2010-03-19 / Columnists

SJEH Wellness Corner

Diabetes And The Importance Of Good Foot Care
Commentary By Sheldon Markowitz Chairman, Department of Internal Medicine and Chief of Endocrinology, St. John’s Episcopal Hospital

Sheldon Markowitz Sheldon Markowitz Diabetes can cause complications that greatly affect the feet. Therefore, proper foot care may help those with diabetes preserve a good quality of life. Over time, diabetes can cause damage to nerves throughout the body; this damage is called diabetic neuropathy. Diabetic neuropathies lead to numbness and sometimes pain and weakness.

Damage to the nerves of the feet, as well as legs, arms and hands, is called peripheral neuropathy. The nerves of the feet are the longest in the body and so are the ones most often affected by neuropathy. Loss of sensation in the feet means that sores or injuries may go unnoticed, leading to infection or ulceration. Circulation problems also may increase the risk of foot ulcers.

More than half of all lower limb amputations in the United States occur in people with diabetes – 86,000 amputations per year, according to the National Diabetes Information Clearinghouse. If you have diabetes, taking good care of your feet is a must. Strict control of your diabetes is also absolutely essential.

Symptoms

Tingling, pain or increased sensitivity, numbness or weak ness are just some of the symptoms of diabe tic neuro pathy. However, many people with diabetes experience no symptoms of peripheral neuropathy at all and are only diagnosed upon a doctor’s examination.

Diagnosis

A doctor’s examination is needed for a diagnosis of diabetic neuropathy. A comprehensive foot exam will assess the skin, circulation, and sensation. Other tests the doctor may prescribe include checking reflexes and assessing vibration perception, nerve conduction studies that check the transmission of electrical current through a nerve, and electromyography (EMG) which shows how well muscles respond to electrical signals transmitted by nearby nerves. At St. John’s Episcopal Hospital, MRA or magnetic resonance angiography and ultrasound also are used to conduct studies of the vascular system, giving the doctor a better look at your circulation and possible damage to the legs and feet.

Treatment

The first step to preventing nerve damage is to bring blood glucose levels within the normal range. Blood glucose monitoring, meal planning, exercise approved by your doctor, oral drugs or insulin injections are needed to accomplish this. Over time, maintaining lower blood glucose levels helps lessen the symptoms of neuropathy. Importantly, good blood glucose control may also help prevent or delay the onset of other types of diabetic complications.

Often treatments may be provided for specific problems caused by peripheral neuropathy. New drugs are now available. Hard-to-heal sores may be treated at the Center for Wound Healing at St. John’s. There are also medications as well as other modalities your doctor can prescribe to help relieve pain and reduce the burning sensation.

Please consult with your physician or podiatrist if you think you might be experiencing any of these symptoms.

To make an appointment with an endocrinologist or a podiatrist, please call St. John’s Physician Referral Line at 1-877-SJEH-DOC (1-877-753-4362) or the Ambulatory Care Center at 718- 869-7690 for comprehensive health care. The Wound Care Center at St. John’s, which is co-directed by the Hospital’s Chief of Podiatry Lloyd Bardfeld, DPM, may be reached at 718-869-8306.

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