Abnormal blood sugar levels and orthopaedic problems don’t seem very likely companions. After all, orthopaedic medicine pertains to broken bones, damaged joints, torn tendons and muscle maladies. However, there’s a dark relationship between elevated blood sugar and orthopaedic issues. Diabetes—a growing problem in America—contributes to many orthopaedic problems. Lower extremity abnormalities, wounds and obstructed circulation all can be connected to diabetes. It’s also a sobering fact that people with diabetes are far more likely to have a leg, foot or toes amputated than those without the disease.
Diabetes in Louisiana is a major health problem. High-calorie, fatty diets and sedentary lifestyle contribute to Louisiana’s ranking number 1 in diabetes deaths, with a rate that’s nearly 50 percent higher than the national average. Sadly, the amputation rates of lower limbs in this state also are spiked alarmingly above the national norm. More than 360,000 people in Louisiana have diabetes, according to the American Diabetes Association.
Mid State Orthopaedic and Sports Medicine podiatrists (doctors who specialize in feet and ankles) Paul Sunderhaus and Maria Saucier are among a growing group of doctors nationally who are trying to reduce the occurrence of life-altering diabetes-related amputation. A daily self-examination, they insist, is critical to detecting foot problems that can quickly deteriorate into major health issues among diabetic patients.
Diabetic nerve damage—known as neuropathy—reduces a person’s ability to feel pain, heat and cold. This loss of feeling sometimes prevents the patient from noticing wounds, blisters, stone bruises and other irritations until the area becomes infected, and diabetes often drastically interferes with the healing process even while a patient is under a doctor’s care. Sunderhaus and Saucier report that they’ve had patients whose neuropathy prevented them from being aware that they had punctured a foot by stepping on a nail. Neuropathy also can change the shape of a person’s feet and toes, and custom-fitted therapeutic shoes may be necessary to prevent abrasion.
Ulcers most often form on the ball of the foot or bottom of the big toe. Ulcers on the side of the foot are generally caused by ill-fitting shoes. Not every ulcer hurts, but each should be seen as soon as possible by a doctor to prevent infection that could lead to amputation. Treatment of ulcers can be tedious and time consuming, but ignoring them inevitably leads to major problems.
Unfortunately, diabetes often causes poor circulation in the lower extremities by narrowing and hardening blood vessels in the leg and foot. This reduces a person’s natural ability to combat infections, sometimes to the point where major surgery is required. A Mid State Orthopaedic and Sports Medicine Center doctor will make recommendations on blood pressure and cholesterol control, an exercise regimen to stimulate blood flow, medication, and if necessary, vascular surgery. It is imperative that patients with circulation problems don’t smoke.
Diabetes inhibits the normal function of nerves that control the body’s release of oil and moisture. This often leads to very dry foot skin that may peel and crack and become infected. It’s important to let a doctor treat the affected area and recommend proper skin conditioning procedures.
The following are recommendations from Mid State Orthopaedic and Sports Medicine Center on care of the diabetic foot:
1. Never walk barefoot. Punctures, nicks and other wounds can go undetected and lead to dangerous infection.
2. Wash your feet each day with mild soap and warm water. Pat dry (do not rub vigorously). Use lotion to keep feet soft and moist. Do not put lotion between the toes.
3. Do not use drugstore medications, antiseptic solutions, heating pads or sharp instruments on your feet. Always keep you feet warm. Wear loose socks while sleeping.
4. Do not smoke.
5. Inspect your feet every day. Look carefully for skin breakdown on every part of your feet and ankles. Use a mirror or get someone to help you if mobility is a problem.
6. Look for swelling in both feet. Swelling in one foot and not the other can be an early sign of Charcot foot, a condition that can destroy joints and bones in people with nerve damage.
7. Buy only comfortable shoes that do not need a “breaking in” period. Purchase shoes late in the day when your feet are generally larger. Measure your feet each time you buy new shoes (feet change shape over time). Do not wear the same shoes every day.
8. Discuss the use of orthotics (special shoe inserts) with your doctor.
9. Never hesitate to see a doctor immediately when having foot problems. Early detection and care can save a limb or prevent other serious complications.
Mid State Orthopaedic and Sports Medicine Center, the oldest and largest orthopaedic medicine practice in Central Louisiana, has offices in Alexandria, Pineville, Natchitoches, Olla, Jena, Marksville and Ville Platte.