For Utah's 90,000 diagnosed diabetics, seemingly minor foot problems can become serious, even limb-threatening. Last year, 267 patients were hospitalized to have part of their lower extremities amputated. And more than 60 percent of nontraumatic amputations are a result of diabetes, according to the Utah Department of Health.
The department has kicked off a campaign to teach those with diabetes the importance of foot care. Area media were invited to a Salt Lake podiatrist's office to see what a foot exam involves and hear why it's so important. The campaign will continue with television, newspaper and radio ads to push the foot-friendly message. And health plans will be given information to share with their diabetic members.
More than 80 percent of those with diabetes who lose a foot to amputation first had foot ulcers, according to Craig Merrill of the department's Chronic Disease Control program. With proper foot care to stop the ulcers before they start or to care for them early, the vast majority of those amputation could have been prevented.
National data says that once a person with diabetes has an amputation, about half of them will have a second amputation within five years. But only 62 percent of providers routinely conduct foot exams at least twice a year for their patients with type 1 diabetes. The number is only slightly higher for type 2 patients.
The goal is to have patients with diabetes visually examine their feet daily, keep them dry (especially between the toes) but moisturized so skin doesn't crack and get in to see a doctor or podiatrist immediately if there's a sore, even one that doesn't look like much, said Dr. Scott A. Clark, podiatrist. People with diabetes need a professional foot exam at least annually, he added.
Diabetes complications can affect nerves and blood supply to the feet. What would be minor cuts or sores on someone else become very dangerous when someone has the disease. And those who have neuropathy, a loss of sensation in their feet, might not know there is a problem until it's very advanced unless they actually see it, he said. They may not feel pain if their feet are numb or tingly.
It's important to wear shoes to protect vulnerable skin even indoors, he said. Shoes need to have rounded toes and a good "toe box" so that the skin doesn't rub or pinch. Clark tells his patients to wear light-colored shoes because they won't trap heat and cause a thermal injury. And wear socks.
Steve Thomas has beautiful feet, the skin soft and smooth, the color even and toenails well clipped. So does young Paul Morris, who's also diabetic. With healthy feet, a thorough visual inspection needn't be a daily event, although the foot care should be, Clark said. But they need to eyeball the feet closely at least twice a month. And the fact that their feet are healthy doesn't mean they won't develop problems later, Clark warned them. If that happens, they need to seek care immediately.
"New lesions, new sores tend to get out of control more rapidly than for those without diabetes," Clark said. He tries to see patients with foot problem on the day they call because it's so potentially serious.
Marsha Latham has some slight cracking on her heel where the skin is very dry, as well as a pressure callous on the ball of her foot. If the skin breaks down in either area, she runs the risk of developing an infection, Clark told her. Even callouses need to be managed to keep feet safe, he said.
E-mail: lois@desnews.com