Advice on Foot Care

The CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2005 and 2007 and found that the prevalence of arthritis in diabetics was 52% and that the prevalence of inactivity was higher in diabetics with arthritis as compared to diabetics without arthritis. This information suggests that arthritis may be an additional barrier to physical activity in diabetics. Diabetics face the same barriers that most adults face when it comes to increasing physical activity: a lack of time and motivation, other responsibilities and difficulty finding physical activities they enjoy. But, for those with arthritis, there are additional barriers which include concern about causing joint damage, aggravating arthritis pain and finding activities which are safe for their joints. Continue Reading »

An abstract presented at the 2007 American Diabetes Association Scientific Session showed reduced lower extremity complications in diabetics who participated in a diabetic management program.

Reduced Incidence of Diabetes Lower Extremity Complications During Participation in Diabetes Disease Management Programs

Authors:
CARTER COBERLEY, BRENT HAMAR, ZACKARY SAMPLES, MATTHEW MCGINNIS, SADIE COBERLEY, ANDRES PEREZ, DEXTER SHURNEY, Nashville, TN

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The Influence of Exercise on Foot Perfusion in Diabetes.

Researchers at the Wound Healing Research Unit at Cardiff University in the UK measured changes in circulation in the foot following brief periods of exercise in participants with and without type 2 diabetes and arterial disease. There were 61 participants and 116 limbs were evaluated. The participants were divided into groups based on the presence or absence of diabetes, peripheral vascular disease and peripheral neuropathy. Measurements were used to evaluate circulation to the lower extremities and specifically at the foot and toes (Transcutaneous oxygen tension (TcPO(2)), transcutaneous carbon dioxide tension (TcPCO(2)), ankle-brachial pressure indices, toe pressures and toe-brachial pressure indices (TBI).

Results: After exercise, toe pressures and toe-brachial pressures increased in the non-diabetic group with arterial disease, but not in the group with diabetes. After exercise, the foot TcPO2 values increased in groups with diabetes.

Summary: These results suggest that brief periods of exercise can improve the cutaneous perfusion (increased circulation in the smaller vessels to the skin and superficial structures) in the feet and toes in patients with diabetes and those with diabetes and arterial disease as a result of the local heating after exercise.

Williams DT, Harding KG, Price PE. The influence of exercise on foot perfusion in diabetes. Diabet Med. 2007 Jun 25.

It is estimated that over 21 million Americans have diabetes. Serious complications associated with diabetes include stroke, heart disease, blindness, kidney disease, high blood pressure, nervous system diseases and amputations. In 2002 there were 82,000 lower extremity amputation in diabetes. Six individuals out of every 1,000 people with diabetes will have a lower extremity amputation. A slow healing or non healing open sore (known as an ulceration) on the foot is the most common reason diabetics will end up with a foot or leg amputation. Over 2 million diabetics have ulcerations and one in four diabetics with an ulcer will have an amputation. Unfortunately, over 25% of diabetics have not heard of an ulcer.

Treating diabetic ulcers is difficult. Preventing diabetic ulcers is not. Preventing diabetic ulcerations is the key in decreasing the risk of amputation. Other important steps to help in avoiding amputation are decreasing the chance of infection and the development of gangrene. Infections can develop at the site of an ulcer, at an ingrown toenail, from a corn between the toes or from a blister or a callous. Gangrene is the result of poor circulation. Any of the above possible causes of infection can result in gangrene if the circulation is poor. Very few individuals will develop gangrene spontaneously. Most individuals have some sort of trauma or injury that predisposes them to development of an open sore (or ulcer), a blister or an ingrown nail.

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