Foot Care

I am not yet into my first year of being dx’d as a T2, but I read and I want to know what to expect in the coming years.

The topic of the day is: Foot Care :slight_smile:

Its fairly common knowledge among us that we need to be aware of things that can happen in our feet due to complications. At this point in my disease, my numbers are pretty low, I don’t think they were ever way over the top in the first place, and I consider them to be tightly controlled, so I am not particularly worried about complications just yet, but I am aware that anything can happen, so being prepared seems a logical thing to do.

My doctor never mentions anything except our fights over how many strips I should get, and lacking insurance, I am on my own to keep an eye out for things that might become problems.

I walk a lot on my treadmill, and this stresses my feet and I won’t attempt to explain what one of them feels like lately. I have been working in the garage on the frozen concrete, as in zero degrees, for a week, and so for all I know, I have frostbite on the bottom of my feet :slight_smile: However, a small amount of paranoia sneaks in whenever something starts to feel different anywhere in my body, and so I tend to be very sensitive to what is not quite right.

Anyway, what should a diabetic be looking for when he/she checks her feet? We are supposed to do it rather regularly, but I am not aware of exactly what it is I should be looking for? I can imagine the extreme which would be toes turning black, stifling pain, and all those horrible things we used to read about, but I am not going there just yet :slight_smile:

What about numbness? Temperature seems like something a foot doctor would consider, but that is hard to do in the dead of the winter with cold hands and feet most of the time.

Anyway, enough of the usual rambling. If we are to take special care of our feet, what is it that we are looking for, when we do so?

Links, or books would be welcome, or maybe those whose doctors check them regularly would share what is being looked at?

Much obliged for any insight or experiences.

John

I check em regularly looking sores, ingrown toenails or cracked skin here’s an article with better advice :
http://www.diabetes.org/living-with-diabetes/complications/foot-complications.html

Check for swelling, redness, tenderness–anything that could be a sign of infection, or possible infection like sores, blisters or ingrown toenails (as Joe mentioned). Look between the toes, too.

Docs check for this & do tests for neuropathy.

The usual warning is not to go barefoot.

People with diabetes tend to have dry skin on their feet, so are told to moisturize, but not between your toes, to keep skin from cracking.

As I understand we have to check our feet because neuropathy is silent and you might not feel the warning from pain. I guess kind of like frostbite if it hurts that’s good, when it doesn’t hurt very bad.

I actually participated in a diabetic foot health study that was being conducted at the University where I teach. If I recall correctly, they tested for sensitivity to pressure, heat and cold sensitivity, hair growth (which is an indication of circulation health), blood pressure in the feet, and overall health for things like sores or cracked skin. It was kind of cool.

I hunt a lot and spend lots of time outdoors, and I’ve definitely noticed that my feet and hands get colder quickly now. My buddies and I will be sitting in the duck blind, and I’ll be freezing my feet even through heavy boots. I’ve kind of just decided this must just be due to a little worse circulation than normal.

Thanks Brett, and everyone else who has chimed in.

Who can show me where to learn why the circulation in a diabetic’s feet would be worse than a normal person, going under the assumption that the BG numbers are and almost always have been in control? I think I find that based on how my life is not working out so well in every other areas, I need to be careful of getting obsessed, so I try to just keep it called curious, and trying to be aware. My A1c was 6.8 in July when I was dx’d, and in three months it was 5.5. Six weeks later, the free day at Walgreens, it came back as 5.0. Not here to debate that accuracy :slight_smile: but its not like the number went back up, or have ever really gone ‘into the really dangerous zone,’ that I can know of. I seldom exceed 140, and when I do by no more than 10 or 15 points, its only a matter of an hour and I am back to 100 or less, so although I am not in denial about my diabetes, I am spending too much time wondering why I would have poor circulation in my feet from what appears to be a, dare I say it here, a moderate case of diabetes?

I could understand a cut or an infection becoming a problem I guess, but loosing feeling from lack of circulation is something I can’t figure out why it would be related to the stage of diabetes that I think I am in.

