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Ten Important Facts About Diabetes and Foot Health
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Ten Important Facts About Diabetes and Foot Health
By Douglas H. Richie, Jr. D.P.M.
20-50% of people with diabetes of more than 10 years in duration will experience distal neuropathy in the lower extremity.
In the foot, the effects of neuropathy on the 3 types of nerves include:
Motor Nerves: muscle atrophy leading to claw-toe deformity
Sensory Nerves: loss of protective sensation
Autonomic Nerves: skin dryness, cracking, and fissuring
Diabetes also leads to limited joint mobility in the foot, decreasing the ability of the toes to flex and yield to shoe pressures and ground pressure.
Neuropathy and limited joint mobility cause elevated plantar pressures under the bone prominences in the forefoot.
Ulceration occurs with elevated plantar pressures, toe deformities, and ill-fitted shoes compounded by lack of protective skin sensation.
Less than 10% of all patients with diabetes wear prescriptive footwear. Yet many patients over the age of 65 are eligible to receive prescription, extra-depth footwear (shoes), fully reimbursed by Medicare.
For the remaining 90% of patients with diabetes who are not professionally fitted for footwear, shoe selection and fitting are of critical importance. Even in the best-fitted shoe, protecting the foot from the shoe is the first line of defense for the foot affected by diabetes.
While doctors and pedorthists rely on pressure-relieving insoles to protect the foot, such strategies protect the sole of the foot only, and do not provide adequate protection from friction and shearing forces. The knuckles of the toes and bone prominences on the side of the foot are still vulnerable.
A properly designed hosiery product can provide a 360° circumferential envelope of protection for the foot affected by diabetes, and absorb damaging friction and shearing forces.
Dispelling myths and misconceptions regarding sock recommendations for persons with diabetes:
Cotton and wool are the worst fibers to recommend for patients with diabetes. Hydrophilic cotton and wool fibers trap moisture inside of the shoe, preventing proper wicking movement away from the skin surface. Cotton and wool fibers lose their shape and compress significantly faster than Hi-Tech synthetic fibers. Cotton and wool fibers also become rough and abrasive with multiple use and machine wash-wear cycles.
Non-elastic - non-binding socks; while fear of binding and restriction of circulation in the patient with diabetes is a valid concern, it is nearly inconceivable that any standard hosiery product forms enough compression to restrict arterial inflow into the foot. Elastic seams at the top of the sock can restrict venous outflow leading to a red skin upper. On the other hand, elastic is necessary to assure conformity of the sock to the foot shape and prevent slippage of the sock into the shoe. The wrinkling of the sock can create a foreign body irritation and lead to ulceration. A properly designed hosiery product will have elastic in the body of the sock but will eliminate elastic bands at the sock upper.
Many shoe fitters and patients overlook the fact that a hosiery product can greatly affect shoe fit. Few persons have their feet measured on a regular basis. When their feet are measured, they commonly fail to wear the hosiery product on their feet while being measured on the Brannock shoe sizing measuring device. Many patients are told to wear thick sports hosiery to protect their feet. However, such patients may overlook the fact that these hosiery products can increase a demand for up to one shoe size greater volume. Properly fitted shoes allow for the expansion of the foot with the day-to-day ambulation. The average person will increase shoe size by one-half size. A medium density sock can enhance shoe fitting while reducing the risk of compromising and pressurizing the foot inside of a poorly fitted shoe.
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