Keep your best foot forward


Diabetes is a new epidemic in America. The non-insulin dependent version is associated with obesity. Right now, two thirds of America would be considered overweight, and half of those are clinically obese. In Spalding County alone, about 12% of our citizens are already diabetic.  Look around next time you go shopping and think about it

There are many very bad effects of this disease, but perhaps the worst effect is on the microcirculation. Peripheral vascular disease and atherosclerosis advance very rapidly in the presence of diabetes. One of the first areas to be affected is the feet.  They are, after all, farthest away from your pump.

It is very easy to take your feet for granted. They not only hold your weight, but they must be capable of supporting more than your weight as you climb stairs, walk, run, or carry things through the day.  They are truly amazing structures.

I pleaded once with Ted, one of our patients who was diabetic, but in full denial of his disease, to take care of himself. When his right big toe turned black, I urged him to get to his doctor’s office immediately for help. He did not, maybe because and his stubborn mind, he really did not have diabetes at all. The next time I saw him, part of his foot was missing. Still stubborn, but inventive, Ted fashioned an artificial foot for himself in his shop. It was not properly padded and it caused serious erosion of the stump of his foot. The next time I saw him, Ted was on crutches without his right leg after and above the knee amputation. He did not live long after that.  It can be argued that stubbornness claimed him as much as the diabetes.

If you are diabetic, you must understand that care of your feet may mean the difference between not only walking or not walking, but life and death. Infections in the feet can spread very rapidly in diabetics whose immune systems are already compromised by the disease.

So, first, keep your diabetes in check. Do everything you can to keep your blood glucose as close to normal as possible. That means adherence to your diet, taking your medications faithfully, and stay in close contact with your health care provider.

Second, inspect your feet every day. It is convenient to do that every time you take a bath or shower because most of us do not wear shoes or socks while bathing.  Wash your feet carefully and dry them just as carefully before putting on socks.  Keep your toenails trimmed and filed so that you do not get ingrown or irritated nails that might cut adjacent toes. Avoid extremes of temperature as you bathe.  Remember that in diabetes, you may not feel an injury until it has already occurred.

Do not smoke. Stay away from anyone who does, because the secondhand smoke still may expose you to nicotine, which constricts blood vessels.

Stay active. Exercise will help keep your glucose under control as well as promote circulation to your extremities. Pay close attention to the quality of your shoes. If your arches or heels are painful or sore, custom orthotics may be a big help. Use thick, absorbent socks to absorb sweat and keep your feet dry.

Promoting circulation to your feet is of paramount importance. In your spare moments at work or in leisure time, make a habit of exercising your toes by moving them inside your shoes. This will help pump blood to and from your feet.

Those of you who know me understand my admiration for technology. I have an infrared sauna in the clinic that promotes circulation by the use of infrared light that releases nitric oxide in your tissues, and that substance dilates blood vessels to promote blood flow.  I now have a new miniature infrared sauna that is designed for your feet. It uses the same infrared wavelengths to promote blood flow and safely warm diabetic feet. I am excited about this technology for a couple of reasons. First, it is effective in promoting circulation in the feet (and hands, for that matter). Second, it is inexpensive, portable, and controlled by the patient – with no negative side effects.  We will start making these available to our patients with circulatory problems in the feet as a valuable preventive measure.

I expect peripheral vascular disease to become a larger problem in our overweight society. It is expensive to treat and easier to prevent.  Now that the insurance industry is in total collapse and chaos as a designed effect of Obamacare, self-care is more important than ever. So I say again – take care of your feet, or like Ted, you will not have a leg to stand on.

For this and other columns by Dr. Bob, visit


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