Sometimes surgical correction of foot deformities is needed to stop pain. However, it is always nice for the patient to find out that a simple remedy to their foot pain is through a change or alteration to their current shoe gear. Take for example, the patient above who came in complaining of pain in his 1st metatarsal phalangeal joint (or big toe joint). He had bought a new pair of boots that seemed to coincide with his new onset of pain. The radiograph results were a powerful tool for the patient to visualize the dramatic change in shape his foot must take to fit in these boots. So, out went the boots, and with them went the pain. He may still have a little arthritis in the big toe joint that may need surgical attention in the future, but for now he will enjoy his activities with less pain. 
 
-Jeff Merrill DPM AACFAS 

Taking a minute or two every day to inspect your feet and observing a few simple rules can make the difference in sparing diabetes patients from a preventable outcome of the disease – a foot amputation. 

“Of all diabetes-related complications, a serious foot ulcer and subsequent amputation might be the most preventable with proper care and vigilance in checking the feet at least once a day for small cuts and other abrasions,” says Jeff Merrill, DPM, AACFAS, a member of the American College of Foot and Ankle Surgeons (ACFAS). “Even those with good control of their blood sugar can experience foot ulcers, especially if neuropathy, a frequent diabetes complication, has caused decreased feeling on the bottom of their feet.”

Loss of sensation inhibits the body’s normal pain response. As a result, walking can apply repetitive, unfelt pressure to a wound, making it larger and deeper. Left untreated, diabetic ulcers lead to serious infections, which may result in amputation. 

Dr. Merrill says foot and ankle surgeons use a variety of surgical and non-surgical methods to heal diabetic ulcers, but stressed early intervention yields the most favorable outcomes.

“Daily self-exams are the best protection. Too often, patients fail to check their feet for small cuts or punctures that over time will ulcerate and become infected,” he says. “If you have diabetes and see anything suspicious on your feet, consult a foot and ankle surgeon for diagnosis and treatment. Even a few days can make a difference in preventing serious foot problems from developing.”

An estimated seven in ten diabetes patients have nerve damage that impairs feeling in their feet. Fifteen percent eventually will develop a foot ulcer. Among those with ulcers, one in four will lose a foot. Each year more than 86,000 amputations are performed as a direct result of diabetes, and studies show half of those who have one foot or leg amputated will lose the other within five years. Proper diabetic foot care, says Dr. Merrill, prevents foot loss.

In some cases, amputation might be the preferred option. If vascular and podiatric surgeries can’t improve blood circulation and foot function, resolve infection or restore foot function, amputation may be the only solution that enables the patient to heal. Today, advances in prosthetics make it possible for patients to return to an active lifestyle, a necessity for keeping diabetes under control.

Foot problems are not an inevitable consequence of diabetes. The risk can be lessened significantly by following a few simple precautions:
​

• Keep your blood sugar under control to help minimize cardiovascular and blood circulation problems
• Lose weight, don’t smoke and adhere to prescribed dietary, medication and exercise regime 
• At least once a day, examine your feet for cuts and other small wounds you may not feel 
• Never walk barefoot, outdoors and indoors 
• Cut nails carefully – straight across and not too short; never trim corns and calluses yourself 
• Wash your feet every day in lukewarm water; dry carefully
• Choose comfortable shoes with adequate room for the toes
• Wear clean, dry, non-bulky socks; change daily 
• Shake pebbles or bits of gravel out of your shoes before wearing 
• Seek treatment from a foot and ankle surgeon if minor cuts and sore spots don’t seem to be healing

​For more information on diabetic foot conditions, contact Dr. Merrill's office at 541-850-6463, or visit the ACFAS consumer Web site, FootHealthFacts.org.

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