Why Do Diabetics Need Special Shoes?

There’s a question that we get in our Blacksburg and Roanoke offices quite frequently – and that is, “Why is it that your diabetic patients require special shoes?”

To understand the answer to this question, one must first understand the diabetic foot. One big reason why it is important for any diabetic person to carefully monitor and control blood glucose levels is that when uncontrolled, many complications can arise. Some complications that are frequently seen in our office are nerve damage, decreased blood flow, and foot and joint problems. All of these problems can and do affect the feet.

Besides the bladder, bowel and stomach issues that can arise from diabetic neuropathy, poor sensation can have devastating effects on a patient’s feet without proper care and attention. Inability to feel pain, pressure or temperature can easily allow for rubs, blisters, burns and other injuries to go unnoticed.

Feet are sensitive and the blood supplying oxygen to the lower extremities may be reduced without you even being aware of it. The decreased oxygen delivery to the feet from poor circulation results in slower healing and nail growth.

Uncontrolled blood glucose levels can be inherently dangerous. “Rollercoaster” blood sugar levels can damage tissues and cells. An elevated blood glucose level can cause dehydration and dryness of the skin as well as promote the growth of bacteria and fungi (since sugars are a good food source for these organisms). Because of this, bladder, gum, and skin infections are common in our diabetic patients with high sugar levels. 

So, Why Special Shoes?

-          Proper shoes are the first line of defense against injury and infection.

-          Well fitting shoes are comfortable and allow proper circulation in the feet.

-          Proper shoes will allow your feet to breathe while still protecting them.

-          Proper shoes can prevent the development of ulcers, blisters and fungus.

How are these shoes different?

-         Deeper and wider to accommodate diabetic inserts, allow more room for feet, and reduce possible pressure points.

-         These shoes provide excellent support which is recommended for anyone buying shoes.

-         Most have a breathable fabric upper to promote good air circulation within the shoe.

-         Most are custom ordered for size or even custom molded to a patient’s foot.

-         The toe boxes are roomier to prevent pinching or squeezing the toes as well as to allow for more room for foot deformities.

-         Many are easily adjustable or have elastic which makes it easier to put on without making the shoe too tight or too loose.

-         Available with Velcro to make putting on shoes easier for patients with peripheral neuropathy who can not feel their fingers well enough to lace shoes. 

 

If you are interested in a pair of these shoes for a loved one or yourself, please give our office a call at (540) 808-4343!

Foot Exams Help Prevent Ulcerations

diabetic foot syndrome

We urge all of our patients to make sure their primary-care physicians check their feet during every office visit for signs of ulcerations that, left untreated, can lead to infection and ultimately result in lower limb amputations.

It’s a simple exam that takes two minutes to determine if you are at risk for developing a foot ulcer. Perhaps the easiest way to remember to get your feet checked is to remove your shoes and socks in the examining room. Most diabetic patients are vulnerable to foot ulcerations caused by poor blood circulation in the lower extremities and neuropathy that inhibits nerve sensation.

Ulcers are the leading cause of foot amputations among people with diabetes, but they are preventable in most cases if doctors routinely check their patient’s feet.

In a routine foot exam we check for nerve sensation, skin irregularities (corns, calluses, punctures and areas of redness), swelling, drainage, and foot deformities that cause unnatural pressure points that are prone to ulceration.

Patients with diabetes who have their feet checked regularly can prevent foot ulcers or have them treated at early stages by their podiatrist.

What Does a Podiatrist Do?

A Podiatrist is a foot and ankle specialist- we offer all services listed below and more!

Dr. Kate Steklachich

Dr. Jennifer Feeny

• Surgeries- everything from removing a bunion to reconstructive surgeries 
• Bunions
• Warts
• Ingrown Toenails
• Routine/Diabetic Foot Care
• Custom Orthotics & Over the Counter Orthotics
• Heel Pain/Plantar Fasciitis
• Heel Spurs
• Bone Spurs
• Neuropathy
• Neuroma
• Corns/Calluses
• Athlete's Foot
• Nail Fungus
• Injuries

The list can really go on and on! Our Blacksburg and Roanoke offices want to stress that we specialize in feet and ankles. A lot of people may think going to a general surgeon or orthopedist for surgery is a better idea than a podiatrist for a problem they are having with their feet or ankles. However, because we specialize and are day in and day out dedicated to this specific area- we know it best! If you have a question about a condition, pain or something else you are experiencing and it isn't listed here or our website- give us a call! We are happy to answer any questions you may have. 

What is Neuropathy?

Dr. Jennifer Feeny, of Shenandoah Podiatry, discusses the reason you have pain in your foot, even though it is numb. Dr. Feeny also discusses the possible causes of neuropathy and treatment options.

Diabetic Peripheral Neuropathy

Diabetic Peripheral Neuropathy is the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes.
Neuropathies are characterized by a progressive loss of nerve fibers

Noninvasive Testing

• Nerve conduction studies and Electromyography- A test commonly used to evaluate the function and the ability of electrical conduction of the motor and sensory nerves.
• Quantitative sensory testing
• Autonomic Function Tests
• Monofilament testing - If the patient does not feel the wire at 4 or more at 10 testing sites- the test is positive for neuropathy

Pathophysiology of Diabetic Peripheral Neuropathy

Result from vascular disease:

• Endothelial dysfunction
• Deficiency of myoinositol-altering myelin synthesis
• Chronic hyperosmolarity-causing edema of nerve trunks
• Increased sorbitol and fructose

Diabetic Neuropathy can contribute to Structural foot deformities

Hammertoes

Bunions

Metatarsal deformities

Charcot foot

Eventual tissue breakdown

The symptoms of peripheral neuropathy include the following

• Hyperesthesia-Is a condition that involves an abnormal increase in sensitivity to stimuli of the senses.
• Paresthesia- Is a sensation of tingling, pricking, or numbness of a person's skin. It is more generally known as the feeling of "pins and needles".
• Dysesthesia-It is defined as an unpleasant, abnormal sense of touch, and it may or may not be, considered as a kind of pain.
• Radicular pain-Is pain "radiated" along the dermatome (sensory distribution) of a nerve due to inflammation or other irritation
• Anhydrosis-Means lack of sweating.

Peripheral Neuropathy Signs

• Loss of sensation in the foot- Results in repetitive stress
• Injuries and fractures
• Loss of vibratory and position sense
• Loss of deep tendon reflexes
• Trophic ulceration
• Foot drop

Treatment


Diet

• Patients with diabetic neuropathy should develop a realistic diet for lowering blood glucose. This should be guided by a nutritionist or doctor

Medicines widely used to help with painful symptoms

• Selective serotonin and norepinephrine reuptake inhibitors- example:Duloxetine (Cymbalta)
• Tricyclic antidepressants- example: Amitriptyline (Elavil)
• Anticonvulsants- example:Gabapentin (Neurontin)
• Pregabalin (Lyrica)- FDA approved for neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia.
• Capsaicin cream (Capsacin)- A natural chemical derived from plants of Solanaceae. This is a topical medicine and is the active component of chili peppers.
• Neuremedy (Benfotiamine)- For the nutritional management of peripheral neuropathy.