Should I have Elective Surgery if I have Diabetes?

It is well known that diabetics are at risk for poor wound healing and infections. This leads many doctors and patients lean away from surgery. Some surgeries are necessary and can be debated, but other surgeries are elective and not life threatening. In Diabetics, there is a strong trend towards conservative care and surgery is nearly taken off the table for these patients. Can you have a safe surgery as a diabetic?

Diabetes is a disease that slowly affects the entire body. Diabetics have decreased blood flow, decreased sensation, and a compromised immune system. These problems do not happen overnight. but rather progress in relation to the blood glucose levels. The higher the blood sugars, the faster the disease progresses and the greater the damage it causes on the body.

Having surgery creates a wound and damages the surrounding tissues. During the recovery time, your body is trying to heal the damage the surgery has created including the wound in the skin. With decreased blood supply, a diabetic has a more difficult time heeling. Blood carries the necessary nutrients t and tools to promote wound healing.

It is very important for your body sense pain. After surgery, your body needs rest and time to recover. Nerves send important information from the surgical site to the brain to help guide the healing process. Diabetics suffer from neuropathy. The high blood sugar damages the nerves and alters a diabetic’s ability to sense pain.

There has been much research on the risks and benefits for diabetics to have elective surgery procedures. Research shows that the incidence of complication in elective foot and ankle surgery is less than 5%. In Diabetics the complication rate is about 13%. Further research has shown that uncomplicated diabetics, or those without neuropathy or peripheral vascular disease has an insignificant increase in risk.

If you are considering surgery and you are a diabetic, it is important to have a full work up. You should have a test done to check the blood flow in the legs. PVD, or peripheral vascular disease, is very common in the diabetic population and in the elderly. This can severely effect your ability to heel. Tests can also be done to determine your sensation lost. If you are area healthy diabetic with well controlled blood sugars with no other medical complication, surgery may still be an option for you.

Sock It To You!

The Perfect Sock

We use them almost every day. They come in all different forms and sizes and some even come with bells and bows. What am I talking about? Your socks! Do you ever wonder if your socks are feet friendly? Believe it or not but socks made out of the wrong fabric or that are poorly made may worsen some common foot conditions.

The American Podiatric Medical Association (APMA) recommends the following when shopping for socks:

Purchase a sock made of a polysynthetic blend. This material will best wick away moisture from the foot, which can prevent blister formation and irritation.

Avoid socks with large seams at the toe or in other areas. Those with diabetes or decreased circulation, who have an increased chance of developing irritation and blistering of the foot skin, should seek out seamless socks whenever possible.

Choose thickness of sock material based on personal preference and comfort.

Evaluate each sock’s fit, making sure that there is no loose fabric around toes or heels.

Conversely, socks that are too tight can decrease circulation and comfort.

If you suffer from sweaty feet also known as hyperhydrosis, it is especially important to buy the correct socks. You may think 100% cotton is the best way to go but a blend of cotton with other natural materials will do a better job of wicking away moisture. Choosing the right sock will keep your feet dryer and less stinky. Maybe you will think again when buying your husband’s socks!
Noticing the importance of choosing the right socks, the APMA recently recognized and gave the seal of acceptance to two new sock products. Injinji Footwear Performance Series Tetratsok has a patented anatomical, five toe-design that separates toes with an anti-friction seamless membrane. The sock is made out of a combination of coolmax wicking fiber, and a durable shell cover of nylon and lycra. This helps protect the foot from slipping and sliding in your shoe.
The Takeda Legwear Big Toe R x L socks are designed specifically for the right and left feet. This allows for a snug and comfortable fit. BigToe R x L socks is also made from Coolmax fabric to keep moisture away from your skin.

They next time you buy socks, take a closer look at the materials. Slip them on and see how they fit. Are they snug? Can you feel the seams? Are there any knobs of fabric that are rubbing against your feet? Just as importantly are your shoes. If your shoes are too tight, it will exacerbate the effects of poor quality socks. Make sure your shoes are the right size and gives you room to wiggle your toes.

