The foot care needs of an individual with diabetes are often more complex than someone without diabetes. A trained foot and ankle specialist is an important part of the healthcare team for the diabetic patient. While anyone can experience general foot conditions, including someone with diabetes, patients with diabetes are at increased risk for the conditions below.
Diabetic Podiatric Care
Patients with diabetes are at an increased risk for decreased circulation or blood flow issues such as peripheral arterial disease or peripheral vascular disease in the lower extremities, peripheral neuropathy (tingling, numbness, or burning in the feet/legs), delayed wound healing, development of foot ulcers, and thickened fungal toenails. Let’s go over how a podiatrist trained in diabetic foot care will be able to help diabetic patients with each of these conditions.
- Decreased circulation of blood flow: Patients with diabetes can suffer from the decreased circulation of blood for many reasons. One main reason may be high glucose levels. These high glucose levels can cause damage to the lining of the patient’s small blood vessels and can impede their circulation. Blood circulation can be improved with increased exercise, regulated blood sugar levels, regulated cholesterol levels, and checking in with your podiatric doctor. Your podiatrist can help you with any foot or ankle issues that may be causing decreased circulation in your lower extremities.
- Peripheral arterial disease: Diabetes increases the risk of peripheral arterial disease. The American Diabetes Association reports that 1 in 3 people over age 50 with diabetes has PAD. An orthopedic doctor can help patients manage their PAD associated symptoms and provide advice to help reduce the risk of heart attack and stroke that may be related to PAD. Your doctor may also recommend lifestyle changes that can lessen the effects of peripheral arterial disease.
- Peripheral vascular disease: Peripheral vascular disease (PVD) is a disorder that affects the patient’s blood circulation, much like a peripheral arterial disease (PAD). This disorder causes the blood vessels outside of your heart and brain to block, spasm, and/or narrow. The vessels supply blood and oxygen to the stomach and intestines, arms, and kidneys. PVD, in turn, can affect these areas of the body and cause major issues. A podiatrist will focus on stopping the progression of the disease and work with patients to manage the pain and symptoms involved with PVD.
- Peripheral neuropathy: Peripheral neuropathy’s symptoms often include tingling, numbness, or burning in the feet and legs. Peripheral neuropathy can be a result of damage to the nerves which are located outside of the spinal cord and brain. For peripheral neuropathy, your doctor may recommend medications like pain relievers, anti-seizure medications, topical treatments, and antidepressants. Other than medications, the podiatrist may suggest physical therapy, transcutaneous electrical nerve stimulation (TENS), plasma exchange therapies, acupuncture, and other surgical options, especially related to tumors that are causing peripheral neuropathy. Depending on the severity of your case, your doctor may also recommend lifestyle changes and at-home remedies.
- Delayed wound healing: Diabetes can cause delayed wound healing. While minor cuts, wounds, and burns, are usually not a big deal for most people, they can lead to serious health issues for those with diabetes. When someone with diabetes has a wound, it can often take a lot longer to heal than the same wound may for a non-diabetic patient. If left untreated without the appropriate local wound care and management, wounds can become infected, leading to more serious problems like sepsis and amputation. These reasons make it imperative for patients to see their podiatrist regularly, and to always notify their doctor if they notice any wounds or abnormal pathology.
- Development of foot ulcers: Foot ulcers are a common complication for patients with diabetes. Ulcers can even get infected if not properly cared for. Your podiatrist might recommend off-loading, by means of custom diabetic insoles, diabetic shoes, braces, padding, compression wraps, modified shoe inserts or casting to keep pressure off your wound and allow it to heal. With debridement, a podiatrist can remove unhealthy tissue around the wound to promote healing. If you have diabetes and have developed a foot ulcer, do not ignore it. Seek treatment as soon as possible.
- Thickened fungal toenails: Thickened fungal toenails should be trimmed on a regular basis. It is highly advised that diabetic patients see their podiatrist to have their nails debrided in order to prevent cuts and wounds. Your podiatrist may elect to run tests to discover the type of fungal infection you are dealing with, allowing them to provide the appropriate treatment plan.
