Re: medical opinion on footcare for diabetics

[Guest guest]

Hi Harry,

Thanks for posting, definitely an interesting read.

Cheers,

Brett.

medical opinion on footcare for diabetics

I have copied below the opinion and recommendations of Dr. K.

Bernstein, M. D., who is a specialist for diabetes from his book Diabetes

Solutions,

Foot Care for Diabetics

Although it is not directly related to the normalization of blood sugars, I

have included this short but important section on foot care because of the

constant danger diabetes poses. The incidence of limb-threatening ulcerations in

diabetics is very high, affecting about one in seven patients. Nonhealing

" diabetic " ulcerations are the major cause of leg, foot, and toe amputations in

this country, after traumatic injuries such as motor vehicle accidents. These

ulcerations do not occur spontaneously; they are always preceded by gradual or

sudden injury to the skin by some external factor. Preventing such injuries can

prevent their sad consequences.

Virtually all diabetics who have experienced ongoing higher-than-normal blood

sugars for more than five years suffer some loss of sensitivity to pain,

pressure, and temperature in their feet. This is because elevated blood sugars

injure and can eventually destroy all sensory nerves in the feet. Furthermore,

the nerves that control the shape of the foot are likewise injured, with a

resultant deformity that includes " claw " or " hammer " toes, high arch, and

prominent bones at the bases of the toes on the underside of the foot. The

nerves that stimulate perspiration in the feet are also affected. This results

in the classic dry, often cracked skin that we see on diabetic feet. Dry skin is

both more easily damaged and slower to heal than is normal moist skin, and

cracks permit entry of infectious bacteria.

Elevated blood sugar also causes impairment of circulation in the arteries of

the legs, as well as in the arteries and small capillary blood vessels that

supply the skin of the feet. In order to heal, injured skin can require fifty

times the blood flow of normal skin. If this increase in flow is unavailable,

the injury will deteriorate, becoming gangrenous, and facilitate an infection

that spreads up the leg. This infection may not respond to antibiotics.

Blood circulation to the normal foot can readily increase one hundredfold, if

necessary, in order to conduct the heat of warm objects away from the skin.

Impaired circulation may make this impossible, and the resultant burn may not

even cause pain.

A deformed foot with bony prominences (knuckles of toes, tips of toes, heels,

and bases of toes at soles) may be continually rubbed or pressed by shoes. This

foot is frequently unable to perceive the extent of such pressure and may not

heal readily if injured. It can be burned at relatively low temperatures.

The following guidelines are therefore essential for all diabetics, to prevent

foot injury and the potentially grave consequences that may ensue:

. Never walk barefoot, either indoors or out.

. Purchase shoes or sneakers late in the day, when foot size is the greatest.

Shoes must be comfortable at the first wearing and should not require breaking

in. Request shoes with deep toe boxes. Pointed-toe shoes should not be worn,

even if the tips are blunted (as in many men's styles). Suitable, very

comfortable shoes are manufactured by Rockport. A variety of appropriate, dressy

styles can be purchased at b in New York City. A number of currently available

brands of athletic shoes and walking shoes are especially accommodating and even

have removable insoles so that orthotics (see below) will fit, without making

the shoe too tight. If necessary, I prescribe orthopedic or custom oxfords for

certain of my patients.

. Inspect the insides of your shoes daily for foreign objects, torn lining,

protruding nails, or bumps. Have them repaired if you find any of these.

. Don't wear sandals with thongs.

. Try to change to a different pair of shoes each day of the week.

. Ideally, your feet should be examined daily for possible injury or signs of

excessive pressure from shoes - blisters, cracks or other openings in the skin,

pink spots, or calluses. Be sure to

check between your toes. Use a mirror or have another person inspect your

soles, if necessary. Contact your physician immediately if any of these signs

are found.

