Diabetic Foot Pain
by Kenneth B. Rehm, DPM Includes photo of Dr. Kenneth B. Rehm, DPM Diabetes is one of the most common reasons people seek relief for painful feet. With diabetes, four types of foot problems may arise in the feet. Nerve Problems due to Diabetes The most common contributor to diabetic foot pain is a nerve problem called Peripheral Neuropathy. This is where the nerves are directly affected by the disease process. There are basically three types of peripheral neuropathy: sensory, motor, and autonomic neuropathy. A large percentage of pain diabetic patients complain of is due to sensory neuropathy. This can show up as "sensitive pain," where the amount of pain is not proportional to the amount of insult that is causing it. For instance, just touching the skin or putting a sheet over your feet in bed could be painful. This can be present at the same time as numbness in the feet. Sensory neuropathy symptoms can include burning, tingling or a stabbing pain. Relief is foremost on someone's mind when painful neuropathy has raised its ugly head. The first thing to do is to check your blood sugar for the past several weeks to see if there has been a trend toward high blood sugar (Editor's Note: The A1c test is traditionally employed to determine this, and should be repeated about every three months.) Persistent high blood sugar can contribute to this type of pain. Massaging your feet with a diabetic foot cream, or using a foot roller, often takes the edge off the pain. Vitamin B preparations are often recommended; and there are a variety of prescription medications that do work. Using cushioned, supportive shoes and foot support inserts is always needed to protect the feet from the pounding, rubbing and irritating pressures that contribute to neuropathic pain. Motor neuropathy can Continue reading >>
Shoes And Orthotics For Diabetics
Proper footwear is an important part of an overall treatment program for people with diabetes, even for those in the earliest stages of the disease. If there is any evidence of neuropathy, or lack of sensation, wearing the right footwear is crucial. By working with a physician and a footwear professional, such as a certified pedorthist, many patients can prevent serious diabetic foot complications. Footwear for people with diabetes should achieve the following objectives: Relieve areas of excessive pressure. Any area where there is excessive pressure on the foot can lead to skin breakdown or ulcers. Footwear should help to relieve these high-pressure areas and therefore reduce the occurrence of related problems. Reduce shock and shear. A reduction in the overall amount of vertical pressure, or shock, on the bottom of the foot is desirable, as well as a reduction of horizontal movement of the foot within the shoe, or shear. Accommodate, stabilize and support deformities. Deformities resulting from conditions such as Charcot involvement, loss of fatty tissue, hammer toes and amputations must be accommodated. Many deformities need to be stabilized to relieve pain and avoid further destruction. In addition, some deformities may need to be controlled or supported to decrease progression of the deformity. Limit motion of joints. Limiting the motion of certain joints in the foot can often decrease inflammation, relieve pain, and result in a more stable and functional foot. If you are in the early stages of diabetes, and have no history of foot problems or any loss of sensation, a properly fitting shoe made of soft materials with a shock absorbing sole may be all that you need. It is also important for patients to learn how to select the right type of shoe in the right size, so Continue reading >>
Recovery & Support For Diabetic Foot Ulcers
Recovery & Support for Diabetic Foot Ulcers The information entered on this page will not be used to send unsolicited email, and will not be sold to a third party. Most people fully recover from a diabetic foot ulcer after the wound is cleaned and disinfected. To prevent new ulcers from forming, NYU Langone doctors recommend long- term use of custom orthotic shoe inserts to better align the bones of the foot and more evenly distribute the weight of the body during movement. This removes excess stress from the areas that are vulnerable to ulcers. Even after youve recovered from a foot ulcer, NYU Langone doctors strongly recommend maintaining a daily regimen of foot cleaning and inspection. This ensures that you notice any foot injury that could lead to an ulcer and get treatment before an infection occurs. Maintaining a healthy weight and quitting smoking can also help an ulcer heal more quickly. NYU Langone doctors encourage people with diabetes to inspect both feet every day for blisters, cuts, scratches, or ingrown toenails. Daily examination ensures that you or a doctor can administer the proper treatment before an infection develops. Without treatment, even a small blister can become an ulcer in a matter of days. Friction between the foot and a sneaker or shoe increases irritation and may worsen a wound. Foot ulcers often develop on the bottom of the foot, so doctors advise using a mirror to inspect that area. People with diabetes who are overweight have an increased risk of developing peripheral neuropathy and lower extremity artery disease . As a result, a foot ulcer or fracture may heal slowly or not at all. Dietitians and nutritionists at NYU Langones Weight Management Program can help you reach and maintain a healthy weight. If obesity makes it difficult to co Continue reading >>
