THE STATE OF THE bUNION ADDRESS

As President Trump talks this week about our current State of the Union, I wanted to give some advice on proper foot care and the State of the bUnion (see what I did there), especially for diabetic patients.

Diabetic patients are subject to two major complications that increase the risk for amputations of the toes, feet and legs. Those two risks are circulatory problems as diabetes mellitus (DM) causes poor circulation which leads to decreased blood flow and decreased oxygen to the tissues of the lower extremities. 

The other complication is diabetic neuropathy, which causes a loss of feeling in the feet thereby reducing the ability to feel pain or injury. I once admitted a patient to the hospital after another doctor told me that the patient was sick with pneumonia. The patient did, in fact, have pneumonia, however I smelled a very foul odor from the patient. My nose led me to his feet. I removed his shoes and was able to see the bones in his foot from a horrible infection. He ended up receiving a life-saving amputation of his leg. I've had quite a few patients undergo amputations, and while some were simply cases of bad luck and not preventable, most could have been avoided by following a few simple tips.

Check your feet every day. At the end of the day, when you remove your shoes, put your hand in your shoe and feel around for anything abnormal, a rock or pebble, a tac poking through, a rough place in the shoe insert, that missing spray bottle of Binaca, etc. Once you've identified that the shoe is good, use your hands and a mirror if necessary to inspect your feet. Look and FEEL with your hands for any rough spots, callouses, cuts, abrasions on your feet. Be sure to check between your toes for that earthy smoked Gouda cheese. Most diabetics retain good sensation in their hands and fingers so that is why I recommend using your hands to feel of your feet. Finally, use a moisturizer of some sort and apply it to your feet. I recommend Eucerin Cream for normal feet or Aquaphor if the skin of your feet is hard enough to shape diamonds. Keeping your skin moist will prevent them from cracking. Once the skin on the feet starts to crack, bacteria can get in through those cracks and cause an infection. See your doctor and have them do a good exam periodically and remember that most diabetics do qualify for special shoes and inserts to help prevent some of the problems mentioned above. Oh, and cut those nails CAREFULLY!  

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