Diabetes ABCs

Diabetes ABCs: W

Wound Care
By Eileen B. Wyner, NP
Bulfinch Medical Group


Wound care refers to the treatment of chronic skin irritations that can be common and chronic in people with poorly controlled diabetes. Chronic skin breakdown or ulcers may occur for many reasons:  trauma; blisters, corns or bunions caused by poorly fitting shoes. Treatment of these lesions requires specialized care by specifically trained personnel such as podiatrists, surgeons, and certified wound nurse specialists who work in conjunction with the patient to ensure good healing.

Diabetes ABCs

Diabetes ABCs: U

Ulcer (foot)


A foot ulcer is a deep open wound, usually on the bottom of the foot that can be  slow or difficult to heal.  If you’ve lost feeling in your feet from neuropathy you might not feel it if you have a cut or blister.  Continuing to walk on even a minor injury can irritate the skin, causing it to break down and develop into an ulcer.  This is a serious condition and immediate medical care is required to prevent the spread of infection.  The good news is by taking good care of your feet you can prevent foot ulcers from developing in the first place.  Check your feet every day for blisters, cuts and sores and call your health care provider if you notice anything that isn’t healing right.  Always wear comfortable, well-fitting shoes and avoid going barefoot.

(Content reviewed by MGH Diabetes Center)

Caring for Your Built-in Transport System

By Eileen B. Wyner, NP
Bulfinch Medical Group

I was just wondering…how many times a day do you think abEileen Wout your feet?  I’m willing to guess that you don’t think about our built-in transport system much at all. Our feet carry us around every day and it’s easy to take them for granted. Sometimes we’re good to them and wear comfortable sneakers; other times we force them into pointy high heels because they look so stylish. A person living with Diabetes needs to be more attentive to our natural transportation and so I’d like to share some points about foot care.

Diabetes can lead to many different types of foot complications including calluses, fungal infections and poorly healing ulcers that can lead to bacterial infections and amputation—these conditions can happen as a long term complication of Diabetes and may be more severe if blood sugars aren’t well controlled.   Neuropathy, a frequent complication for people living with Diabetes, occurs when blood sugars are poorly controlled over time and there is damage to the nerve fibers. Symptoms of neuropathy can include the sensation of tingling in the feet, decreased sensation to temperature and altered sensation to pain.  Peripheral vascular disease or PVD occurs when there is damage to the lower extremity blood vessels, while poor circulation can cause pain and contributes to poorly healing injuries. Both of these conditions may not be completely preventable but they are manageable and your self-care is an important part of this. You may want to see a vascular specialist if your symptoms are severe, and it’s very important to stop smoking if you are currently.

There are many steps that you can take to keep your feet healthy. It’s very important to self examine your feet each time you get out of the shower or bath. You may not feel things as you did in the past and you may have an injury to your foot that you didn’t feel when it happened.  Doing a self exam, you can see the injury and begin to take care of it. Check for signs of ingrown toenails, blisters, and calluses. Seek medical attention for any suspicious injuries and see a podiatrist twice a year for a full foot exam (they can also assist in caring for complications). If you are cutting your own toenails it’s important not to cut them too closely to the toe to avoid ingrown nails. Also, it’s best not to file the heels or calluses on your own as it’s easy to get abrasions that can lead to infection.  Keep your skin moist by using a skin cream on the foot (but not between the toes).  It’s fine to get pedicures, but there are a few “rules”:

  1. Avoid pedicures if you have poorly controlled blood sugars.
  2. If there is any question about how clean the salon is, DON’T GO THERE.
  3. Bring your own cuticle tools to any pedicure and manicure and clean them well yourself.
  4. Tell the technician that you have Diabetes and do not want your nails and cuticles cut too short.
  5. Do NOT have any calluses or corns filed down. See the podiatrist for this.

Another important step in keeping your feet healthy is keeping your blood sugars and A1C in good control. This will decrease the risk of infection and may help to improve pain of neuropathy.  Review your medications and diet with your healthcare team if you are having problems keeping up with either.  Be sure your shoes fit very well to avoid any blisters, ingrown toenails, or pain. Shoes and boots for the bad weather are equally as important to ensure sure your feet stay dry, especially inNew England snowy winters and rainy springs.

I always get the funniest looks when I talk to my patients about going barefoot.  People tell me they have carpet at home or only walk on the grass. I visibly cringe at that point. Tiny little particles in carpet, grass, beach sand and the ocean are all potential culprits for injury that can cause serious infections.  Remember, you may have decreased sensation in your feet so the splinter that would have made you howl 5 years ago can go undetected until a more serious problem presents itself. At the very least, socks with treads are essential for around the house, and beach shoes are a must for the beach and pools both indoor and out.

So tonight, take off your shoes, wiggle your toes and think of all the ways you can show appreciation for your built in transportation system. Give yourself a foot massage, prop them up on the couch, and treat yourself to reruns of Everybody Loves Raymond.  And tomorrow, set up an appointment with the podiatrist. Your feet will smile.


A Sneaker by Any Other Name…

Toning shoes, sneakers that claim to help improve posture, burn more calories and help tone your lower body simply by walking in them, have been the hot fitness trend of the summer and fall. Also called fitness shoes or instability sneakers, the shoes are built on the idea of maintaining balance while walking on an unstable surface.  The soles of these shoes are rounded rather than flat, forcing the wearer to engage the muscles in their legs and ankles more in order to stay balanced.  Sketchers, New Balance and Reebok each have their own version of fitness shoe, but at about $100 or more per pair, are they really worth it?

Sketchers provides case studies on their website supporting their claim that Shape-Ups sneakers help tone and strengthen leg, back and abdominal muscles, yet a study of several brands of toning shoe conducted by the American Council on Exercise (ACE) showed no significant difference in muscle activity in the legs and back compared to regular running shoes.  There are also concerns that the shoes’ design could cause injuries to the Achilles tendon and fall-related injuries for people who have difficulty balancing.  Regardless of whether or not the shoes are as effective at toning the lower body as they claim, they’re still no substitute for a regular fitness routine.  In most cases, a regular pair of walking or running shoes, provided they have the proper fit, will serve you just as well. 

Wearing shoes and socks during daily activity will go a long way in protecting your feet from injury and reducing the risks of developing serious foot complications, but only if they fit correctly.  Shoes that are too tight can cause blisters or other breaks in the skin that can become infected if not treated properly, while shoes that are too loose will not provide adequate protection.  When buying a new pair of shoes, whether they’re toning shoes or regular sneakers, look for ones that offer plenty of wiggle room for your toes (but not so much that your foot slides around in them) and provide support for the back of your foot without rubbing against your ankle. 

What do you think about toning shoes?  Are they worth the hype, or just a fad?

(Information reviewed by MGH Physical Therapist)