If the skin of your feet is dry, lubricate the entire foot. Suitable

lubricants include mink oil, olive oil, any vegetable oil, vitamin E oil, and

emulsified lanolin. Do not use petroleum jelly (Vaseline), mineral oil, or baby

oil, as they are not absorbed by the skin. Do not smoke cigarettes. Nicotine

causes closure of the valves that permit blood to enter the small vessels that

nourish the skin. Keep feet away from heat. Therefore no heating pads, hot water

bottles, or electric blankets. Do not place feet near sources of warmth such as

radiators or fireplaces. Baths and showers should feel cool - not even lukewarm.

Temperature should be estimated with your hand or a bath thermometer, not with

your feet. Water temperature should be less than 92°F, as even this temperature

can cause burns when circulation is impaired. A bath thermometer is suggested.

Do not soak your feet in water, even if so instructed by a physician. This

causes macerated skin, which breaks down more easily and doesn't heal well. When

bathing or showering, get in, get washed, and get out. Don't soak. Beware of

rain, swimming pools, and any environment that may wet your feet or your shoes.

Do not put adhesive tape or other adhesive products like corn plasters in

contact with your feet. Fragile skin might be peeled off when the tape is

removed.

Do not put any medications in contact with your skin that are not prescribed

by your physician. Many over-the-counter medications, such as iodine, salicylic

acid, and corn-removal agents, are dangerous.

If the skin of your feet is dry, your cardiologist should try to avoid

medicines called beta blockers for hypertension or heart disease, as these can

inhibit perspiration that moistens the feet. Do not attempt to file down,

remove, or shave calluses or corns. This is dangerous. Do not permit

podiatrists, pedicurists, or anyone else to do so. If calluses are present, show

them to your physician. Ask him or her to arrange for your shoes to be

stretched, prescribe new shoes, or supply you with appropriate orthotic inserts.

Your physician may instruct you in the use of a shoe stretcher or " ball and

ring " to modify ill-fitting footwear.

' Do not trim your toenails if you cannot see them clearly. Ask a friend or

relative, podiatrist, or your physician to do this for you. If the corners of

your nails are pointed, you can file them with an emery board or have someone

else trim them. If you have thickened toenails, ask your physician to have

clippings tested for fungus infection. If infection is present, he should

prescribe tincture of fungoid. This solution must be applied twice daily to the

nails to be effective. It must be used for about twelve months to effect a cure.

Don't wear stockings or socks with tight elastic bands. Don't use garters.

Don't wear socks with holes or that have been darned. Phone your physician

immediately if you experience any injury to your foot. I consider even a minor

injury to be an emergency. Procrastination can be disastrous.

[Guest guest]

VERY GOOD info on foot care! Thanks for the post!

For a couple of years, I was having a problem with foot infections and

indeed, very dry skin. In fact, I've had dry skin since the early 70s up

until the past couple of years, which no physician would ever tackle before

I was finally diagnosed as diabetic in 2002. When the infection came to a

head as evidenced by fungus on the big toe nail, I used an antifungal

prescribed by my physician, but also used a cream called Diabetiderm,

prescribed by my ortho. (Diabetiderm is not a prescription med but some

orthos sell it at their offices, and you can also buy it at Wallgreen's.)

Thus far, Diabetiderm is the only thing I used that finally got my feet to

be soft and supple and I intend to keep them that way. The infection is gone

(at least for now) and my feet are in much better shape than they have been

for at least three decades.

The biggest problem I have with the recommendations is the idea of wearing a

different pair of shoes every day of the week. I'm envisioning a closet with

7 pairs of shoes. I think the best most of us can do is two pairs, to switch

off every other day. Insurance will pay for one pair per year but will pay

for three sets of insoles.

I didn't see anything in the recommendations on what kind of socks are best

other than to say that they should not be tight at the top. I would think a

good lightweight cotton sock would probably be the best, as it would allow

the foot to breathe more. Best to get socks at places like Walmart or

Penneys, though, as I find the socks you would buy at a shoe store to be

top-dollar and probably won't do much more for your feet.

Bill Powers

[Guest guest]

Really good stuff, Harry.

One thing that was not emphasized or included with using lotions, etc. on

the feet is do not put anything between your toes. It will not air out and

can create problems in that warm, moist area.