Diabetes and Foot Ulcers

There are over 23 million American with diabetes, and another 57 million with pre-diabetes. Many argue that diabetes is becoming an epidemic. As technology continues to advance the efficiency of our world, it also takes away the need for physical exertion. In order to get the exercise necessary to stay healthy, we have to “go work out.” Most of us are dropping the ball on this; and thus, America is gaining weight. This combined with fast food and fat filled diets are causing diabetes to be on a continual rise. Unfortunately, many underestimate the severity of the disease. Diabetes is a very serious condition that has many complications which includes blindness, cardiovascular disease, kidney failure, and foot ulcerations. These complications are acquired over time and greatly increase mortality rates. A person diagnosed with diabetes before the age of 40 will lose 15-20 years of their life!
Out of all of the complications linked to diabetes, the complication that causes the most hospitalizations is foot ulceration. Many of these ulcers may lead to amputations and this greatly increases the mortality rate. A person has a better chance of survival with colon or breast cancer than they do having a diabetic amputation. There are several reasons why diabetes has such strong effects on the feet; all of these complications combine into a formula for disaster if one does take proper measures to protect their feet and their health.
Causes foot ulcers 1o1
1) Macrovascular/Microvascular complications. Diabetes is the inability of the body to control blood glucose levels. The rise in blood glucose, or hyperglycemia, is when there is excess sugar in your blood stream. This can facilitate clot formation and increase your chance of heart attack and stroke, but more commonly leads to micro vascular complication that decreases your blood flow in small vessels and in your extremities. A decrease in blood supply in an area, such as the foot, makes it difficult for your body to keep those tissues healthy.
2) Foot deformities. The excess sugar in circulation can deposit in tissues and joints and lead to foot deformation. Diabetics may see changes in their foot structure or feel pain with motion. In very serious cases, the foot develops Charcot’s foot. In this instance, the bones in the foot are actually being destroyed. The deformity is often described as the foot becoming a” bag of bones.” These deformations change how forces are applied across the foot. Normally, when walking, weight is nearly evenly distributed across your foot, deformations cause increases in pressure at certain areas. This facilitates tissue break down
3) Peripheral Neuropathy. Neuropathy is the loss of nerve function. The nerves most commonly affected are sensory nerves. Over time, diabetics experience nerve damage due to the increased levels of sugar. Initially, this damage presents as tingling and burning but eventually leads to loss of feeling. Thus, diabetics lose the ability to feel pain, the body’s natural warning sign. It is very dangerous for diabetics to be unable to perceive a problem in the foot. For an example: If one steps on a piece of glass, they would be unaware and walk around on the glass all day.
Preventing Ulcers 101?
1) Controlling your blood sugar levels with diet and exercise is the best way to prevent all diabetic complications. When diet and exercise is not enough, there are medications that can assist your body in maintaining appropriate amounts of sugar in your blood.
2) Inspect your feet regularly. Look in-between your toes under and all around. Watch your feet for any changes in appearance, temperature, and feeling. Before or when changes are noted, contact a podiatric physician. A podiatric physician can help prevent and accommodate changes in your feet due to diabetes.
3) Avoid walking around barefoot, in sandals, or any other open shoes. This leaves your feet vulnerable to getting cuts, bruises, bumps, and infections.
Diabetes is a multisystem disease that can cause many complications. Foot ulcers are highly prevalent, but also highly preventable. It is important to consult your physician to help you control your blood sugar levels. Podiatric Physicians are foot specialist that have extensive training in diabetic feet and wound care. They will provide you with the best care to prevent foot ulcers and amputations, the leading cause of diabetic hospitalizations.

