A Holy Foot

It’s frightening but it occurs with all too much frequency in my NYC podiatry practice and in the surrounding areas. And we’re not talking about feet that are walking in St. Peter’s Square, on the Temple Mount, or in Mecca, or whatever else makes you feel holy, and not necessarily in that order.  The topic this week, is seriously more serious- and that is the diabetic foot ulcer.

As we have previously discussed in the pages of this blog, the incidence of diabetes is expanding faster than the waistline at a Texas barbeque.  It’s a problem domestically and internationally, as developing countries adopt a more, shall we say, Western, diet and lifestyle.  And along with that increase, diabetes has become the leading cause of blindness, kidney failure, and lower extremity amputations in the US.  In fact, diabetes is the cause of over 70% of amputations worldwide.   And many of those amputations start with a diabetic foot ulcer.

The two main manifestations of diabetes in the lower extremity are peripheral arterial disease, or compromised circulation, and neuropathy, or numbness.  PAD is worse, but diabetic neuropathy is more common, and more commonly involved in amputations.  Numbness often starts as burning pain, or pins and needles in the foot, eventually leading to complete numbness, in which the neuropathic foot may not feel the needle, staple, or tight shoe that is digging into the skin, leading to a breakdown of tissue, and an open wound, or ulcer.  In the best case scenario an ulcer is an annoyance that requires weeks or months of treatment, in the office or operating room to close the wound.  In the worst case scenario, an ulcer leads to a bone infection, for which antibiotic treatment is usually not effective, and thus leading to the need for amputation to remove the infected segment of bone and save the healthy bone.

And now for the good news- this is preventable.  The most common cause of a diabetic foot ulcer is a tight shoe.  So, my young friends, here’s the easy advice from your NYC podiatrist.  If you’re diabetic, especially if you are neuropathic or have impaired circulation, check your feet every day.  Make sure shoes fit properly, are free of objects floating inside them (I have some stories), and socks are not bunched up.  Don’t cut your own toenails or calluses (yes, I do that for you.  It’s not glamorous, but it saves lives).  Keep your sugar under control.  And see your friendly local podiatrist on a regular basis, at least every 3 months.  By taking those simple steps, you can live a long and ulcer-free life.

See you in the office.

Ernest Isaacson

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