Thanks again for the post!

ESS

[Guest guest]

While I am tempted to think Dr. Bernstein's advice is a bit extreme, it may be

just right for some. I am fortunate in that my feet are in very good condition

after 41 years of being a type 1 diabetic. I have very good circulation, and

for the record, I do not go bare foot!

I believe, as diabetics, visits to a podiatrist are covered by Medicare and

insurance plans beyond what they are covered for non-diabetics. Some may want

to look into that.

Dave

God doesn't hate sinners, just sin!

medical opinion on footcare for diabetics

I have copied below the opinion and recommendations of Dr. K.

Bernstein, M. D., who is a specialist for diabetes from his book Diabetes

Solutions,

Foot Care for Diabetics

Although it is not directly related to the normalization of blood sugars, I

have included this short but important section on foot care because of the

constant danger diabetes poses. The incidence of limb-threatening ulcerations in

diabetics is very high, affecting about one in seven patients. Nonhealing

" diabetic " ulcerations are the major cause of leg, foot, and toe amputations in

this country, after traumatic injuries such as motor vehicle accidents. These

ulcerations do not occur spontaneously; they are always preceded by gradual or

sudden injury to the skin by some external factor. Preventing such injuries can

prevent their sad consequences.

Virtually all diabetics who have experienced ongoing higher-than-normal blood

sugars for more than five years suffer some loss of sensitivity to pain,

pressure, and temperature in their feet. This is because elevated blood sugars

injure and can eventually destroy all sensory nerves in the feet. Furthermore,

the nerves that control the shape of the foot are likewise injured, with a

resultant deformity that includes " claw " or " hammer " toes, high arch, and

prominent bones at the bases of the toes on the underside of the foot. The

nerves that stimulate perspiration in the feet are also affected. This results

in the classic dry, often cracked skin that we see on diabetic feet. Dry skin is

both more easily damaged and slower to heal than is normal moist skin, and

cracks permit entry of infectious bacteria.

Elevated blood sugar also causes impairment of circulation in the arteries of

the legs, as well as in the arteries and small capillary blood vessels that

supply the skin of the feet. In order to heal, injured skin can require fifty

times the blood flow of normal skin. If this increase in flow is unavailable,

the injury will deteriorate, becoming gangrenous, and facilitate an infection

that spreads up the leg. This infection may not respond to antibiotics.

Blood circulation to the normal foot can readily increase one hundredfold, if

necessary, in order to conduct the heat of warm objects away from the skin.

Impaired circulation may make this impossible, and the resultant burn may not

even cause pain.

A deformed foot with bony prominences (knuckles of toes, tips of toes, heels,

and bases of toes at soles) may be continually rubbed or pressed by shoes. This

foot is frequently unable to perceive the extent of such pressure and may not

heal readily if injured. It can be burned at relatively low temperatures.

The following guidelines are therefore essential for all diabetics, to prevent

foot injury and the potentially grave consequences that may ensue:

. Never walk barefoot, either indoors or out.

. Purchase shoes or sneakers late in the day, when foot size is the greatest.

Shoes must be comfortable at the first wearing and should not require breaking

in. Request shoes with deep toe boxes. Pointed-toe shoes should not be worn,

even if the tips are blunted (as in many men's styles). Suitable, very

comfortable shoes are manufactured by Rockport. A variety of appropriate, dressy

styles can be purchased at b in New York City. A number of currently available

brands of athletic shoes and walking shoes are especially accommodating and even

have removable insoles so that orthotics (see below) will fit, without making

the shoe too tight. If necessary, I prescribe orthopedic or custom oxfords for

certain of my patients.

. Inspect the insides of your shoes daily for foreign objects, torn lining,

protruding nails, or bumps. Have them repaired if you find any of these.

. Don't wear sandals with thongs.

. Try to change to a different pair of shoes each day of the week.

. Ideally, your feet should be examined daily for possible injury or signs of

excessive pressure from shoes - blisters, cracks or other openings in the skin,

pink spots, or calluses. Be sure to

check between your toes. Use a mirror or have another person inspect your

soles, if necessary. Contact your physician immediately if any of these signs

are found.