Mary Saved My Legs

Mary and Simon have been close friends throughout their entire lives. As children, they grew up next door to each other in an average suburb. They were very active children playing every sport imaginable and always supported one another through the years. As they grew older, their hobbies changed from running around the neighborhood to cooking, reading, and spending time with their families. Over time, their good lifestyle habits changed and both became slightly overweight. Still, Mary and Simon were the average Americans. Both had a slightly high cholesterol and blood pressure, but they were not obese nor did they feel their health was on a downhill spiral. At 55 years old, they both had large families, grandchildren and building up a good retirement plan.
Still living near one another, Mary and Simon met for lunch once a month. One day, Mary surprisingly ordered a salad rather than her typical burger and fries. Simon immediately asked what was going on! He didn’t even know a salad was on the menu! Mary had been diagnosed with type 2 diabetes a few weeks earlier and her doctor informed her that she could no longer live her life the way she has been. She needed to control her diet and get on an exercise plan. If she fallowed his direction, Mary could stay off medication and live a full life. With the encouragement from her family, Mary joined the YMCA and started walking the track and is even thinking about signing up for an aerobics class. Her, along with her husband bought a few new receipt books and started to adjust their meals to a diabetic friendly diet. As she was explaining the changes in her life, Simon chuckled to himself. “Mary, I have had diabetes for a year now. I take my pill everyday and things are just fine.” Mary was appalled! “Simon, you have to take care of yourself. Don’t you watch the news? Diabetes ruins people’s lives!” Mary continued to try to encourage Simon to join her work outs and to try some new receipts, but Simon always insisted that life was good and he was going to enjoy it.
Five years later, Mary and Simon met on some unusual circumstances. An old high school friend died of a heart attack at 61 years old. At the funeral, they talked for hours about how unfortunate it was for their friend to die at such a young age. They found out he had a plethora of health issues that stemmed down to Diabetes. He had both of his legs amputated less than a year before his death. Mary, still not on any medications, was quite healthy. She had an excellent diet and works out every day with her husband. They took up several new hobbies that keeps them active and pay close attention to what they eat. She told Simon she has never felt better in her entire life. She can play with her grandchildren and enjoys life to fullest. She can’t imagine what her life would be like if she did not listen to her doctor’s advice and had the support from her family to make those tough changes in her life. Simon looked at her in amazement and questioned, “You are still on NO medications. Nothing!”
By then, Simon was having trouble keeping his blood sugar under control. He had been putting on more weight and was recently put on insulin. He still had high cholesterol and blood pressure. He went on to tell Mary about how much pain he experiences in his feet. It is tingling, numbing and just unbearable. He had no idea that their recently deceased friend had diabetes, or that you could lose your legs from the disease. He was very jealous of Mary. She was so happy and was actually enjoying life. He has a real hard time playing with his grandchildren and his own children are always harping on him to take care of himself. He always said he wanted to enjoy life and do what he wanted and ate what he wanted. He looked at Mary and said, “I could be enjoying life so much more if I would have listened to you five years ago.”
Mary had been waiting for Simon to realize this. She gave him her primary care doctor’s name along with her daughter’s phone number who practiced podiatric medicine. Simon and Mary schedule for him and his wife to come work out with them and take diabetic cooking classes at the local community center. It took a Simon awhile to change his lifestyle, but years later, Simon wrote Mary a thank you letter.
Dear Mary,
I realized today that you saved my life. My brother just lost both of his legs. He was diagnosed with diabetes a few years after me and did exactly what I did when I was diagnosed. Ignored the illness. With your help, I was able to make changes in my life that saved my legs and my life. Though I should have made those changes with you years earlier, I realize now that it is never too late to get control of your life. I still have my legs and my life. I owe that to you.
Love Simon
Mary later found out that Simon had been suffering from diabetic neuropathy. When he first went to Mary’s daughter, the podiatric physician, he already had an ulcer on his right foot. With her wound care training and his dedication to improve his life, Simon now lives a near normal life. He no longer has any feeling in his feet, and therefore, he must be especially cautious with his feet and must pay close attention to any changes. Since his has been controlling his diabetes and got on the right track with his health, it is much more unlikely that Simon will ever lose his legs. He visits both his primary care doctor and podiatric physician on a regular basis and follows their orders. Mary and Simon are now 75 and are enjoying their families and their retirement.
If you or a loved one has diabetes, it is never too late to save your legs and your life. The changes that need to made are hard, but they are necessary. Look to others to help you and support you. Make a plan, write it down, and share it with your family. It is your future, and you deserve to experience it.

The Risk Associated with the Diabetic Foot

Diabetes, a disease where the body does not produce its own insulin (Type I) or where the body improperly uses its own insulin (Type II), results in increased blood sugar levels. Seven percent of Americans or 20.8 million people in this country are living with diabetes. This is a life-long disease that can severely affect the body’s major organ systems, particularly the feet and ankles.

Oftentimes, symptoms of diabetes such as numbness and tingling first appear in the feet. This is due to decreased sensation called neuropathy. Poor circulation and increased infection rates are common among diabetics and this combined with neuropathy is a recipe for disaster in the lower extremities. A diabetic ulcer usually comes from a simple corn, callus or blister. This occurs due to increased friction on a bony prominence such as a hammertoe or bunion. Ulcers and infections can also result from unknowingly stepping on a sharp object such as a piece of glass or needle while walking barefoot. One may only discover this occurrence after noticing blood or pus draining from their feet. Ulcerations can lead to a raging infection and ultimately loss of a toe or toes, part of the foot or even the leg or legs.

Another complication of diabetes is Charcot Joint, which is found in diabetics with neuropathy. Charcot causes a complete collapse of the joints in the foot most commonly in the mid-foot area leading to a permanent foot deformity known as rocker-bottom. Those with Charcot are also prone to ulcerations and amputations from this deformity.

Early detection and prevention are key factors in effectively dealing with the diabetic foot. A simple comprehensive foot exam by a local podiatrist at least once or twice a year can identify problems early and dramatically decrease the amputation rate. A podiatrist is frequently the first physician to identify the initial signs and symptoms of diabetes.