Insoles: Diabetic And Arthritis Insoles
Excessive pressure on the diabetic footbrought on by an unyielding shoe insole, inadequate arch support, or a poorly fitted shoeoften results in ulceration and subsequent amputation. To keep feet properly supported and protected, its important to use insoles that offer total contact, support, and comfort. Insoles like the Duo/Laminate D-Sole , FREEDOM Trilaminate 1 Insole , and FREEDOM Full-Contact Insole utilize Plastazote or a similar material that has gained a reputation for use with the neuropathic foot and in managing the arthritic foot. These materials offer maximum cushioning and superior pressure distribution for the entire plantar surface. Incorporated heel cup and longitudinal arch combine for stabilization, support, and a comfortable fit. Add accommodations, such as scaphoid or met pads, for additional relief to high-pressure areas. Heat-mold for a customized fit. Save time and keep a pair inside each pair of shoes to keep feet protected. Diabetic Insoles like the Duo/Laminate Insoles , FREEDOM Trilaminate Insoles , and FREEDOM Full-Contact Insoles , utilize Plastazote or a similar material that has gained a reputation for use with the neuropathic foot and in managing the arthritic foot. These materials offer cushioning and pressure distribution for the entire plantar surface. These diabetic insoles incorporate a heel cup and longitudinal arch that combine for stabilization, support and a comfortable fit. In addition to these insoles, you can add other accommodations, such as scaphoid pads or metatarsal pads , for additional relief to high-pressure areas. All of these insoles can be heat molded for a customized fit. If you are looking to make your own customized diabetic insoles, we also have a diabetic orthosis kit of insole materials . Continue reading >>
Diabetes Information, Shoes & Arch Supports | Common Foot Problems
Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow sugar (glucose) to enter cells to produce energy. Type 2 diabetes, which is far more common, occurs when the body becomes resistant to the effects of insulin or doesnt make enough insulin. Various factors may contribute to type 1 diabetes, including genetics and exposure to certain viruses. Although type 1 diabetes typically appears during adolescence, it can develop at any age. Despite active research, type 1 diabetes has no cure, although it can be managed. With proper treatment, people who have type 1 diabetes can expect to live longer, healthier lives than in the past. Type 2 diabetes, once known as adult-onset or noninsulin-dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), your bodys main source of fuel. With type 2 diabetes, your body either resists the effects of insulin a hormone that regulates the movement of sugar into your cells or doesnt produce enough insulin to maintain a normal glucose level. Untreated, type 2 diabetes can be life-threatening. Theres no cure for type 2 diabetes, but you can manage or even prevent the condition. Start by eating well, exercising and maintaining a healthy weight. If diet and exercise arent enough to control your type 2 diabetes, you may need diabetes medications or insulin therapy to manage your blood sugar. Diabetes mellitus (DM) represents several diseases in which high blood glucose levels over time can damage the nerves, kidneys, eyes, and blood vessels. Diabetes can also decrease the bodys ability to fight infection. When diabetes is not well controlled, damage to the organs and impairmen Continue reading >>
Foot Support | Diabetes
An estimated 15 million Americans are affected by diabetes. At least half will need foot care and would benefit from shoe modifications or orthosis. Care of the diabetic foot offers the greatest challenge and probably the most significant achievement in pedorthic care. Management of the diabetic foot is the benchmark of pedorthic footwear in comprehensive medical care. As members of the team providing long-term treatment to the diabetic patient, the Practitioners at Foot Support play an important role in the care of the diabetic foot. First, we provide the necessary prescription footwear, including shoes, shoe modifications, and orthoses. We also assist patients with proper shoe selection and shoe fit, and maintain the required inventory to ensure that patients receive the type of shoes prescribed. The second part of the Practitioners role is in patient education. Practitioners at Foot Support are a valuable resource for instructing patients in all aspects of footwear: the purpose and proper use of the prescribed footwear, criteria for good fit, and appropriate shoe materials and styles for the diabetic foot. Foot Support Practitioners reinforce information other team members provide on foot inspection, hygiene procedures, and injury prevention. They also stress the need for follow-up so that the Practitioner can make necessary minor adjustments to the current footwear and determine whether changes in the prescription are needed as the patient's feet change. Third, Practitioners at Foot Support play an important role in monitoring progress of patients who come with a written prescription from their physician. The Practitioner serves as the link between the physician and the patient. On return visits, the Practitioner checks the performance of the prescription footwear Continue reading >>