If the skin of your feet is dry, lubricate the entire foot. Suitable

lubricants include mink oil, olive oil, any vegetable oil, vitamin E oil, and

emulsified lanolin. Do not use petroleum jelly (Vaseline), mineral oil, or baby

oil, as they are not absorbed by the skin. Do not smoke cigarettes. Nicotine

causes closure of the valves that permit blood to enter the small vessels that

nourish the skin. Keep feet away from heat. Therefore no heating pads, hot water

bottles, or electric blankets. Do not place feet near sources of warmth such as

radiators or fireplaces. Baths and showers should feel cool - not even lukewarm.

Temperature should be estimated with your hand or a bath thermometer, not with

your feet. Water temperature should be less than 92°F, as even this temperature

can cause burns when circulation is impaired. A bath thermometer is suggested.

Do not soak your feet in water, even if so instructed by a physician. This

causes macerated skin, which breaks down more easily and doesn't heal well. When

bathing or showering, get in, get washed, and get out. Don't soak. Beware of

rain, swimming pools, and any environment that may wet your feet or your shoes.

Do not put adhesive tape or other adhesive products like corn plasters in

contact with your feet. Fragile skin might be peeled off when the tape is

removed.

Do not put any medications in contact with your skin that are not prescribed

by your physician. Many over-the-counter medications, such as iodine, salicylic

acid, and corn-removal agents, are dangerous.

If the skin of your feet is dry, your cardiologist should try to avoid

medicines called beta blockers for hypertension or heart disease, as these can

inhibit perspiration that moistens the feet. Do not attempt to file down,

remove, or shave calluses or corns. This is dangerous. Do not permit

podiatrists, pedicurists, or anyone else to do so. If calluses are present, show

them to your physician. Ask him or her to arrange for your shoes to be

stretched, prescribe new shoes, or supply you with appropriate orthotic inserts.

Your physician may instruct you in the use of a shoe stretcher or " ball and

ring " to modify ill-fitting footwear.

' Do not trim your toenails if you cannot see them clearly. Ask a friend or

relative, podiatrist, or your physician to do this for you. If the corners of

your nails are pointed, you can file them with an emery board or have someone

else trim them. If you have thickened toenails, ask your physician to have

clippings tested for fungus infection. If infection is present, he should

prescribe tincture of fungoid. This solution must be applied twice daily to the

nails to be effective. It must be used for about twelve months to effect a cure.

Don't wear stockings or socks with tight elastic bands. Don't use garters.

Don't wear socks with holes or that have been darned. Phone your physician

immediately if you experience any injury to your foot. I consider even a minor

injury to be an emergency. Procrastination can be disastrous.

[Guest guest]

While I am tempted to think Dr. Bernstein's advice is a bit extreme, it may be

just right for some. I am fortunate in that my feet are in very good condition

after 41 years of being a type 1 diabetic. I have very good circulation, and

for the record, I do not go bare foot!

I believe, as diabetics, visits to a podiatrist are covered by Medicare and

insurance plans beyond what they are covered for non-diabetics. Some may want

to look into that.

Dave

God doesn't hate sinners, just sin!

medical opinion on footcare for diabetics

I have copied below the opinion and recommendations of Dr. K.

Bernstein, M. D., who is a specialist for diabetes from his book Diabetes

Solutions,

Foot Care for Diabetics

Although it is not directly related to the normalization of blood sugars, I

have included this short but important section on foot care because of the

constant danger diabetes poses. The incidence of limb-threatening ulcerations in

diabetics is very high, affecting about one in seven patients. Nonhealing

" diabetic " ulcerations are the major cause of leg, foot, and toe amputations in

this country, after traumatic injuries such as motor vehicle accidents. These

ulcerations do not occur spontaneously; they are always preceded by gradual or

sudden injury to the skin by some external factor. Preventing such injuries can

prevent their sad consequences.