I don’t have any of the things most of you mentioned on my feet. I check them all the time, but they have been cold lately, as its really cold here in Utah, and I was working in the garage on the concrete, in addition to probably stretching the feet and toes working on the cars. You can get into some weird positions, and I may have pulled a muscle in the place where the toes meet the foot, mostly on the ball of the foot, in any of the hundred times I would get up from one of those funky positions, so it feels “weird” kind of flat, and just no way to explain it other than, its different. Still have feelings there, as I can poke it with a pointy object and its no different than anywhere else on the foot. Its not really numb. Just feels that way when I walk on it

Not looking for a diagnosis here but looking for what I think I got, some feedback on what to look for, which my doctor never, ever mentioned, and just basically some place to say it. I may be a borderline hypochondriac :slight_smile:

Still, its on my mind, and I can’t help the wondering, because as I said, I don’t see why a diabetic with such apparently good control, would have poorer circulation, than a ‘healthy’ person. Maybe its just being 54 years old that causes things to ache and get sore. I know the rest of me gets that way

Not crazy about going to my doctor about it just yet. Don’t have insurance that allows me any options for treatment, so I will wait a bit and see what happens.

Much obliged for everyone’s input and time. Nice to have a place to ask questions about such things and learn from other’s experiences.

John

John, you’re right in that if your numbers are good, your risk for any circulatory issues is much lower. And I feel it’s important to be vigilant and alert about changes in your body without being a worrier. I see a podiatrist and an ophthalmologist yearly to make sure I know what’s going on in my body.

The reason circulation is affected is because numbers over 140 mg/dL cause cell damage. The extra glucose and the efforts made by the body to accommodate it deteriorate small nerves and blood vessels - which can necessarily lead to neuropathy, retinopathy, etc. Even a great average or a great A1c does not guarantee that we won’t have numbers that fall outside of normal control and rise too high. That’s just being diabetic. Our bodies get put through the ringer a bit more than non-diabetic bodies - even when control is decent. That being said, complications are not inevitable just because our bodies are under more stress.

Melissa is right on about this. The two things that effect your feet are peripheral vascular disease (hardening and restrictions in your arteries and veins) and peripheral neuropathy (nerve damage). I already have signs of perhiperal vascular disease with hair loss on my legs, but my main blood supply to my feet remains strong as I exercise aggressively. But I am starting to see neuropathy as my toes are starting to suffer from numbness. I am not really happy about this and I really have to be diligent about my blood sugar control and monitoring my feet. Melissa’s recommendation to keep numbers down below 140 mg/dl is great. That is my goal and unfortunately, I’ve not had great success in getting doctors to help me with that goal.

For many, these sorts of complications may never happen or be years out, but you need to be smart and informed about these conditions. Loss of feeling circulation and feeling can creep up on you and really put your feet at risk. Even if you end up with severe problems, with diligent care you will be fine. Some people (like Dr. B) even argue that with tight blood sugar control, you can heal peripheral neuropathy over time.

As always, I thank everyone who has replied and offered information and support. My numbers never go over 140, but for an occasional oops on my part that maybe be 10 or 20 for an hour. I have been walking most every day, at least a few miles on the treadmill, or when it was warmer, outside, but can’t walk anymore, as it hurts my feet way too much. I haven’t be dx’d that long, as I said, and my A1c didn’t come back as super high. How long I was at 6.8 I have no idea, but somehow, that never struck me as an immediate threat to my feet and my house, which is what will have to go to pay for what I think is going to happen.

My problem is no insurance, and I have issues with my feet and my toes and no way to see a neurologist and get things checked out. Its confusing because it is so cold lately, that my feet are cold due to that, which is a winter thing anyway, but something does not feel right as it started in my right foot, and today its a bit in my left as well. I just cannot conceive of how any damage could occur that quickly, although no one really knows how long they have been diabetic. It was my hope that I was dx’d early on, and that things could be taken care of, but now I am depressed over this, in addition to having been major depressed before the dx…

Could be nothing, but the inability to have it checked is a strain on my system. Merry Christmas, I guess my kids get nothing, and I get a ton of debt. Cannot even conceive of how much it will cost to get things checked out. Sometimes, I don’t know why I even bother, and now if I have problems, that only answers my question. There is no reason to bother.

