Ignoring foot care dangerous

Ignoring foot care dangerous

With the percentage of diabetics approaching 10 per cent of the population, front-line health-care providers conducting physical examinations should make a point of asking their patients to remove their shoes and socks, advises Tony Choi, a Sudbury-based chiropodist.

Neuropathy in the lower extremities, one of the most common complications of diabetes, can have dire consequences, from ulcers and fissures to fungal nails, gangrene and amputation.

Choi, who runs the Algonquin Foot Clinic with his chiropodist wife, Devon Jahnke, estimates that half of his patients are diabetics.

Because their feet are often insensate, diabetics may ignore calluses and corns caused by ill-fitting footwear.

“If a callus or a corn isn’t treated, it becomes so thick that it can break down the tissue underneath and cause an ulcer on the bottom of the foot,” said Choi. “An ulcer is definitely something you want to prevent from occurring because it creates an opening for infection.”

People experiencing numbness or tingling in their feet may not even bother bringing it to the attention of a physician, thinking it will go away.

“The symptom is subtle, so they let it go,” said Choi. “At first, it’s intermittent, but if they have it while they’re walking, that’s usually a sign that it’s not just nerve compression. It’s something more.”

Good blood glucose management and foot care can minimize the chances of complications, but if the patient lets things slide, a seemingly benign condition can quickly progress to infection, gangrene and amputation.

A pamphlet on foot care tips displayed in the waiting room at the Algonquin Foot Clinic warns diabetics against walking barefoot or in open-toed shoes or sandals, to avoid wearing tight stockings or high heels and to refrain from using razor blades or strong chemicals on corns or calluses. Applying hot water bottles or heating pads to the feet and bathing in hot water are also advised against.

“Diabetics shouldn’t be going barefoot because if they have neuropathy and there’s something there, they wouldn’t feel it,” said Choi.

Another reason for wearing shoes and socks is that diabetics produce less sweat, so their skin tends to be dry. That, in turn, leads to fissures in the heel area and the need for moisturizers.

“By going barefoot, you’re exposing your feet to an environment that isn’t conducive to hydration,” said Jahnke. “Wearing shoes and socks protects the feet from drying out.”
Fungal nails are another problem diabetics have to deal with.

“Diabetics are more prone to getting infections and don’t fight them off as well because their immune systems aren’t functioning at peak efficiency,” explained Choi.

A diabetic can stub his toe on the coffee table and not even be aware of trauma to the nail.

“That can cause the nail plate to lift up and can allow bacteria, fungi and yeast to get inside and use the toenail as a host environment,” said Jahnke.

Fungal nails can be as much as an inch thick and are treated by mechanical debridement. Anti-fungals can also be effective, but can’t be prescribed in some cases because of side effects. Topical medications, said Choi, don’t work very well.

Diabetics are also susceptible to another condition called Charcot foot. Caused by a sudden trauma or even minor repetitive trauma, Charcot foot results in a sudden softening and fracture of the bones causing the foot to lose its shape.

“The foot can look like someone has run over it with a tractor trailer,” said Jahnke. “It’s like a loose bag of bones.”

Choi and Jahnke treat the condition by immobilizing the foot in an air cast and cooling it using ice tape. Left untreated for too long, Charcot foot can lead to amputation.

Both Choi and Jahnke are graduates of George Brown College’s chiropody program, now offered by the Michener Institute for Applied Health Sciences in Toronto. Choi is also a graduate of the New York College of Podiatric Medicine.

Like most health-care professionals, there is a shortage of chiropodists in Canada and especially in Northern Ontario, said Choi.

The Algonquin Foot Clinic attracts patients from as far away as Wawa, Hearst, Kapuskasing, Manitoulin Island and Parry Sound.

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