Proper Routine Foot Care Is Essential To Minimize Complications of Diabetes
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“These boots are made for walkin’ and that’s just what they’ll do. One of these days these boots are gonna walk all over you…”

Whether it’s leather boots or loafers or a pair of Nike Airs, shoes that fit well are a matter of particular importance to people with diabetes. In fact, a daily regimen of foot care is an essential component of self-care for their disease. When seemingly minor foot problems are overlooked or go undetected in an individual with diabetes, potentially serious complications can quickly arise. It’s a reality that is all too familiar to Dr. Angus McBryde, Professor, Department of Orthopaedic Surgery.

Dr. Angus McBryde performs an exam of a patient's foot.

“Something like an ingrown toenail that wouldn’t matter much to you or me can be potentially disastrous for patients with diabetes,” Dr. McBryde said. Because diabetes causes nerve damage or “neuropathy” in the feet, cuts or injuries can go unnoticed by patients. They become less likely or unable to feel minor injuries because the feet have lost natural protective sensation. When these feet become “insensate,” they also become more prone to infections and the normal healing process is impaired. Changes in the shape of the feet or toes occur such as the development of claw toes or hammertoes. The foot then no longer fits in the shoe properly.

“A superficial pressure or friction blister can quickly turn into a deep ulcer, becoming a major problem,” Dr. McBryde said. In addition to the medical treatment he provides for such ulcers, he stressed, “The patient has to get the pressure off the foot totally and immediately.” Yet he recognizes that sometimes, “This can be hard to do for someone with an active lifestyle or someone who can’t walk well on crutches.”

Recreational athletes with type 1 or type 2 diabetes who suffer foot complications present an additional challenge to Dr. McBryde, one of three orthopaedic surgeons that staff the USC Sports Medicine Center. The key is determining how these individuals can stay active without contributing to or exacerbating a problem. “They have to get into an activity that won’t let them get into trouble such as biking or swimming or using a soft treadmill with the right kind of shoe,” he said.

If an infection becomes severe enough, amputation of a toe, foot or leg may be necessary. An estimated 54,000 amputations are done each year on people with diabetes. While the nature of the disease increases the risk for amputation, Dr. McBryde noted that good foot care could significantly postpone or abort the necessity of such a traumatic intervention.

Grooming needs to be a careful process, such as keeping toenails trimmed and making sure the space between the toes is clean and dry. Shoes should be chosen with care. “The proper type of shoes cannot be overemphasized, and if necessary patients need to be fitted for shoes that have extra depth and/or custom molded orthoses to better support the foot,” he said. And while he stresses diligence for patients with diabetes to protect their feet, the task doesn’t have to be a daunting one. “Routine foot care is basically common sense. It’s all about avoiding acute and chronic injuries and taking good care of the skin.”

Reprinted from Connections newsletter, September 2003

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