I am not one bit in favor of the albatross the government here in the US is about to hang around all of our necks as the solution to healthcare. I am very much opposed. I would just have liked to live in a place where I could afford my own health care but no job, declining health, and now this… I am feeling like I am going to loose everything because of this disease, when for the short time I have had it, I thought I was lucky to catch it early and be able to avoid major issues. At 54, I figured another five or six years and I would be gone anyway, so it seemed manageable, but now, here I sit all alone, wondering where this will all lead me.

That’s me tonight. I just wish I wasn’t around to see myself deteriorate. Its just not worth the aggravation that all this causes, if I am gonna lose anyway.

Thanks for all the help. Good night.

John

John,

Understand the frustration & depression. You are not going to be gone in 5-6 years! You’ve done amazingly bringing your BG into great control & you do have great control. Any damage, if there is any, is often healed by more normal BG.

An A1c of 6.8 at diagnosis isn’t severe at all. Mine, diagnosed Type 1 at 53, was 11.8. And yes, I do have some damage as a result of walking around for years with steadily climbing BG until I almost died with BG at 809.

It’s natural to attribute every ache & pain to diabetes because we’re all scared of complications. I had plantar fasciitis, which is excruciating. If I hadn’t had this many times many years before being diagnosed, I would have thought it was a diabetic complication.

I’m not a podiatrist or neurologist, but your foot pain could be totally unrelated to diabetes. It could be from overdoing the treadmill or even your shoes. Why don’t you take a break from the treadmill & long walks to see if this helps. Lift weights instead or do floor exercises to give your feet a rest.

Give your tootsies a nice massage, put your legs up & breathe.

John, depressing thoughts and diabetes go hand in hand. But I can tell you that I’ve had diabetes for 19 and a half years and spent 16 of those years with my A1c above 8.0. And I have no complications.

Like Gerri said, we’re often quick to attribute our other ailments to diabetes. Like Gerri, I’ve had foot pain that turned out to be plantar fasciitis and found that some simple stretches were all I needed. Staying off your feet when you have foot pain is a great suggestion, too. Choose activities like stationary cycling, weights, stretches, etc., that put less pressure on your feet. Try stretching your Achilles tendons and calves, and draw the alphabet with your toes a couple times a day to keep bloodflow going through your extremities. Try not to change your gait with the pain and try massaging with lotion at night.

Your A1c is great, your control is within a normal control range, and you are only 54. Please don’t assume you’re on your way out. We’re here for you, buddy.

Drawing the alphabet with your toes–what a great suggestion! Could you explain how to do this? Standing, toes pointed? When I was a kid, I had bad ankles & had to wear ugly shoes. I did exercises that included picking up marbles with my toes & putting them in my hand. To this day, I can pick up most anything with my toes. They’re prehensile!

If you ever have plantar fasciitis again (hope not), I found a great foot brace for only $12 that really helped, in addition to stretching. My doctor said I’m prone to this because I have really high arches & went barefoot too much.

Hi John,

I see on your profile you are in Utah, have you checked out Utah’s Premium Partnership for Health Insurance? It is a program run by the State of Utah to help out folks in situations like yours.

I know it’s hard, especially this time of year. But there is a reason to bother, your kids. They get to spend another Christmas with you.

Hang tough, brother!
Scott

What I’ve read says to do the exercise sitting or lying down, drawing the letters in the air with your big toe. The rare times I remember do this one, I do it in bed before or after sleeping. Works better than counting sheep. :wink:

The stretches I do for my p.f. are “toe/calf raises” where I come up and down on my toes 5 times in succession and “wall push-ups” but where you attempt to keep your heels flat on the floor and you really bring your whole body (including butt and hips, which makes it harder) in toward your hands 5 times in succession. When I first started doing them last year, I could feel shooting pain throughout my plantar fascia. I did both exercises in 5 sets of 5 each 3 times a day and felt no pain within 2-3 weeks. My doc also told me tennis shoes (with orthotic insoles) or high heels only - no flipflops, no barefoot, and no slide-ons - because your plantar fascia becomes cramped when it has to hold your shoes on.