Diabetic Insoles | Diabetic Foot Pain Relief |orthotic Shop
Propet Contour Pro - Diabetic Insoles - 3 Pair Propet Contour Pro - Insoles - Men's - Free Shipping. The Propet A5512 Diabetic Orthotic Inlay is specifically designed to offer diabetic patients comfort and safety in each step. This diabetic orthotic doesn't compress or collapse - it uses a high rebounding moldable polyurethane base for long-lasting diabetic foot protection. The top layer is made with Plastazote material and the base layer contains EZ Form Foam. The Propet A5512 Diabetic Orthotic Inlay is Sadmerc coded and is designed for quick and easy fitting so diabetic patients experience less sheer motion and friction inside their shoes. Synergy Liquid Orthotics - massaging insoles designed to re-balance, cushion massage and invigorate the foot with each step you take. Helps improve blood circulation as you walk. Satisfaction guaranteed. See size chart below. Archcrafters Delicate Custom Comfort Insoles - great for sensitive feet. Poron plastazote conforming topcover for shock absorption. Medium density for cushioning & arch support. $119.95 at the Orthotic Shop Continue reading >>
how Does Diabetes Affect My Foot?
The application of the diabetic foot care program is part of an integrated rehabilitation process--and you are the most important team member! The relationship with your orthotist/pedorthist is a lifelong commitment to your health, walking ability, independence and overall quality of life. Diabetes will affect your foot in three ways. How you care for your diabetes and manage your sugars will impact how soon these changes occur and the severity of the impact. If your sugar levels are always high, you may notice changes as soon as 10 years from your diagnosis. If your sugar levels are kept under control, these changes will occur very slowly. The Three Changes: Diabetes makes your nerves in your feet fall asleep. Nerves supply the tiny muscles inside your feet. When the nerves fall asleep, the foot muscles become weak. The nerves become weak and do not work, which can make your feet numb and you will not be able to feel the bottom of your feet. Your feet can change shape and develop curled or crooked toes, bony bumps, flatter feet or wider feet, and calluses. Nerves also supply the sweat glands to your feet. If the nerves fall asleep, your feet do not sweat and you get dry feet. Blood flow to your feet decreases. Diabetes decreases the amount of blood that flows to your feet. Blood brings food and oxygen to the feet. It also brings medicines to your feet. If you are taking medication for an infection, the full dose of the medicine may not reach your feet. If your blood flow is weakened, your skin can become thinner. This can cause you to get cuts or sores more readily. The decreased blood flow also slows down the healing process, which can cause long-term infections. Infections are harder to cure. Diabetes weakens your immune system and your ability to fight an infection. Continue reading >>
Diabetic Foot Problems
People with diabetes are at risk for foot problems. This handout explains why these problems occur and what you can do to protect your feet. Why are foot problems so common in people with diabetes? In people with diabetes, high blood glucose can cause two complications — both of which can result in foot problems. You may have one or both of these: Nerve damage (neuropathy). Nerve damage from high blood glucose usually begins in the hands and feet. It can cause painful symptoms — tingling, aching, or throbbing — but it can also reduce sensation. If you can’t really feel cold, heat, or pain in your feet, it’s easy to ignore an injury or infection. And unfortunately, in people with diabetes, even a small blister or stubbed toe can become serious. Poor circulation. High blood glucose can damage your blood vessels and reduce blood flow to your feet. This means that injuries take longer to heal. Over time, poor circulation in your feet can even change the shape of your feet and toes. This can cause problems with the way you walk. Are foot problems really that serious? In people with diabetes, yes — foot problems can be very serious. In the worst cases, they can lead to deformed feet, wounds that won’t heal, and serious infections that require surgery. In fact, diabetes-related foot problems are a leading reason for leg and foot amputations. Fortunately, good care can lower your chance of serious problems. You and your medical caregivers can work together to care for your feet. However, the most important things are those you do (and don’t do) on your own to protect your feet. Work with your diabetes care team To protect and treat your feet, take these steps with your doctor, diabetes educator, or other provider: Follow your diabetes treatment plan to control y Continue reading >>
