Dr. Ronald Lepow (320x240)
Dr. Ronald Lepow, assistant professor of orthopedic surgery at Baylor

Identifying and addressing foot problems as a result of diabetes should be a priority for diabetics. A podiatrist with Baylor College of Medicine outlines the types of foot issues that can be encountered and how they can be treated.

“Diabetes is a multisystem disease, and the circulation in the feet and legs may be diminished because there are problems with blood vessels that get narrowed or clogged as a result of the diabetes,” said Dr. Ronald Lepow, assistant professor of orthopedic surgery at Baylor. “A major cause of foot problems in diabetics is lack of blood flow.”

A common foot issue in diabetics is that pressure areas, such as calloused or injured areas, do not heal as rapidly due to poor circulation as they would in a person who is not diabetic, Lepow said. This can lead to ulcerations or a variety of infections in these traumatized areas.

Dry skin on the feet is a common dermatological issue that diabetics can face. Oil and moisture to the skin is affected by nerve damage, resulting in dry and cracking skin.

It’s important for diabetics to have regular visits with their family physician as well as their podiatric physician when needed, he said. A podiatrist can ensure that they are wearing the right types of shoes and socks and quickly address more serious diabetes-related foot injuries. Often, a physician who specializes in vascular issues is consulted to determine the level of vascular impairment.

Lepow said that diabetics should wash and dry their feet well and inspect them every day after bathing. He said to look for scratches, blisters, injuries, cuts and bruises. Dry skin on the feet should be addressed using a cream that is at least 20 to 40 percent urea based, because it loosens the dry skin. While dry skin may not seem like a serious issue, it can crack, allowing bacteria to get in and cause more serious complications such as infections or ulcers.

A podiatrist also can help determine the best type of shoes for a diabetic patient. These shoes have some structural characteristics that those in retail stores do not, including a wider and deeper toe box that allows the toes to move around unencumbered and cuts down on friction and pressure. They also have a solid sole in them and cushioning in areas that store-bought shoes usually do not have. Podiatrists also can recommend different types of custom shoe inserts.

Lepow recommends wearing socks that do not cause any friction or pressure, such as cotton socks. For those who have excessive sweating in their feet, he recommends moisture wicking socks. Thicker socks should be worn in the winter.

To treat an ulcer on the foot, a podiatrist will take all precautions to ensure there is no pressure in the area of the ulcer. This can mean wearing an orthotic, special shoe or even a boot during the time the ulcer is treated. It also is important to take immediate steps to heal the ulcer using topical treatments. If that is unsuccessful, a comprehensive vascular exam can help determine whether the problem is more upstream.

For those who suffer diabetic neuropathy, meaning they lose feeling in their feet or have burning, sharp pain or stinging in their feet, there are medications available to help address this.

Lepow also recommends to look into the resources that Medicare offers for regular appointments with a podiatrist and financial help for appropriate shoes.