Like you, I have crazy high arches and love going barefoot. And…my roommate in college used to joke with me about my prehensile toes because I pick things up with them. We have weird foot things in common, Gerri! LOL

I tried several braces and they didn’t do too much for me. Finally found one I thought was okay, but I don’t remember the brand. It’s dark blue, neoprene and velcro, and went halfway up my leg. What was yours?

Melissa,

Thanks for the alphabet exercises & the others. A doc who recommends high heels–love him. I’m guilty of barefoot, flip flops & slides. After numerous bouts of pf, I’m trying to do better. Truth is, I hate wearing shoes. I get scathing looks from my husband whenever I’m caught shoeless. Poor guy had to listen to me whine about pf too many times.

We’re sisters in feet (sounds better than foot sisters-lol)!

This is the brace that helped me. Doesn’t look like much, but instant relief the moment I put it on. Unlike some of the others, this one can be worn with shoes.
http://www.footsmart.com/P-FootSmart-Arch-Brace-10079.aspx

I tried one of the leg brace types & another that curled the toes up & held them in this position. Neither did much.

Hey John…can well understand your concern!!! Naturally, you want to be pro active, and prevent problems from happening in the first place. I have a problem with Raynaud which causes fingers and toes to turn blue in cold climate, or when temperature take a sudden drop without necessarily being extremely cold. As well, I have bunoins…which cause rednesss in the joint of my big toes. I check my feet daily because I also have some numbness…and try not to panic. Here too, I can’t help but wonder if I’m seen as a bit of a hypochondriac!!! The bottom line is…better be safe than sorry & keep checking those tootsies!
Take care…linda.

I was expecting to be gone in five or six years before the diabetes diagnosis. Diabetes is not the reason at all. It goes way beyond that and came around before the dx.

Today I can barely walk when I have to use my toes. I can “flat foot” :slight_smile: it all around, but no bending of any toes. The joints and the balls of my feet feel like I am walking on crushed stone. Just sitting with them up, wiggling them, and with the heater on them, and a blanket to keep them warm.Not too close, not too hot.

I have many more problems than diabetes, as do so many of us, and I will not turn this into a complaint session. The truth is, the few people I have told about my dx, have all felt badly, but I honestly told them that diabetes is the very least of my problems. I figured that with my numbers, it would not really be a major health issue in the time I plan to stay around, but now that things are on my mind about my feet and who knows what else, its just one more stone on the pile.

I have been walking every day for exercise for over ten years, but I suppose anything is possible, but its an odd time for things to start to go wrong, and be causing such discomfort.

I think the worst part is the outrageous amount of money I am going to have to pay, to find out why I can’t walk anymore. That probably bothers me more than any complications that may or may not arise. I guess I really just don’t want to be alive anymore. Too much pain, to much stress, to many issues I can’t deal with on my own anymore. Christmas doesn’t help much :slight_smile:

I appreciate everyone’s kind words and advice.

onward and upward to more important problems folks.

Thanks,

John

Am sorry to hear of your multiple problems. That’s more than enough to deal with without financial worries on top of it all. Depressing for sure. The holidays don’t help, the dark cold weather doesn’t help either. I’m coming back in my next life as a bear so I can hibernate through winter!

Won’t cure you, but I soak my feet in a tub of hot water & Epsom salts. The magnesium in the salts is soothing to hurty feet. You can get Epsom salts at any drug store–cheap.

Thanks Gerri :slight_smile:

I assure you, I will not come back :slight_smile: Whatever comes next, has to be better than this, simply because nothing could be worse.

I remember not that long ago, when I loved the winter, and loathed the summer. I always said I hibernated July and August, and did my best work in the colder months. A wise person once said that if life worked out the way we wanted it to, there would be no sense living it in the first place.

John

I saw a bathroom scale with a mirror (at a slight angle) below a clear top so you could look at the bottom of your feet to do a regular review of any changes. (cuts , blisters etc.)

Seems like a good way to get in a routine.