Diabetic Foot | The Bmj
Satish Chandra Mishra, consultant surgeon and scientist 1 , 1Department of Surgery, Bhabha Atomic Research Centre Hospital, Mumbai, India 3Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India 4Global Health and Development Group, Imperial College London, St Marys Hospital, London, UK Correspondence to: A Mehndiratta abha{at}mail.harvard.edu Diabetic foot can be prevented with good glycaemic control, regular foot assessment, appropriate footwear, patient education, and early referral for pre-ulcerative lesions Examine the feet of people with diabetes for any lesions and screen for peripheral neuropathy and peripheral arterial disease, which can lead to injuries or ulceration Refer patients with foot ulceration and signs of infection, sepsis, or ischaemia immediately to a specialised diabetic foot centre for surgical care, revascularisation, and rehabilitation Foot disease affects nearly 6% of people with diabetes 1 and includes infection, ulceration, or destruction of tissues of the foot. 2 It can impair patients quality of life and affect social participation and livelihood. 3 Between 0.03% and 1.5% of patients with diabetic foot require an amputation. 4 Most amputations start with ulcers and can be prevented with good foot care and screening to assess the risk for foot complications. 5 We provide an update on the prevention and initial management of diabetic foot in primary care. This clinical update is based on recommendations in the standard treatment guideline, The diabetic foot: prevention and management in India 2016, published by the Indian Ministry of Health and Family Welfare. 33 A multidisciplinary guideline development group consisting of surgeons, primary care practitioners, and a patient representative developed these Continue reading >>
Diabetes - Foot Care
Diabetes can reduce blood circulation and damage the nerves to the feet. Ask your doctor to examine your feet regularly for any evidence of nerve damage or poor circulation. Foot problems can be avoided if you take care of your feet and act quickly if you have a problem. On this page: Foot care is particularly important if you have diabetes. Foot problems are a common complication of this condition. Your feet can be affected in two ways. Blood supply may be affected, resulting in slower healing. You may also lose some feeling in your feet due to nerve damage. A person whose nerves are damaged by diabetes may not realise they have minor cuts or blisters, which can lead to ulcers. Foot problems can be avoided if you take care of your feet and act quickly when you have a problem. Get your feet checked at least once a year by a doctor or podiatrist to detect problems early and help prevent complications. Circulation in people with diabetes Poor blood circulation can affect the blood supply to your feet. When this is reduced, cuts and sores may not heal. An early sign of poor circulation to the feet may be pain or cramps in the backs of your legs when walking. Circulation problems can be caused by hardening or narrowing of arteries as they become clogged up. Common causes include: smoking high blood fats raised blood glucose levels. How to improve circulation for people with diabetes Suggestions to improve your blood circulation include: Control your blood fat levels. Keep blood glucose levels as close to normal as possible. Don’t smoke. Smoking causes spasm and narrowing of blood vessels. Smokers have more heart attacks, strokes and circulation problems than non-smokers. Exercise daily. A brisk walk will help keep the blood flowing around your body. Foot care for people w Continue reading >>
Clinical Decision Support Software For Diabetic Foot Risk Stratification: Development And Formative Evaluation
Clinical decision support software for diabetic foot risk stratification: development and formative evaluation 1 David G. Glance ,2 and Sandra C. Thompson 3 1Western Australian Centre for Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, M706, 35 Stirling Highway, Crawley, 6009 WA Australia 2Director Centre for Software Practice, The University of Western Australia, M002, 35 Stirling Highway, Crawley, 6009 WA Australia 3Director Western Australian Centre for Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, M702, 35 Stirling Highway, Crawley, 6009 WA Australia 1Western Australian Centre for Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, M706, 35 Stirling Highway, Crawley, 6009 WA Australia 2Director Centre for Software Practice, The University of Western Australia, M002, 35 Stirling Highway, Crawley, 6009 WA Australia 3Director Western Australian Centre for Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, M702, 35 Stirling Highway, Crawley, 6009 WA Australia Deborah E. Schoen, Email: [email protected] . Received 2015 May 12; Accepted 2015 Nov 26. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated. This article has been ci Continue reading >>
Do I Need Diabetic Shoes?
