A patient asked me, "What kind to shoes should I be wearing as a diabetic?" For the answer, there are a few guidelines to follow. The best thing to do first is to see a podiatrist and have your feet evaluated. Not only will you get a thorough exam, but you will also receive invaluable information and education about your feet and the structure of your feet. In addition, many podiatrist offices like ours, Prairie Path Foot and Ankle Clinic, are certified to fit and dispense diabetic shoes such as Dr. Comfort brand, if you qualify per Medicare standards.
For those patients whom that is not an option, then there are several qualities to look for in a shoe. Firstly, it should have a wide toe box. This is in order to accommodate any foot structural deformities, such as bunions or hammer toes. This would prevent any irritation against the skin that could turn into an ulcer or an open sore.
The next thing to look for is good padding along the sole of the shoe. Some have extra cushioning in order to accommodate any bony prominences or areas of increased pressure, again, to prevent a sore from forming. In addition, the shoe should be easy to adjust with laces or velcro, in order to take into account the fact that the feet may swell at the end of the day, and the shoe can easily expand.
Most importantly, until you are confident that your shoes are well fitting and free of risk, you must break in your shoes. Wear them a couple of hours a day, and slowly increase until you can wear them all day. Be sure to check your feet for areas of redness and irritation, and if you do find this, take the shoes back to where you purchased them and schedule an appointment to have your feet examined again by a podiatrist to make sure no new sores or ulcers have occurred.
Please stop by our office at Prairie Path Foot and Ankle Clinic and see our line of Dr. Comfort diabetic shoes. After a thorough diabetic foot exam, our Certified Podiatric Medical Assistant will be happy to assist you in picking out a pair of shoes. Happy Walking!
Monday, August 23, 2010
Sunday, January 31, 2010
Why is my foot ulcer not healing?
A diabetic patient asked me the other day, "Dr. Arain, why is this ulcer not closing? I feel like it has been on the bottom of my foot forever!"
An ulceration is a sore or opening in the skin that may be very superficial, or may be very deep and go through the layers of skin, and maybe even down to the bone. This is more common in diabetics, and that is why it is of the utmost importance for people with diabetes to see a podiatrist, or foot and ankle specialist, on a regular basis.
My answer to her question was that there are several reasons why a wound or ulceration will not heal.
The first thing you look at is infection. If the sore is infected, it will never heal. Signs of infection include redness, purulent drainage, pain, or swelling. However, a wound may not look infected, or it may be so deep that the podiatrist can "probe" to bone. If this is the case, the podiatrist may need to take a culture, or scraping, to see if there is indeed bacteria in the wound that is infecting the wound. If in fact an infection is present, then an oral or IV antibiotics will take care of the infection and allow the body to heal.
The second thing to consider is lack of blood flow. If the wound is simply not getting enough blood, then with or without infection, the actual tissue is not getting enough nutrients to allow it to heal. In that case, your podiatrist can work with a vascular specialist to determine why there is lack of blood flow and possibly intervene to improve the bloodflow in order to improve chances of healing.
The third aspect to look at is pressure. A person without diabetes can handle fluctuations in pressure of simple weightbearing or walking, however sometimes due to bony deformities, the pressure of the bone or simply of an ill-fitting shoe will prevent the ulcer from healing. Think of it as "micro-trauma" to the sore. In that case, an accomodation can be made to the shoe or even alter the shoe gear temporarily or permanently in order to relieve pressure.
If all of these issues are resolved and the wound is still present, then look at other factors such as nutrition, and other metabolic issues, and even other impacts on health such as tobacco use or alcohol use. On the other hand, sometimes the wound may need some outside help such as wound care elements. There are many options, including topical gels, and bioengineered skin substitutes.
Remember, if a wound or ulcer is not healing, there has to be a reason, and your podiatrist can help. If you are in the Chicago area, please visit our clinic in Elmhurst, Prairie path foot and ankle clinic at 630-834-FOOT, or our Schaumburg location at Schaumburg Foot and Ankle Clinic 847-985-8380.
Please visit our websites at elmhurstfootdoc.com and schaumburgfootdoc.com
An ulceration is a sore or opening in the skin that may be very superficial, or may be very deep and go through the layers of skin, and maybe even down to the bone. This is more common in diabetics, and that is why it is of the utmost importance for people with diabetes to see a podiatrist, or foot and ankle specialist, on a regular basis.
My answer to her question was that there are several reasons why a wound or ulceration will not heal.
The first thing you look at is infection. If the sore is infected, it will never heal. Signs of infection include redness, purulent drainage, pain, or swelling. However, a wound may not look infected, or it may be so deep that the podiatrist can "probe" to bone. If this is the case, the podiatrist may need to take a culture, or scraping, to see if there is indeed bacteria in the wound that is infecting the wound. If in fact an infection is present, then an oral or IV antibiotics will take care of the infection and allow the body to heal.
The second thing to consider is lack of blood flow. If the wound is simply not getting enough blood, then with or without infection, the actual tissue is not getting enough nutrients to allow it to heal. In that case, your podiatrist can work with a vascular specialist to determine why there is lack of blood flow and possibly intervene to improve the bloodflow in order to improve chances of healing.
The third aspect to look at is pressure. A person without diabetes can handle fluctuations in pressure of simple weightbearing or walking, however sometimes due to bony deformities, the pressure of the bone or simply of an ill-fitting shoe will prevent the ulcer from healing. Think of it as "micro-trauma" to the sore. In that case, an accomodation can be made to the shoe or even alter the shoe gear temporarily or permanently in order to relieve pressure.
If all of these issues are resolved and the wound is still present, then look at other factors such as nutrition, and other metabolic issues, and even other impacts on health such as tobacco use or alcohol use. On the other hand, sometimes the wound may need some outside help such as wound care elements. There are many options, including topical gels, and bioengineered skin substitutes.
Remember, if a wound or ulcer is not healing, there has to be a reason, and your podiatrist can help. If you are in the Chicago area, please visit our clinic in Elmhurst, Prairie path foot and ankle clinic at 630-834-FOOT, or our Schaumburg location at Schaumburg Foot and Ankle Clinic 847-985-8380.
Please visit our websites at elmhurstfootdoc.com and schaumburgfootdoc.com
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