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Mistle Toes

Christmas is coming which, besides Santa, hearkens the arrival Old Man Winter. Winter can be especially hard on the feet of people with diabetes. So, if you want to stay on the right side of your Chiropodist’s naughty and nice list, here are four tips for people with diabetes to help keep their feet healthy for the winter season.

1. Moisturize. Diabetics are already prone to dry skin, and the low humidity of our northern winter climate makes the problem worse. Dry skin cracks easily, which can lead to skin ulceration or serious infections. Your Chiropodist can provide a proper moisturizer meant for the thick skin of your feet, regular wax bath therapy, and other treatments to combat the problem.
2. Proper winter footwear is essential. It needs to fit correctly, be in good repair, and be suited to your foot type. Poor footwear creates friction points that can lead to skin breakdown and ulcers for people with diabetes. It’s best to shop for your winter boots (or any footwear) later in the afternoon, since your feet swell during the day. If you wear orthotics, be sure to bring them with you for sizing. Your Chiropodist can provide unbiased advice and a prescription to help you shop for what will be best for you.
3. Remember the “wear” part of “winter footwear!” Those fantastic winter boots do you no good if they’re not on your feet. Many people with diabetes suffer from a lack of feeling called neuropathy. This puts them at real danger of frost-bite that can happen without them even knowing it. Also, neuropathy can make people more prone to falling. The warmth and extra traction of winter footwear helps guard against both of these concerns.
4. Just as in any season, regular visits to their Chiropodist are essential for people with diabetes to maintain good foot health and to keep their feet merry all year long.

Web Feet is a quarterly blog posted by Registered Chiropodist David Murphy. Dave has ten years’ experience in his field and works at Kawartha Total Foot Care Centre’s main clinic in Bobcaygeon, Ontario as well as the practice’s sites at Lakefield Physiotherapy & Foot Health Clinic and the Curve Lake First Nation Health Centre.

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Web Feet is a quarterly blog posted by Registered Chiropodist David Murphy. Dave has ten years’ experience in his field and works at Kawartha Total Foot Care Centre’s main clinic in Bobcaygeon, Ontario as well as the practice’s sites at Lakefield Physiotherapy & Foot Health Clinic and the Curve Lake First Nation Health Centre.

There’s a moment of wonder for every chiropodist before reaching into a patient’s shoes at what discoveries might be revealed. From pennies to pins and everything in between, I’ve seen my share of “shoe treasures” over the years. The sheer oddness of some of them may bring a smile to one’s face, but for people with diabetes and diminished sensation caused by peripheral neuropathy, the result can be anything but amusing – skin ulcers, serious infections, even amputations.

Here are a few examples of some shoe finds this year, and they make clear just how important it is for people with reduced sensation to check the insides of their footwear regularly.

1. Tacky Tricks
Shortly into back-to-school season, I removed the insole of one particular teacher’s shoes to reveal a bevy of thumb tacks! Unbeknownst to her, it seems she was the subject of some classroom pranksters. This “joke” could have become decidedly not funny very quickly had the tacks remained undiscovered.

2. Ho, Ho, Hold on a Minute!
The holidays are such a wonderful time full of tradition. Last season, a patient visited me shortly after the family’s annual Christmas tree cutting adventure. Just as he finished telling me that his work boots are the most comfortable boots he has ever owned, I reached in and pulled out a branch with an entire clump of pine needles that would rival any of Charlie Brown’s Christmas trees. Needless to say we went on to further sensation testing.

3. One Piña Colada Please… Hold the Cocktail Umbrella
A patient returned last winter from some fun in the sun with what I thought was a sliver embedded in his sole, perhaps picked up on a long walk on the beach. On closer examination of his deck shoes, I realized that I was right about the sliver but wrong about its origin. It was from an umbrella – a cocktail umbrella to be precise. Perhaps the next time the customs agent asks you to remove your footwear on return from your favorite all-inclusive winter destination you may also want to use this opportunity to check the insides of your shoes for unwanted stowaways!

4. Dog Gone It!
Attention pet owners… knick, knack, paddy whack give a dog a bone? This four legged member of the family used its owner’s shoe as a cozy hiding spot for a favourite bone. Unfortunately for the pet owner who was unaware of what was hiding in his Hush Puppies, the shards of fragmented bone had caused a severe infection by the time I discovered them.

5. Automatic Toe-nition
My last recollection is one that was quite remarkable and humorous to everyone involved… initially. This particular patient could not understand why on earth he could still start his car (push button ignition) when his keys had been missing for days, even leaving him to wonder perhaps about artificial intelligence or some sort of electromagnetic disturbance. He had even involved his mechanic who was also very puzzled. It was only when his wife noticed the bleeding in his socks that she checked his shoes and the mystery was solved. There they were – his full set of keys pushed into the end of his shoe. The patient was completely unaware, felt nothing, not even the bottle opener also attached to his key collection. The sad ending to this story is that complications developed and progressed to the point that his great toe required amputation.

These examples illustrate the severity and potentially life-changing impact of neuropathy. It’s something we see and treat regularly at Kawartha Total Foot Care Centre.

Know the Warning Signs and Your Risks for Neuropathy

Neuropathy can range from a mild tingling or a “pins and needles sensation,” to sharp stabbing pain, and complete numbness. This occurs when the nerves in the feet that supply the brain with sensory information are damaged. Neuropathy can result from a variety of factors such as chemical toxicity, alcoholism, and chemotherapy. However, the most common cause by far of neuropathy and neuropathic changes in feet is diabetes.

In diabetics, the neuropathic changes are caused by the fluctuating blood sugar levels. The inconsistent blood sugar levels, over time, erode the insulating layers that cover the nerves, leading to altered or complete loss of sensation.

Prevention is the Best Medicine

Don’t let a nail in your shoe be the wake-up call to give your neuropathy proper consideration.

1. If you have been previously diagnosed with neuropathy, are diabetic, or have a family history of diabetes, it’s critical to have your feet examined and cared for regularly by a Registered Chiropodist. This assessment should include a full clinical vascular and neurological exam, dermatological exam, biomechanical evaluation, and a footwear assessment, along with ongoing foot medical care.

2. If you are a diabetic, controlling your blood sugar is crucial, having a healthy balanced diet and active lifestyle is a necessity, and getting enough restful sleep is essential in preventing or delaying neuropathic changes.

3. Self Examinations – use your hand and a mirror to check your feet as well as the inside of your footwear daily. This will become habitual and will likely prevent any close calls from becoming a more serious matter later on.

4. For those individuals who have diabetes and/or neuropathy and find their symptoms progressing or find they are having a big impact on daily life, then certain medications may provide benefit. Be sure to measure your blood sugar regularly – you can’t manage what you don’t measure! Bring these results to your family doctors and/or endocrinologist regularly and work with them to manage your condition.

5. At Kawartha Total Foot Care Centre, we have had success with weekly infrared light therapy sessions. This form of treatment helps treat the symptoms of neuropathy and although results are very specific to the individual, it may be the difference between keeping up with your normal daily activities or not.

My earlier stories might be a dose of lighthearted humour, but I know first-hand that neuropathy is no laughing matter. Remember that while we may not be able to reverse nerve damage, chiropodists can certainly help patients to better manage symptoms, prevent impacts from neuropathic foot changes, and improve quality of life.

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