Dr. Nilin M. Rao, from Integrated Orthopedics of Arizona, has comprehensive training, which includes the diagnosis and treatment of all disorders in the lower extremities. He has several years of experience treating diabetic patients, and recommends a preventative approach to diabetic foot care, including frequent doctor visits for preventative care and maintenance to sustain optimal foot health and catch any problems before they progress.
“It is important for diabetic patients to see their podiatrist every 3 months for diabetic foot checks to make sure everything looks good,” Dr. Rao said. “We advise that diabetic patients do not attempt to trim their own toenails or calluses at home and have their podiatrist do this for them. Due to the effects of peripheral neuropathy and poor blood flow, a small cut can lead to a big problem. During these visits, I will do a full assessment of the feet and ankles, including debride their nails, trim calluses, and provide them with important diabetic education. I also provide wound care for patients with any diabetic wounds or ulcerations.”
For diabetic patients, Dr. Rao suggests they should:
- Maintain and control their glucose levels (check blood sugar daily)
- Check their feet daily for any wounds and maintain proper hygiene (wash your feet daily)
- Set up appointments for routine nail and callus debridement
- Apply lotion to the tops and bottoms of your feet, but not between the toes (can provide an environment for fungal infections)
- Always wear shoes and socks, even at home – never walk around barefoot
- See a podiatrist regularly to help prevent any foot or ankle problems
- Regularly exercise
“I always tell my diabetic patients to keep me informed of any abnormalities that they notice or find on their feet,” Dr. Rao said. “I want to see them if they have a cut, wound, abnormal lesion, rash, any sign of infection, or development of pain. Preventative care and maintenance are so important when it comes to the feet. Seeing your podiatrist right away when you notice a problem can prevent advancement and progression of the condition, helping to avoid infection, pain, and possible amputation.”
Why it’s important to have an experienced doctor as your care provider/partner?
When deciding what doctor or care provider you would like to see, you should make sure the doctor in question is qualified, Dr. Rao says.
“I think it’s important to have an experienced doctor as your provider because you want to see someone who has likely seen and treated your specific problematic pathology successfully,” Dr. Rao said. “I spent the past 4 years in training at top residency and fellowship programs, working alongside some of the best podiatrists, orthopedists, and wound care specialists, and seeing and treating a broad spectrum of foot and ankle pathology.”
Whether you’re searching for a doctor for routine care or need specialized surgical treatment, it is important to be on the same page as your doctor and ask all the questions you may have.
Integrated Orthopedics of Arizona has highly trained physicians/surgeons from most orthopedic sub-specialties, allowing them to provide comprehensive orthopedic care for their patients. Dr. Rao is a board-qualified and fellowship-trained podiatric foot and ankle surgeon. He has gone through comprehensive training, including the diagnosis and treatment of complex foot and ankle pathologies and has extensive training in foot and ankle reconstructive surgery, advanced arthroscopic techniques, injection and regenerative therapy, cartilage repair, minimally invasive surgery, deformity and bunion correction, sports injuries, and trauma.
Dr. Rao is from Cleveland, OH. He attended Miami University (Ohio) for his undergraduate studies and received a Bachelors in Psychology/Neuroscience. After this, he pursued simultaneous doctoral degrees from Kent State University. There, he completed his DPM as well as a MS and PhD in exercise physiology. After completing his degrees, he went on to do a three-year Podiatric Medical and Surgical Residency, with the added credential of Reconstructive Rearfoot and Ankle Surgery, at the Highlands-Presbyterian/ St. Luke’s Medical Center, in Denver, Colorado. Then, Dr. Rao had an additional one-year fellowship in foot and ankle sports medicine, trauma and reconstruction at the Silicon Valley Reconstructive Foot and Ankle Fellowship with the Palo Alto Medical Foundation-Sutter Health in Mountain View, California.
Dr. Rao has authored many publications in textbooks and scientific journals. He is also the recipient of many distinctions and awards, and speaks regularly at national, state, and local meetings and conferences. He is board certified by the American Board of Podiatric Medicine and board qualified in both foot surgery and rearfoot and ankle surgery by the American Board of Foot & Ankle Surgery.
If you are interested in booking an appointment with Dr. Rao for diabetic or general podiatric care, please contact us.