1. Diabetes & Diabetic Foot Care Maria M. Buitrago, DPM, MS, FACFAS, FAENS

2. Diabetes Diabetes mellitus is a chronic disease that affects about 29.1 million Americans (~10% of the population) It causes your blood sugar levels to be higher than normal

3. Diabetes Diabetes Type 1 Body produces less or no insulin 5-10% Insulin Diabetes Type 2 Impairs the body’s ability to convert sugars, starches, and other foods into energy 90-95%

4. Diabetes Diabetes is the 7th leading cause of death by disease in the United States, 2010 2 out of 3 persons with diabetes die from complications from heart disease or stroke

6. Why are feet so important to those with diabetes? Nerves Circulation Immune System (ability to fight infection) Kidneys Eyes

7. Nerves Diabetes can damage the nerves in the feet – this is called peripheral neuropathy Affects about half of all persons with diabetes This can lead to a condition called “Charcot Foot”

8. Symptoms of Peripheral Neuropathy Numbness, pain, tingling or burning in the feet Pain at night Cramping

9. Peripheral Neuropathy The erosion with callus on the tip of the toe is typical of the type of injury which results with sensory neuropathy of diabetes

10. Charcot Foot Diabetic complication where because of diabetic motor and sensory neuropathy, you can develop multiple midfoot fractures. The result is a misshapen foot as seen here.

11. Circulation Diabetes can also affect circulation in the feet Poor circulation can affect the ability of the body to heal when damaged

12. Gangrene Form of necrosis that develops due to insufficient blood supply Usually the result of atherosclerosis of the arteries of the leg

13. Gangrene

14. Immune System Diabetics are also more prone to infection – the body’s immune system that normally fights infection responds slower Cellulitis – infection in the skin.

15. Kidney Disease Diabetes is the main cause of kidney failure in 44% of all new cases (2011) In 2011, 49,677 people of all ages began treatment for kidney failure due to diabetes

16. Kidney Disease In 2011, a total of 228,924 people of all ages with kidney failure due to diabetes were living on chronic dialysis or with a kidney transplant

17. Eye Disease In 2005–2008, of adults with diabetes aged 40 years or older, 4.2 million (28.5%) people had diabetic retinopathy, damage to the small blood vessels in the retina This may result in loss of vision

18. Amputations About 86,000 lower limbs are amputated annually due to complications from diabetes About 60% of non-traumatic lower-limb amputations among people aged 20 years or older occur in people with diagnosed diabetes

19. Amputations The key to amputation prevention Early recognition Regular foot exams, at least annually

20. Warning Signs Skin color changes Elevation in skin temperature Swelling of the foot or ankle Pain in the legs

21. Warning Signs Open sores on the feet Ingrown and fungal toenails Bleeding corns or calluses Dry cracks in the skin, especially around the heel

22. Diabetic Foot Care Wash your feet daily with lukewarm water and mild soap Inspect your feet and toes daily for cuts, bruises, sores or changes to the toenails Look after your health (loose weight, stop smoking, exercise and reduce alcohol consumption)

23. Diabetic Foot Care Cut your toenails straight across, never cut into corners, use an emery board Do not try to remove corns or calluses yourself and NEVER use commercial corn cures – they can burn the skin. Don’t go barefoot

24. Diabetic Shoe Gear Be properly measured and fitted for shoes Poorly fitted shoes are a common cause of problems in the foot Have your feet measured every time you buy new shoes (foot size and shape change over time)

25. Diabetic Shoe Gear New shoes should be comfortable when purchased and should not need to be “broken in” Shoes should fit both the length and width of the foot, with plenty of room for the toes

26. Diabetic Shoe Gear Avoid shoes with high heels, pointed toes or tight around the toes (these put too much pressure on the foot and can contribute to ulcers) Don’t wear anything that is too tight around the legs – this can constrict circulation to legs and feet

27. Diabetic Shoe Gear Don’t wear shoes without socks – could cause friction blisters Don’t wear sandals or other open-toed shoes – they don’t protect your feet Wear well padded white socks – when you take socks off you can see blood

28. Diabetic Shoe Gear Shop for new shoes at the end of the day because your feet swell Change socks and shoes every day. Have at least two pair of shoes so you can switch them every other day

29. Diabetic Shoe Gear Look inside your shoes every day for things like gravel or torn linings. These things could rub against your feet and cause blisters or sores

30. THANK YOU