A few weeks ago on Twitter, I saw a request from the Book Department of the American Diabetes Association for bloggers who might be interested in reading and reviewing books. As someone who enjoys reading and is always looking for blog topics, I jumped at the opportunity. Rather than being assigned a book, I was able to select the book(s) I wanted to review. I decided that I would opt for books that were a bit outside my comfort zone: books that rightly or wrongly I might not normally read. The books that I chose were provided to me free-of-charge, but my reviews, as always, are my own opinions.
My first selection was a short book by Neil M. Scheffler, DPM, FACFAS titled 21 Things You Need to Know About Diabetes and Your Feet.
Why did I pick this book? I chose it because I currently have no issues with my feet related to diabetes and I usually skip the chapter on foot care when reading diabetes books. By selecting this book, I wanted to force myself to read and learn everything that the podiatrist author deemed important. I also wanted to compare his recommendations to what is happening with my care team, my feet, and my diabetes.
Dr. Scheffler has written a concise guide to just about everything you need to know about having healthy feet and about the specific risks that those of us with diabetes face. Like every other discussion about diabetes and feet, he spells out the grim statistics on the first page and doesn’t take long to start talking about amputations. Fortunately he very quickly moves on to the good news as stated by the Center for Disease Control (CDC) that “comprehensive foot care programs, i.e., those that include risk assessment, foot-care education, and preventive therapy, treatment of foot problems, and referral to specialists, can reduce amputation rates by 45% to 85%.”
The “21 Things” referred to in the title are the 21 chapters of the book. Topics include the Diabetes Foot Care Team, Diabetic Neuropathy, Foot Ulcers, Shoes and Socks, and Emergencies. One thing that I particularly appreciated was the discussion that foot care requirements are not the same for everyone. Kind of a YDFMV (Your Diabetic Foot May Vary) attitude. (Thanks, Bennet of YDMV.) Although the author states that everyone should check their feet daily, he is quick to concede that a recently diagnosed Type 1 in her twenties probably does not have the same needs as someone who is a senior citizen with 20 years of diabetes and numbness in his feet.
So how do I measure up with the care of my feet which have carried me through 37 years of Type 1 Diabetes?
I’ll tell you the bad stuff first. By the third paragraph of Chapter 2, I’m already looking at a failing grade. Rather than an annual exam with a foot specialist, I have never seen a podiatrist in my life except for a free 5-minute exam at the ADA Expo in October. I wear sandals and thonged flip-flops frequently. Last year I didn’t go to the doctor for a bloody toe from an extended downhill climb in wet hiking boots. My endocrinologist does not check my feet.
Before you take me into custody for a foot intervention, let me explain myself. My feet have always been in good shape and the last time my endo saw them, she stated that she wished all of her patients had feet as well-cared for as mine. Although many endocrinologists check feet at every visit, the ADA Standards of Care only require an annual comprehensive foot exam that includes checking for pulses and sensation as well as a visual screening. For me that exam is performed at my annual physical by my internist and my endo questions me to ensure that it has been done.
I am fortunate to have no numbness in my feet. I can feel the tiniest grain of sand and quickly respond to shoes or socks causing irritation. I use moisturizing foot creams daily to prevent painful heel cracks. My flip-flops are thick-soled with good arch support and I only wear them at home (okay, also at the beach). I wear high-quality socks such as Thorlo and Smart Wool. When hiking I often put on dry socks at lunchtime and always wear gel protectors (they’re like toe socks) on my second toes to prevent the kind of injury I had last year. I am still agile enough to inspect my feet and clip my nails.
Believe me, I take foot care very seriously even though I don’t follow every rule. I accompanied my father-in-law to many podiatrist appointments for wound care of foot ulcers resulting from Type 2 diabetes and congestive heart failure. One of my friend’s husband with diabetes had a leg amputated a few years ago. I have heard Kelly’s story of her continuing battle to save her foot as she fights various tissue and bone infections. There are others in the DOC who struggle with balance and numbness in their feet.
