Diabetic Foot Care

A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe (metatarsophalangeal joint). Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles in toward the other toes . The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Varus. Bunions can also lead to other toe deformities, such as hammertoe.

 

Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult--all contributing to chronic pain.

 

Bunions have been with mankind since the beginning of time. Undoubtedly they have received more attention since shoes have become a vital part of our fashion. It is generally recognized that those who have a bunion deformity most probably inherited the tendency from an earlier generation. So often people are told "don't have anything done until you can't stand the pain"! This is a misconception! Our rule of thumb is that when it becomes obvious that you have a bunion, that is the time to correct it!

 

Treatment for Bunions

 

Certainly the goal in bunion treatment is to limit the deformity and to stop the progression if it has already begun. This can only be done in the very beginning stages. When it is seen that the deformity is beginning in children and young adults, often the use of a good custom orthotic will stop the progression of the deformity. Also wearing shoes that do not irritate the deformity is also wise.

 

Surgical Treatment

 

The greatest hurdle that people with bunion deformities have to overcome is history. In most instances, these people have had a relative with the same deformity who years ago had surgery and they remember the pain and the weeks and months in casts and on crutches. They also remember that after going through all of this pain and suffering, in many instances the bunion came back.

 

The good news is that in the past 10 years new techniques and better instrumentation have been developed. Bunion correction of today involves the use of micro instruments with precise cuts in the bone to correct the deformity, thus limiting the rate of re-occurrence. The old days of the doctor saying "I'm going to have to break the bone and reset" it are gone. If anyone says that to you, run as fast as you can! Gone are the days of casts and crutches and wheel chairs post-operatively. Only in the most severe cases must the patient be "non-weight bearing". In most cases, the patients at the Ford Center can resume a fairly normal lifestyle in days or weeks rather than months.

 

At the Ford Center for Foot Surgery, the procedures are done with I.V. sedation administered by one of our qualified anesthesiologists. We also use a regional anesthetic which is much safer than a general anesthetic. We can do this because we do not use tournequets when we do foot surgery. This minimizes post operative pain as well as the risk of blood clots. The net result of this is that the patient is awake and can walk within minutes following the surgery but their foot is numb for 18 - 20 hours.

 

The procedure itself is accomplished through an incision on the inside of the foot, thus there are no unsightly scars. The capsule of the joint is exposed and is opened revealing the "bump" on the side of the metatarsal bone. The over growth of bone is removed. Next a very precise "V" cut is made in the bone from one side to the other and the end or head of the bone is moved over. This narrows the foot back down to its normal width. To maintain this, a small screw is placed in the bone to secure the correction. The skin and soft tissues are then sutured and the foot bandaged. The foot is then placed in a post op shoe that will be worn for several weeks.

 

As a general rule, our patients return to comfortable shoes in 2 to 3 weeks.

 

 

 

 

 



According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.

Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation. With a diabetic foot, a wound as small as a blister from wearing a shoe that's too tight can lead to a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When a wound is not healing, it is at risk for infection and infections spread quickly in diabetics.

When a diabetic foot becomes numb, it may be at risk for deformity. One way this happens is through ulcers. Small, unattended cuts become open sores, which may then become infected. Another way is the bone condition Charcot Foot. This is one of the most serious foot problems diabetics face. It warps the shape of the foot when bones fracture and disintegrate, and yet, because of numbness there is no pain, and the individual continues to walk on the foot. Our practice can treat diabetic foot ulcers and early phases of Charcot (pronounced "sharko") fractures using a total contact cast and prevent more serious damage or deformity. This treatment allows the ulcer to heal by distributing weight and relieving pressure. For Charcot Foot, the cast controls foot movement and supports its contours. 

If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts, and nail discoloration. Get someone to help you, or use a mirror.

Here's some basic advice for taking care of diabetic feet:

  • Always keep your feet warm.
  • Don't get your feet wet in snow or rain.
  • Keep feet away from heat (heating pads, hot water pads, electric blankets, radiators, fireplaces). You can burn your feet without knowing it. Water temperature should be less than 92 degrees. Estimate with your elbow or bath thermometer (you can get one in any store that sells infant products).
  • Don't smoke or sit cross-legged. Both decrease blood supply to your feet.
  • Don't soak your feet.
  • Don't use antiseptic solutions (such as iodine or salicylic acid) or over-the-counter treatments for corns or calluses.
  • Don't use any tape or sticky products, such as corn plasters, on your feet. They can rip your skin.
  • Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, contact our office for treatment.
  • Use quality lotion to keep the skin of your feet soft and moist, but don't put any lotion between your toes.
  • Wash your feet every day with mild soap and warm water.
  • Wear loose socks to bed.
  • Wear warm socks and shoes in winter.
  • When drying your feet, pat each foot with a towel and be careful between your toes.
  • Buy shoes that are comfortable without a "breaking-in" period. Check how your shoe fits in width, length, back, bottom of heel, and sole. Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. Wear new shoes for only two hours or less at a time.
  • Don't wear the same pair of shoes everyday. Inspect the inside of each shoe looking for foreign objects, protruding nails, or any rough spots inside before putting them on. Don't lace your shoes too tightly or loosely.
  • Choose socks and stockings carefully. Wear clean, dry socks every day and always wear socks with shoes. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toes socks will not squeeze your toes. Avoid stockings with elastic tops or garters.
  • Never wear sandals or thongs (flip-flops) and never go barefoot, indoors or out.
  • In the winter, wear warm socks and protective outer footwear. Avoid getting your feet wet in the snow and rain and avoid letting your toes get cold.
  • Don't file down, remove, or shave off corns or calluses yourself.

Contact our office immediately if you experience any injury to your foot. Even a minor injury is an emergency for a patient with diabetes.


Search

Our Podiatric Library

Patient Education

Podiatrist - Sparks, Ford Center for Foot Surgery , Sparks NV, 89431 (775) 331-1919