Poorly controlled blood sugar can damage many parts of the body, including the nerves and vessels that go to the feet. Because of this, people with diabetes have an increased risk of developing foot problems. Wearing specially designed shoes can help reduce risk and promote healthy circulation in your feet. Read on to find out more about shoes designed for people with diabetes and whether you might need them. High blood sugar contributes to poor blood circulation. It can also damage nerves in your feet, a condition called neuropathy. Neuropathy can cause you to lose feeling in your feet, which may make it difficult for you to realize if you cut yourself or injure your foot. If you leave a cut untreated, it can lead to an infection. Poor circulation can make it difficult to heal cuts and infections. Diabetic foot pain and ulcers: Causes and treatments » You might develop open sores on your toes or the bottom of your feet. You may also develop calluses, or thick areas of hardened skin. The following are all more likely to occur in people with diabetes: bunions corns fungal infections gangrene Nerve damage can also change the shape of your feet. People with diabetes are more likely to develop hammertoe, which is a deformity that causes the toe joints to bend inward. Even foot problems that might seem insignificant, like blisters or athlete’s foot, can be a cause of concern if you have diabetes. Because of poor circulation to the area, any foot problem will take longer to heal and may instead compound and grow into a dangerous infection that can progress and lead to amputations if not correctly treated. That’s why any foot issues should be called to the attention of your doctor if you have diabetes. Foot injuries and changes to the foot’s shape can make your regular Continue reading >>
The Effect Of Removing Plugs And Adding Arch Support To Foam Based Insoles On Plantar Pressures In People With Diabetic Peripheral Neuropathy
The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy Lin et al.; licensee BioMed Central Ltd.2013 Removable plug insoles appear to be beneficial for patients with diabetic neuropathic feet to offload local plantar pressure. However, quantitative evidence of pressure reduction by means of plug removal is limited. The value of additional insole accessories, such as arch additions, has not been tested. The purpose of this study was to evaluate the effect of removing plugs from foam based insoles, and subsequently adding extra arch support, on plantar pressures. In-shoe plantar pressure measurements were performed on 26 patients with diabetic neuropathic feet at a baseline condition, in order to identify the forefoot region with the highest mean peak pressure (MPP). This was defined as the region of interest (ROI) for plug removal.The primary outcome was measurement of MPP using the pedar system in the baseline and another three insole conditions (pre-plug removal, post-plug removal, and post-plug removal plus arch support). Among the 26 ROIs, a significant reduction in MPP (32.3%, P<0.001) was found after removing the insole plugs. With an arch support added, the pressure was further reduced (9.5%, P<0.001). There were no significant differences in MPP at non-ROIs between pre- and post-plug removal conditions. These findings suggest that forefoot plantar pressure can be reduced by removing plugs and adding arch support to foam-based insoles. This style of insole may therefore be clinically useful in managing patients with diabetic peripheral neuropathy. Plantar ulceration is a crucial issue in diabetic populations as it frequently leads to subsequent infection and amputation of the lo Continue reading >>
The Best Shoes For People With Diabetes
Two complications people with diabetes may be at risk for are poor circulation and the absence of sensation, according to John Giurini, DPM, Chief, Division of Podiatry at Beth Israel Deaconess Medical Center . (Beth Israel Deaconess Medical Center is an affiliate of the Joslin Diabetes Center). People with these diabetes complications may not be aware of whether or nottheir shoes fit correctly, so their feet must be properly measured and fitted before purchasing shoes. Have feet measured periodically, because feet change over time. Shop later in the day, because feet swell throughout the day, especially if you have heart disease and kidney problems. Have shoes fitted with the socks youll be wearing with those specific shoes. That way youll know they will fit properly. The distance between your longest toe and the tip of the shoe should be of your thumbs width, so you have the right amount of space to fit your feet. When you buy a new pair of shoes, break them in before wearing them for a long period of time. Wear them for one to two hours, then check your feet for any cuts or blisters. Wear them three to four hours the next day, and so on, until they feel comfortable, Giurini says. Important Shoe Features for People with Diabetes Shoes should be made of soft leather, because they can stretch. Choose a cushioned sole over a thin, leather sole, because the shock absorption is better. The back of the shoe should not collapse to one side or the other, because it wont provide good support. Choose laced shoes over loafers, so they fit better and provide better support. People with diabetes and specific foot deformities should buy shoes that match the width of their foot, perhaps with extra depth. Those with diabetes and severe foot deformities can get a custom molded shoe m Continue reading >>
