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The Answer Doc with Dr. Christopher Munger, M.D.
What I think when I see bare feet
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    As summer nears, I have been seeing more and more people out and about in sandals or walking barefoot in their yards. Most people look at bare feet and think of freedom or warm weather.  I see people going barefoot and the first thing that comes to mind is diabetes.
    Diabetes?  Yes, diabetes.
    If you have diabetes, your feet are extremely important.  Diabetes can cause damage to small arteries in a person’s legs and feet.  This arterial damage can cause two major complications:
     1. Peripheral neuropathy:  When the small arteries are damaged this in turn leads to a reduced blood flow to small nerves.  When these nerves are starved of oxygen they can become dysfunctional and even die.  This causes the pins and needles and eventually the numbness that plagues many diabetics.  When people have peripheral neuropathy they cannot sense their feet which means they can’t feel when they cut their foot or an infection in starting.
     2. Small vessel disease:  decreased blood flow starves tissues in the foot of vital
nutrients, including oxygen, antibodies to fight infection, and chemicals produced by the body to help repair and restore tissues.  As well, when infection is present, this reduced blood flow can prevent antibiotics from penetrating the tissue to fight the infection.
    The combination of peripheral neuropathy and small vessel disease can lead to a number of complications:
    1. Non-healing ulcers
    2. Chronic infection
    3. Callous formation
    4. Bony deformity
    5. Gangrene and loss of limb.
    Fortunately, with proper medical treatment, complications such a peripheral neuropathy and small vessel disease can be avoided or their progress delayed.
    This brings us back to bare feet.  If you are a diabetic, you should NEVER go barefoot. Being barefoot exposes feet to fungus that can cause breaks in the skin as well as small wounds that can be entry points for infection.  Even if you don’t have problems such as peripheral neuropathy, foot infections are harder to heal in diabetics.
    Finally, as a diabetic, you must check your feet DAILY.  Check your feet (including the soles and between the toes) for cracking, peeling, calluses, or open sores. Create a routine for your feet where you check them and apply a hypoallergenic lotion daily.   If you have a fungus, treat it.  If it doesn’t get better quickly, see your doctor, as fungal infections of the feet can lead to more serious infections.  If you have large calluses or bunions, see your doctor. He may recommend prescription footware.  If you have an open sore, see your doctor immediately.
We all need to take care of our feet.  For diabetics, it must be a committed daily regimen.    

    Dr. Christopher Munger’s column appears every other Sunday. Dr. Munger is board-certified in family practice. He is a member of the Family Health Care Center in Statesboro and admits patients to East Georgia Regional Medical Center. He is originally from California. He received his bachelor’s degree from UCLA, his medical degree from Columbia University in New York City and completed his training in family practice at the University of Virginia. He lives in Statesboro with his wife and two dogs.
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