I’m not stupid. This is serious stuff. Although Dr. Scheffler would wish that I saw a podiatrist, I think that he would approve of how I care for my feet, work on achieving good blood sugars, and very importantly, don’t smoke.
I am getting older and have had diabetes for a long time. Just because I have never had a podiatrist appointment in the past doesn’t mean that I never will in the future. In fact I probably will. And like everything with diabetes, what I do is not necessarily what you should do. Follow your good sense, the advice of your medical team, and take care of your feet.
If you would like to purchase this book or any other books in the American Diabetes Association Store, please go to this link: http://www.shopdiabetes.org/
Great post Laddie! I agree that foot requirements are not the same for everyone. Even though I have been down the “problem foot road,” I think having your internist do an annual check for pulses and sensation is enough for a lot of people. Even though I have neuropathy, my circulation is good and doctors say that is important for healing. The things that happened to me really had nothing to do with being diabetic so I certainly wouldn’t want to tell anyone they need to follow certain rules because they are diabetic. Like you said, be sensible about it.
Kelly, although I know that you’ve had some terrible medical care in your journey, I think you’ve also had the benefit of some of the new therapies to encourage healing of wounds. For all of us with diabetes, the statistics about the reduction in the numbers of lower limb amputations are encouraging. As always, you’re my hero:-)
Lucky girl with no foot problems! Mine started when I was a mere 32 years old, injured my hip and then wore flip flops all summer…it was the straw that broke the camel’s back and started my war with plantar fasciitis (and the PF seems to still be winning, after 8 years.) I can’t stress enough that everyone, regardless of diabetes, needs to wear shoes with good arch support, especially once you are out of the springy-body-of-your-20s. 🙂
I feel fortunate to have never gotten plantar fasciitis because it does seem that most people never get rid of it completely. Like you, I do insist on good arch support in shoes. Even my flip-flops, which are not the drugstore variety, have a good footbed. My sandals are also good brands like SAS, Ecco, etc. Sorry you still have to struggle with PF after so many years:-(
Great post Laddie… I’ll be looking for that book myself. And I’ve got to make that appointment with the podiatrist. Today.
I urge the same caution in selecting a podiatrist one uses to select an endocrinologist. Back in my early days of T1 (1967 forward) I saw a podiatrist annually at the insistence of my endocrinologists. I think it has become less standard than it used to be, yet probably no less necessary. So it’s a good idea, Laddie, to remind us all to “check in” with our feet and know a good podiatrist.
That said, I think podiatry is a bit different than most of the specialists we tend to see as T1s and would go so far as to recommend caution in selecting one. And remember that a second opinion for anything major or invasive is wise.
I’ve seen countless podiatrists in several states even though I’ve never had any significant foot problems. This is the only specialty I’ve seen in my 46 years of this where I’ve experienced, on multiple occasions, an absolute attempt to prescribe or recommend things I did not need. One recommended major surgery for a small complaint during an annual well exam. Another charged me $1300 for custom orthotics I didn’t need in the first place, and never used. I saw one last week whom I overheard ordering x-rays (without discussing with me first) that I knew I didn’t need. I passed.
I’ve also had annual diabetic foot exams and treatment for a broken toe by some absolutely wonderful podiatrists. So I’m not trying to punch the entire discipline.
I am suggesting, however, that due diligence in checking out podiatrists’ credentials and reputations is a very good idea. And then add some of your own common sense and good instincts.
Thanks for the terrific job reviewing my book! My goal with this book, and my previous articles and book for the ADA, was to educate people with diabetes about how to prevent foot related problems. So many of my patients came to me with problems late in their course. If only I had seen them sooner. Even some patients of mine, people I thought I had educated better, would show up with a full blown infection requiring surgery.
It sounds like you are doing well , despite not having seen a podiatrist. Keep up the good work.
Dr. Neil Scheffler
Thank you so much for your comment, Dr. Scheffler. I do plan to keep taking good care of my feet and I know that some day that will probably entail seeing a podiatrist. Maybe sooner than later.
You must have had a premonition?
oh, how I want the whole diabetes-foot thing to be a myth! this is a good reminder.
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