Voice of the Diabetic

Voice of the Diabetic

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THE IMPORTANCE OF TREATING

DIABETIC FEET

by Kenneth B. Rehm, DPM

From the Editor: The U.S. Centers for Disease Control

tells us diabetes is the biggest producer of non-traumatic amputations in the

United States. Most of these will be amputations of severely infected, non-healing,

gangrenous feet and lower legs (86,000 in 1996, says CDC). Once things are that

bad, there are few other options-so the best course, for diabetics and their

health care providers, is prevention.

Dr. Rehm is a specialist in problems of the diabetic foot.

Lately, he has taken his knowledge of foot care, and used it to create several

foot-care products. But the core of any prevention program is patient education—so

let's see what Dr. Rehm has to tell us.

I've been in practice for over 20 years. I graduated from medical school in

1976. I devote my practice to diabetic foot medicine. In 1992, I took a diabetic

foot care fellowship at the Hansen's Disease ("leprosy") center in

Carville, Louisiana, and we established a diabetic clinic there under the direction

of Dr. Patout. People who have leprosy have neuropathy, much like diabetics

do. We also developed diabetic foot care programs throughout the Mississippi

Delta, to help people who didn't have access to regular medical care.

There's a very high diabetic population down in the deep South. We also did

a lot of work helping to develop the LEAP, the Lower Extremity Amputation Prevention

program, that helps people save their feet.

Since I've come back to the San Diego area, we've developed

our own version of the LEAP program here. When people come to see us, we have

a several-point program of education, foot inspection and examination. We focus

on the structure of the foot, the walking, the balance, the skin and the education

and inspection.

Many of our patients show diabetic peripheral neuropathy. The

patient's foot can be extremely painful, or numb, or both at the same time.

Neuropathy shows up in many different ways, as dry skin, toenail problems, loss

of sensation; it can show up as what we call hyperaesthesia, too much pain.

Sometimes you lose proprioception, the ability to tell where your foot is in

space. What's important about diabetic neuropathy is that if a non-diabetic

has a numb foot, he or she knows it has gone numb, but in a diabetic who has

severe peripheral neuropathy, the nerve pathway that tells you the foot is numb

can itself be numb, so a lot of people don't realize the foot surface is numb.

How does diabetes involve the feet? It involves the feet by

basically causing nerve problems, circulation problems, muscle and joint problems

and infection problems—and these cause other things: Numbness, burning,

dry skin, muscle weakness, calluses, cold feet... These in turn can cause orthopedic

problems, such as: Deformities, walking problems, hammer toes, high pressure

areas in the bottom of the foot where you get the big calluses under the metatarsal

areas, thus ulcerations and other skin problems. And dry skin is a common manifestation

of diabetes.

When a person has diabetes, the textbook says over 70% of foot

complications can be prevented, but I say virtually 100% of them can, if they're

caught early enough. This is the key thing! Almost all diabetic foot problems

can be prevented, if caught in time. And when you say "caught early enough,"

that means treating the problem when it happens, managing conditions like neuropathy,

rehabilitating people once they've had an injury or fracture.

PREVENTION IS THE BEST TREATMENT. The three things about prevention are very

important: Mental conditioning, overall physical conditioning, and to keep your

feet healthy. This last item includes several items, such as: Keep your feet

clean. Keep your feet warm. Keep your feet protected with the right shoes and

socks. Keep your feet SAFE — in other words, don't mow your lawn barefoot.

Keep your feet free of excess moisture. Keep your feet conditioned and free

from excess dryness. Keep your feet and toenails trimmed and healthy.

There are three more that I'd like to mention. Keep your feet

working with exercise. In other words, excess glucose, from your diabetes, can

build up in the joints and stiffen them. Keep your feet balanced when walking.

A lot of people need arch supports, orthotics, in their shoes, so their feet

don't wiggle all around, so they're not pronating, not putting sheering pressure

in the bottom of their feet, which could cause hot spots, abrasions, and the

possibility of ulcers. The last thing in the program is "keep your feet

in check." That means you check them and you ask your doctor to check them.

Diabetics should always have good shoes, and socks that fit properly, as well

as foot cream, toenail oil, and foot shampoo.

My final word of wisdom is to be proactive. If you take care

of your feet, you don't have to lose your feet or legs. Trouble doesn't have

to happen.

EDITOR'S NOTE: Dr. Rehm's clinic, The Diabetic Foot and

Wound Treatment Center, offers the following products he helped design. I've

sampled them; and found them of good quality. Contact: Dr. Kenneth B. Rehm,

The Diabetic Foot and Wound Treatment Center, 1529 Grand Avenue, Suite C, San

Marcos, CA 92069; (760) 744-6226 (office phone) or (760) 744-6277 (fax)

* DiabetiCream, $30.00 (plus S&H), for a 4-oz. tube. Apply

to clean, dry feet to help alleviate dryness and cracking. Use with massage

to help increase circulation.

* Dr. Rehm's Special Foot Soap, $12.00/bar (plus S&H). Hand-made

in small batches by the Maeda Family in Calexico, CA 92231

* ToesEase, ( foot and toenail cleaner) $20.00 (plus S&H)

for an 8-oz. supply

* The Diabetic Sock, $10/pair (plus S&H), distributed by:

Stillwater Knitting Co., P.O. Box 287 Mount Airy, N.C. 27030. Non-binding top,

extra width in calf, non-constricting, hand- knit seamless toe, antimicrobial

treatment. 94% cotton, 5% nylon, 1% spandex, Made in USA.

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