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Back: Podiatric Care Vital to Successfully Managing Patients with Type 2 Diabetes

Picture of Dr. Taubman


   Ross E. Taubman, DPM

   President
   American Podiatric Medical Association
   Bethesda, Maryland

 


In my practice as a podiatric physician over the last 25 years, I have witnessed and treated many patients who arrive in my office complaining of redness and slight numbness to their lower extremities. What many of those patients never realized before entering my practice, however, is that they were displaying some of the classic signs and symptoms of type 2 diabetes. This general neglect of foot care and diabetes has only increased into the 21st century, as diabetes is now considered to be a health epidemic in our country.

The most recent statistics show that 8 percent of the United States population has diabetes, and that an additional six million people are undiagnosed. As those of us in the medical community know, many foot ailments present themselves in people with undiagnosed diabetes. Undiagnosed and untreated foot conditions can ultimately lead to serious foot and ankle problems, most notably amputations. 

In the United States, more than 60 percent of the patients who receive non-traumatic, lower-limb amputations have diabetes. In 2004, almost 71,000 Americans with diabetes needed amputations. Studies have shown anywhere from 40 to 80% of diabetic amputations can be prevented with attention to proper footcare and working together as part of a diabetes management team. 

Podiatric physicians and surgeons, or podiatrists, plays an integral role in the diabetes management team, along with a primary care physicians, endocrinologists, dentists, ophthalmologists and nutritionists. Diabetes can affect proper nerve function and lead to sensory changes, including neuropathy and loss of protective sensation. The increased risk of atherosclerotic disease in people with diabetes causes an increased incidence of peripheral arterial disease, affecting blood flow to the extremities. This combination of loss of protective sensation and decreased blood flow can have disastrous consequences for a person with diabetes. If you have a patient with diabetes, it is vitally important to do a comprehensive foot examination at least twice a year, including checking a patient’s vascular and neurological statuses. Podiatrists routinely do this for their patients with diabetes at every visit. Identification of peripheral arterial disease and taking the proper steps in terms of blood pressure control, cholesterol management and blood sugar control can also reduce associated risk of coronary and cerebral vascular events. 

This type of early treatment and team management can help prevent diabetic foot ulcerations, hospitalizations and, ultimately, amputations. All of those in the medical community, from PCPs to nurse care practioners, should be vigilant about observing the warning signs of diabetes in the feet, and referring to a podiatrist if necessary for prompt treatment. 

Patients should see a podiatrist or PCP immediately if they notice the following conditions:

  • Calluses, blisters, or dry and cracked skin anywhere on the foot can imply poor circulation or foot health, especially if the patient does not feel them.
  • Thin, fragile, shiny or hairless skin, which can denote decreased circulation to the foot.
  • Patients and Primary Care Physicians should check the patient’s shoes for torn linings or foreign objects. If torn shoe linings do not irritate a patient’s foot when they walk, they may have nerve damage. Other warning signs include foot deformities like hammertoes, a past history of foot ulcers, or lower leg or thigh pain when walking.

While the number of those with diabetes continues to rise, early diagnosis and proper disease management – as well as informing patients what to look out for on their own – may help significantly to prevent an unnecessary loss of limbs.


For information to share with your patients on diabetes and footcare check out our most recent patient education material on "Helping Your Feet Last a Lifetime" by Richard R. Rubin, PhD, CDE click here.