Virtually all diabetics who have experienced ongoing higher-than-normal blood

sugars for more than five years suffer some loss of sensitivity to pain,

pressure, and temperature in their feet. This is because elevated blood sugars

injure and can eventually destroy all sensory nerves in the feet. Furthermore,

the nerves that control the shape of the foot are likewise injured, with a

resultant deformity that includes " claw " or " hammer " toes, high arch, and

prominent bones at the bases of the toes on the underside of the foot. The

nerves that stimulate perspiration in the feet are also affected. This results

in the classic dry, often cracked skin that we see on diabetic feet. Dry skin is

both more easily damaged and slower to heal than is normal moist skin, and

cracks permit entry of infectious bacteria.

Elevated blood sugar also causes impairment of circulation in the arteries of

the legs, as well as in the arteries and small capillary blood vessels that

supply the skin of the feet. In order to heal, injured skin can require fifty

times the blood flow of normal skin. If this increase in flow is unavailable,

the injury will deteriorate, becoming gangrenous, and facilitate an infection

that spreads up the leg. This infection may not respond to antibiotics.

Blood circulation to the normal foot can readily increase one hundredfold, if

necessary, in order to conduct the heat of warm objects away from the skin.

Impaired circulation may make this impossible, and the resultant burn may not

even cause pain.

A deformed foot with bony prominences (knuckles of toes, tips of toes, heels,

and bases of toes at soles) may be continually rubbed or pressed by shoes. This

foot is frequently unable to perceive the extent of such pressure and may not

heal readily if injured. It can be burned at relatively low temperatures.

The following guidelines are therefore essential for all diabetics, to prevent

foot injury and the potentially grave consequences that may ensue:

. Never walk barefoot, either indoors or out.

. Purchase shoes or sneakers late in the day, when foot size is the greatest.

Shoes must be comfortable at the first wearing and should not require breaking

in. Request shoes with deep toe boxes. Pointed-toe shoes should not be worn,

even if the tips are blunted (as in many men's styles). Suitable, very

comfortable shoes are manufactured by Rockport. A variety of appropriate, dressy

styles can be purchased at b in New York City. A number of currently available

brands of athletic shoes and walking shoes are especially accommodating and even

have removable insoles so that orthotics (see below) will fit, without making

the shoe too tight. If necessary, I prescribe orthopedic or custom oxfords for

certain of my patients.

. Inspect the insides of your shoes daily for foreign objects, torn lining,

protruding nails, or bumps. Have them repaired if you find any of these.

. Don't wear sandals with thongs.

. Try to change to a different pair of shoes each day of the week.

. Ideally, your feet should be examined daily for possible injury or signs of

excessive pressure from shoes - blisters, cracks or other openings in the skin,

pink spots, or calluses. Be sure to

check between your toes. Use a mirror or have another person inspect your

soles, if necessary. Contact your physician immediately if any of these signs

are found.

If the skin of your feet is dry, lubricate the entire foot. Suitable

lubricants include mink oil, olive oil, any vegetable oil, vitamin E oil, and

emulsified lanolin. Do not use petroleum jelly (Vaseline), mineral oil, or baby

oil, as they are not absorbed by the skin. Do not smoke cigarettes. Nicotine

causes closure of the valves that permit blood to enter the small vessels that

nourish the skin. Keep feet away from heat. Therefore no heating pads, hot water

bottles, or electric blankets. Do not place feet near sources of warmth such as

radiators or fireplaces. Baths and showers should feel cool - not even lukewarm.

Temperature should be estimated with your hand or a bath thermometer, not with

your feet. Water temperature should be less than 92°F, as even this temperature

can cause burns when circulation is impaired. A bath thermometer is suggested.

Do not soak your feet in water, even if so instructed by a physician. This

causes macerated skin, which breaks down more easily and doesn't heal well. When

bathing or showering, get in, get washed, and get out. Don't soak. Beware of

rain, swimming pools, and any environment that may wet your feet or your shoes.

Do not put adhesive tape or other adhesive products like corn plasters in

contact with your feet. Fragile skin might be peeled off when the tape is

removed.

