Suffer from Diabetes? Take care of your feet...

Posted on: Rapid City Journal

If your feet are talking to you after a long day on them, count yourself lucky.

Jenice Casey and the millions of other diabetics who suffer from peripheral neuropathy of the feet can’t feel their feet. That lack of nerve sensation too often causes wounds that can lead to amputation of the foot or leg.

Diabetes is the leading cause of non-traumatic limb amputation in the U.S., says Dr. Rylan Johnson, a Rapid City podiatrist and surgeon who offers a free class about diabetes foot care through Regional Medical Clinic Endocrinology and Diabetes Education.

“It happens all too frequently,” Johnson said.  As diabetes reaches epidemic levels in America, the disease’s foot complications increase as well, Johnson said. Not all diabetics experience neuropathy, however. The problem can develop quickly or slowly and it can vary from patient to patient from some loss of sensation to total numbness.

He encourages diabetics to establish their risk for foot problems with an initial diabetic foot screening, which tests for light touch sensation that a healthy foot can feel, but a person with neuropathy cannot.

“Pain is the driving factor for most foot patients. Diabetic patients don’t have that pain. They don’t have a pain threshold,”Johnson said. “And when you can’t feel your toes, even trimming a toenail can be a dangerous endeavor.”

When feet can’t communicate pain, people will develop tissue breakdown because of the constant pressure of walking and standing on them that quickly turns into an open wound, particularly in diabetics. High or uncontrolled blood sugar levels inhibit the body’s natural capacity to heal itself, Johnson said.

“A diabetic will literally just wear a hole in their foot,” he said.  That’s what happened to Casey before she even knew she had an open wound on the bottom of her foot.

The 59-year-old pharmacy technician at Rapid City Regional Hospital was diagnosed with type 2 diabetes 27 years ago. The disease runs in her family, also affecting five of her six siblings, as well as her mother, grandmother, great-grandmother and plenty of aunts and uncles.

She has struggled to manage her blood sugar levels at optimal levels over the years — at first with diet, then oral medication and, more recently, daily insulin injections. Two years ago, she developed one of the most common complications of her disease: foot numbness.

“You feel unbalanced, especially in the middle of the night when you get out of bed … like you’re walking on a sponge or something. You just can’t feel balanced,” Casey said, describing peripheral neuropathy. Casey first learned of the condition during a regular checkup. A small black spot on the bottom of her big toe, once it was debrided, turned out to be an open wound about the size of a pencil eraser.

“I was in and out of a boot for the next six or seven months,”Casey said of the effort to heal that wound.  Treatment options include wearing a diabetic boot and shoe inserts that take pressure off the wound area, but that also can lead to new pressure points developing on other parts of the foot.  Casey’s foot finally healed in two weeks after Johnson put her in a total contact cast — a hard fiberglass cast that takes all the pressure off the wound area.

A similar problem developed on her other foot shortly after Casey missed one of her regular exams because of illness.  “I missed my last one and I almost caused a wound to start on my other foot,” she said.  Amputation is Casey’s worst fear, something she knows is all too real of a threat.

She’s back to a strict maintenance exam schedule every six weeks with a doctor, and she examines her own feet every morning when she steps out of the shower. She wears special shoe inserts to protect her feet and skips high-fashion footwear in favor of shoes that leave plenty of room to accommodate a hammertoe and other foot problems.

What’s important is keeping her feet healthy, she said.  When she told her daughter that one of her shoe purchases “look like grandma shoes,” her daughter said. “Well, you are a grandma, so I guess you can wear them.”

Diabetic foot neuropathy has changed more than her shoe fashion choices, however. She had to change jobs to avoid long days on her feet, and the once-avid volksmarcher has cut way back on the amount of walking and hiking she does.

“I love to walk and hike. That’s limited now,” Casey said.  But preventing a foot problem is much better than trying to heal one, Johnson said.

“Get your feet checked and understand if you are at risk,” he said. “You don’t want your introduction to diabetic foot care to be a wound.”

Please call the Foot, Ankle & Lower Leg Center office in Las Vegas anytime @702-878-2455 between Monday – Friday and we would be happy to set up an appointment for you.  Please visit our website @ FallCenter.com or www.walkwithdiabetes.com.   The Foot, Ankle & Lower Leg Center has Diagnostic imaging:  Digital X-Rays, Ultrasound or Advanced Imaging will be used to aid in the diagnosis.

Dr. Anthony Ricciardi at the Foot, Ankle & Lower Leg Center has completed training in endoscopic/minimally invasive surgery for chronic heel pain and nerve pain, foot and ankle joint replacement for restoring pain free motion, arthroscopic surgery, bunion surgery, fracture repair, flat foot correction, external fixation for complex deformities and extensive experience in peripheral nerve surgery including diabetic peripheral neuropathy and reconstructive surgery of previously failed foot surgical procedures.  In addition to his surgical training Dr. Ricciardi focuses on sports medicine of the foot and ankle through regenerative techniques using the patient’s own blood/platelets for healing chronic foot and ankle problems (pain) as a result of repetitive sport injuries.  This cutting edge technology enables patients to continue training with little or no down time.  Dr. Ricciardi continues to be active in teaching and training other podiatric surgeons on innovative surgical techniques in foot surgery.  Dr. Ricciardi is Board Certified by the American Board of Podiatric Surgery, a Fellow of the American College of Foot and Ankle Surgeons and Fellow of the Association of Extremity Nerve Surgeons.  Dr. Ricciardi’s vision is to bring each patient the most current state of the Art Technology and personalized treatment options to meet their Foot and Ankle needs (from conservative care to surgical options).  Dr. Ricciardi believes in quality service and puts his patients first!