normal cholesterol and lipid levels, and not smoking can prevent large blood vessel disease.Your physician may give you a prescription for low dose aspirin, Persantine or Trental to increase the circulation in the blood vessels.
For fungus infections of the nail, your physician may prescribe a topical over-the-counter antifungal solution, or oral antifungal medication such as Sporanox, which can be expensive and affect the liver. At times, surgical removal of the nail may be needed.
Neuropathy causes loss of sensation in the feet. It develops over a period of time. It may be described as tingling, burning, painful, or "my feet are completely dead". Your physician may offer prescription drugs, such as Elavil, Tegretol, Dilantin, or Valium to block the burning and pain of neuropathy. He may recommend capsaicin creams to apply to the area.
High blood glucose levels result in a sorbitol buildup in the nerves, which causes a lowering of myo-inositol levels in the nerves. Several endocrinologists in our area recommend trying the vitamin inositol in an attempt to reduce the symptoms of neuropathy. We all are waiting for the completion of a study on Aldose Reductase Inhibitors to block sorbitol in the nerve tissue. In the meantime, ask your physician about the use of inositol in your situation.
Changes in the shape of the foot, with new callus build-up, may break down and ulcerate. One severe type of change is called Charcot foot. The typical Charcot's foot is warm, swollen, reddened, and may be confused with an infection.
Prevention is the key to the health of your feet. The insensitive foot is subject to injury from walking barefoot on hot surfaces, stepping on sharp objects, using callus remover chemicals, hot water bottles, soaking feet, or wearing ill-fitted shoes. People with diabetes must look and feel their feet each day. If a callus develops, applying a moisturizing cream with massage will prevent the breakdown and cracking of skin around the callus and healthy tissue. Shoes must fit properly. Visit a Certified Pedorthist to assure proper shoe fit. Customized insoles made on a mold of your foot may be provided by a podiatrist.
I recently saw a Footglove that can be worn like regular socks. This stocking has "fingers" made of breathable cotton. It allows skin that is irritated to dry and heal and prevent reoccurring conditions. Your local pharmacist will assist you by providing information and special products to aid you in footcare.
Bill has great respect for his feet today. Thankfully, he has a healthy foot. As a pharmacist I see people with diabetes many more times than any other health professional, and I know I had a positive role in his recovery.
Healthy feet can be a good indicator of diabetes control:
- Inspect feet and between toes daily for blisters, cuts, and scratches. A mirror can aid in seeing the bottom of the feet.
- If vision is impaired, have a family member inspect feet daily, trim nails, and buff down calluses.
- Wash feet daily, dry carefully, especially between toes.
- Avoid extremes of temperature and test water before bathing.
- If feet are cold at night, do not apply hot water bottles, heating pads, or soak feet in hot water-instead, wear socks.
- Do not use chemical agents for the removal of corns or calluses.
- Inspect the inside of shoes daily for foreign objects, nail points, or torn linings.
- Wear properly fitted stockings, avoid wearing mended stockings, or those with seams. Change stockings daily.
- Garters should not be worn.
- Shoes must be comfortable at the time of purchase, and they should be broken in gradually.
- Never wear shoes without stockings, sandals with thongs between the toes, or walk barefooted.
- Toes nails should be cut straight across.
- Corns and calluses should be cared for after explicit instructions from the physician or podiatrist.
- Use a moderate amount of moisturizing cream applied after bathing to reduce the tendency for cracks and fissures. Never put creams between the toes.
- Calluses should be planed down daily with an emery board, pumice stone, or special file. Do not cut them.
- Visit your physician regularly, and inform your podiatrist that you are a diabetic.
- All people with diabetes should visit a podiatrist regularly, depending upon need. Your podiatrist can tell you how frequently you need to visit.
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