Do not put any medications in contact with your skin that are not prescribed

by your physician. Many over-the-counter medications, such as iodine, salicylic

acid, and corn-removal agents, are dangerous.

If the skin of your feet is dry, your cardiologist should try to avoid

medicines called beta blockers for hypertension or heart disease, as these can

inhibit perspiration that moistens the feet. Do not attempt to file down,

remove, or shave calluses or corns. This is dangerous. Do not permit

podiatrists, pedicurists, or anyone else to do so. If calluses are present, show

them to your physician. Ask him or her to arrange for your shoes to be

stretched, prescribe new shoes, or supply you with appropriate orthotic inserts.

Your physician may instruct you in the use of a shoe stretcher or " ball and

ring " to modify ill-fitting footwear.

' Do not trim your toenails if you cannot see them clearly. Ask a friend or

relative, podiatrist, or your physician to do this for you. If the corners of

your nails are pointed, you can file them with an emery board or have someone

else trim them. If you have thickened toenails, ask your physician to have

clippings tested for fungus infection. If infection is present, he should

prescribe tincture of fungoid. This solution must be applied twice daily to the

nails to be effective. It must be used for about twelve months to effect a cure.

Don't wear stockings or socks with tight elastic bands. Don't use garters.

Don't wear socks with holes or that have been darned. Phone your physician

immediately if you experience any injury to your foot. I consider even a minor

injury to be an emergency. Procrastination can be disastrous.

[Guest guest]

Hi,

Yes I go see one every 9 weeks and he said that my feet looks great.

Re: medical opinion on footcare for diabetics

While I am tempted to think Dr. Bernstein's advice is a bit extreme, it may

be just right for some. I am fortunate in that my feet are in very good

condition after 41 years of being a type 1 diabetic. I have very good

circulation, and for the record, I do not go bare foot!

I believe, as diabetics, visits to a podiatrist are covered by Medicare and

insurance plans beyond what they are covered for non-diabetics. Some may

want to look into that.

Dave

God doesn't hate sinners, just sin!

medical opinion on footcare for diabetics

I have copied below the opinion and recommendations of Dr. K.

Bernstein, M. D., who is a specialist for diabetes from his book Diabetes

Solutions,

Foot Care for Diabetics

Although it is not directly related to the normalization of blood sugars, I

have included this short but important section on foot care because of the

constant danger diabetes poses. The incidence of limb-threatening

ulcerations in diabetics is very high, affecting about one in seven

patients. Nonhealing " diabetic " ulcerations are the major cause of leg,

foot, and toe amputations in this country, after traumatic injuries such as

motor vehicle accidents. These ulcerations do not occur spontaneously; they

are always preceded by gradual or sudden injury to the skin by some external

factor. Preventing such injuries can prevent their sad consequences.

Virtually all diabetics who have experienced ongoing higher-than-normal

blood sugars for more than five years suffer some loss of sensitivity to

pain, pressure, and temperature in their feet. This is because elevated

blood sugars injure and can eventually destroy all sensory nerves in the

feet. Furthermore, the nerves that control the shape of the foot are

likewise injured, with a resultant deformity that includes " claw " or

" hammer " toes, high arch, and prominent bones at the bases of the toes on

the underside of the foot. The nerves that stimulate perspiration in the

feet are also affected. This results in the classic dry, often cracked skin

that we see on diabetic feet. Dry skin is both more easily damaged and

slower to heal than is normal moist skin, and cracks permit entry of

infectious bacteria.

Elevated blood sugar also causes impairment of circulation in the arteries

of the legs, as well as in the arteries and small capillary blood vessels

that supply the skin of the feet. In order to heal, injured skin can require

fifty times the blood flow of normal skin. If this increase in flow is

unavailable, the injury will deteriorate, becoming gangrenous, and

facilitate an infection that spreads up the leg. This infection may not

respond to antibiotics.

Blood circulation to the normal foot can readily increase one hundredfold,

if necessary, in order to conduct the heat of warm objects away from the

skin. Impaired circulation may make this impossible, and the resultant burn

may not even cause pain.

