The usual advice is that along with your doctor, your team members are—or should be—a diabetes educator or nurse, a nutritionist, a podiatrist, and perhaps other specialties.
You need your feet to walk.
But why include a specialist on feet? For one thing, because during their lifetime about 15 percent of people with diabetes will develop an open wound or ulceration on a foot, according to the American Podiatric Medical Association. And 20 percent of these ulcerations will lead to amputations. The really sad thing is that you and your podiatrist can prevent most of these problems—if you have a podiatrist and go to him or her regularly. Some of the early warning signs of problems include ingrown toenails, toenail fungus, and aches and pains in your legs. But nearly one-third of a sample of 1,000 American respondents polled by Yankelovich Partners for the APMA said that they wouldn't seek professional medical treatment for these symptoms. The problem with feet is that you really need them for walking, which the APMA says is the best exercise for your feet. It also contributes to your general health by improving circulation, contributing to weight control, and promoting all-around well being. I decided some time ago that I had better love my feet if I were going to continue to take those hikes in the redwood forests near my home that I so enjoy and keep me in shape. That's why I see my podiatrist regularly and why I was so happy to be able to ask the president of the APMA about the most important things to do to take care of feet. The current APMA president is Terry Albright, DPM, who is also the president of the Scholl College of Podiatric Medicine in Chicago, one of the seven such colleges accredited by the Council on Podiatric Medical Education. In August Ronald S. Lepow, DPM, who is in private practice in Houston, will replace Dr. Albright as APMA president. Two things that Dr. Albright told me were recommendations that I'd heard of but hadn't been following myself. The first was not to cut into the corners when cutting toenails. I knew that was the best plan for people with neuropathy, but didn't realize that it applied to all of us. "The best strategy is for everybody to cut their toenails straight across," Dr. Albright says. "If the toenail is not laying straight on the toe it begins to form a curve. If you try to dig down in the corner you may leave a little piece of nail, which we call a nail spicule, As that grows out it could be like a needle and puncture the skin. People may not feel it, and with the normal bacteria on the skin they are at risk of developing an infection and possibly amputation. I've seen some horrendous toenail infections because of that spicule digging into the skin." The second was that everybody with diabetes should always wear shoes or slippers—even at home. I wondered if that was really necessary for people who don't have neuropathy. "Yes," Dr. Albright replies. "I have seen some cases of people walking around barefoot in the house. I've seen people who have animals in the house get animal hair that penetrates into the bottom of the foot and develops an abscess and infection." In addition, Dr. Albright stresses the importance of good fitting shoes. Also, socks that keep you warm, wick the perspiration away from your foot, and don't wrinkle are best. A good sock should have cotton in it along with wool for warmth and synthetic fiber for shape, he says. Much of what Dr. Albright says—and a lot more information—can be found on the APMA Web site. The key page for people with diabetes is Your Podiatric Physician Talks about Diabetes. But what if you don't have a podiatric physician? Here again, the answer is at the APMA's Web site. "The locator is the best part of the site," Dr. Albright maintains. "It is a service to the public and to our members. We have got a lot of acclaim because of it." The Member Locator lets you search for any of the association's members in your hometown. Dr. Glenn Gastwirth, the APMA's executive director says that the association includes 10,500 of the 12,000 to 13,000 American podiatrists in practice today.
The American Diabetes Association originally published this article on its Web site as one of my “About the Internet” columns.
As my podiatrist, Dr. Thomas O. Hyland, DPM, in Capitola, California, was cutting my toenails the other day, I mentioned to him that Dr. Albright said above, "The best strategy is for everybody to cut their toenails straight across." When I asked my podiatrist that, it was just as he was cutting back a corner of the toenail on my big toe.
Generally, Dr. Hyland agrees with Dr. Albright. But when your toenails are already as curved as mine, a podiatrist needs to cut back the corners, Dr. Hyland says.
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