Management and prevention of diabetic complications is a team effort of physicians and a compliant patient. It is important for diabetics to check their feet every day, never walk barefoot, wear comfortable shoes that are not too tight and check shoes for any foreign objects. Feet, ankles and lower legs should be well moisturized. The skin on the bottom of the feet and especially heels are prone to dryness and cracking. A thick cream with at least a 10-20% urea moisturizing agent instead of plain lotion is best for this area as the skin is tougher and thicker on the soles of the feet. However, the area in between the toes should be kept dry. Fungus like warm, moist environments and fungal infections can occur with increased moisture in between the toes. Sock selection is also important. Seamless socks help prevent friction and skin irritation. White socks are preferred as any drainage or blood spots can become clearly visible immediately. Synthetic socks are also better at wicking away moisture keeping the area in between the toes dry. Those with thick fungal nails should have a podiatrist cut their toenails to prevent cuts and bruises that can ultimately lead to ulcers and amputations.

If you are diabetic and notice any changes in your feet or ankles such as bleeding, a callus, or ulcer, it is imperative that you seek treatment from your local podiatrist immediately to avoid a serious infection and possible amputation.

Diabetic Neuorpathy

Burning, tingling, and numbness in your toes and feet may be the first signs of diabetes. Peripheral neuropathy is a dysfunction of nerves and is commonly seen in the hands and feet. There are two types of nerves that may be affected: small nerve fibers, and large nerve fibers. Small nerve fiber damage will cause abnormal sensation and large nerve fiber damage leads to decreasing sensory perception and coordination. Damage to these nerves can be caused for several reasons, but the most common is diabetes. The progression of the neuropathy is highly dependent on the glucose levels in the blood, though the exact mechanism of damage is still unknown.

In uncontrolled or undetected diabetes, there are abnormally high levels of glucose or “sugar” in the blood. The abnormal levels of glucose causes multiple problems in your body including, eye, kidney, and cardiovascular damage. Often, the first problem noticed is the atypical sensations in the feet caused by peripheral neuropathy or nerve dysfunction. The symptoms are progressive and start at your toes and move up like a sock. Diabetic patients often complain of tingling, burning, numbness sensations, similar to the sensations a person feels when their foot “falls asleep.” Over time, the damage will lead to complete loss in sensation. This is the leading cause for diabetic foot ulcerations. A person with lost foot sensation still has motor (muscle) function and can continue to walk, but they are unable to detect sores or pain. Unknown sores on the feet combined with other diabetic complications leads to ulcers (open sores) and sometimes amputations.

To assess your peripheral nerve function, a podiatric physician can do several basic screening tests. While the patient’s eyes are closed, the podiatric physician uses several tools to test the small and large fiber nerves in the foot. Such tools consist of a Semmes Weinstein Monofilament (similar to fishing line), tuning fork, and a Q-tip. It is such a simple screen and takes only five minutes to perform, so, there is no excuse for diabetics or pre-diabetics not to get tested. Early detection of neuropathy can greatly decrease its progression and protect the feet from ulcers, infections, and even amputations.

Diabetes is one of the leading causes of death in the United States and the complications associated with the disease can greatly impede on a person’s quality of life. It is important to prevent and detect diabetes early to avoid and slow down the debilitating damage of the high glucose levels in the blood. Diabetes has a great effect on a person’s feet and often shows some of the first signs of diabetic complications. Thus, one with diabetes or diabetic risk factors should pay close attention to their feet and contact their podiatric physician.

Is Athlete's Feet Serious?

Most people do not worry if they have a little athlete's foot since they don't feel it is a serious problem. On the contrary, athlete's feet is serious and especially serious if you a diabetic. Athelete's foot is caused by a fungus and if left untreated can lead to a more serious bacterial infection.

The fungus in athlete's foot loves warm, dark and moist areas. So you are more likely to get an athlete's foot infection if your feet perspire excessively or if you are around wet areas like a swimming pool. In addition, it can be contracted in your home by other people and even your pets. The fungus can be picked up from infected skin that has shed onto floors, mats, bed linens, and other surgaces as well as by direct contact.

Athlete's foot causes small breaks in the skin that can allow bacteria to spread. This can lead to a very serious infection called cellulitis, which is an infection of the skin. Cellulitis spreads eaily to the lymph nodes and bloodstream. If left untreated, this condition can be life-threatening.

Athlete's foot can also lead to fungal infections of the toenails, which can be difficult to treat.

Mild cases of athlete's feet can be treated with over-the-counter remedies but if you are a diabetic you should see a podiatrist. Diabetics are more prone to infection and it is best to treat any foot problem immediately and appropriately. 25% of all hospital admissions for diabetics are foot related. More serious types of athlete's feet require stronger forms of treatment. The podiatrist can prescribe stronger anti-fungals and teach you how to prevent these problems from reoccuring.