A deformed foot with bony prominences (knuckles of toes, tips of toes,

heels, and bases of toes at soles) may be continually rubbed or pressed by

shoes. This foot is frequently unable to perceive the extent of such

pressure and may not heal readily if injured. It can be burned at relatively

low temperatures.

The following guidelines are therefore essential for all diabetics, to

prevent foot injury and the potentially grave consequences that may ensue:

.. Never walk barefoot, either indoors or out.

.. Purchase shoes or sneakers late in the day, when foot size is the

greatest. Shoes must be comfortable at the first wearing and should not

require breaking in. Request shoes with deep toe boxes. Pointed-toe shoes

should not be worn, even if the tips are blunted (as in many men's styles).

Suitable, very comfortable shoes are manufactured by Rockport. A variety of

appropriate, dressy styles can be purchased at b in New York City. A number

of currently available brands of athletic shoes and walking shoes are

especially accommodating and even have removable insoles so that orthotics

(see below) will fit, without making the shoe too tight. If necessary, I

prescribe orthopedic or custom oxfords for certain of my patients.

.. Inspect the insides of your shoes daily for foreign objects, torn lining,

protruding nails, or bumps. Have them repaired if you find any of these.

.. Don't wear sandals with thongs.

.. Try to change to a different pair of shoes each day of the week.

.. Ideally, your feet should be examined daily for possible injury or signs

of excessive pressure from shoes - blisters, cracks or other openings in the

skin, pink spots, or calluses. Be sure to

check between your toes. Use a mirror or have another person inspect your

soles, if necessary. Contact your physician immediately if any of these

signs are found.

If the skin of your feet is dry, lubricate the entire foot. Suitable

lubricants include mink oil, olive oil, any vegetable oil, vitamin E oil,

and emulsified lanolin. Do not use petroleum jelly (Vaseline), mineral oil,

or baby oil, as they are not absorbed by the skin. Do not smoke cigarettes.

Nicotine causes closure of the valves that permit blood to enter the small

vessels that nourish the skin. Keep feet away from heat. Therefore no

heating pads, hot water bottles, or electric blankets. Do not place feet

near sources of warmth such as radiators or fireplaces. Baths and showers

should feel cool - not even lukewarm. Temperature should be estimated with

your hand or a bath thermometer, not with your feet. Water temperature

should be less than 92°F, as even this temperature can cause burns when

circulation is impaired. A bath thermometer is suggested.

Do not soak your feet in water, even if so instructed by a physician. This

causes macerated skin, which breaks down more easily and doesn't heal well.

When bathing or showering, get in, get washed, and get out. Don't soak.

Beware of rain, swimming pools, and any environment that may wet your feet

or your shoes. Do not put adhesive tape or other adhesive products like corn

plasters in contact with your feet. Fragile skin might be peeled off when

the tape is removed.

Do not put any medications in contact with your skin that are not prescribed

by your physician. Many over-the-counter medications, such as iodine,

salicylic acid, and corn-removal agents, are dangerous.

If the skin of your feet is dry, your cardiologist should try to avoid

medicines called beta blockers for hypertension or heart disease, as these

can inhibit perspiration that moistens the feet. Do not attempt to file

down, remove, or shave calluses or corns. This is dangerous. Do not permit

podiatrists, pedicurists, or anyone else to do so. If calluses are present,

show them to your physician. Ask him or her to arrange for your shoes to be

stretched, prescribe new shoes, or supply you with appropriate orthotic

inserts. Your physician may instruct you in the use of a shoe stretcher or

" ball and ring " to modify ill-fitting footwear.

' Do not trim your toenails if you cannot see them clearly. Ask a friend or

relative, podiatrist, or your physician to do this for you. If the corners

of your nails are pointed, you can file them with an emery board or have

someone else trim them. If you have thickened toenails, ask your physician

to have clippings tested for fungus infection. If infection is present, he

should prescribe tincture of fungoid. This solution must be applied twice

daily to the nails to be effective. It must be used for about twelve months

to effect a cure.

Don't wear stockings or socks with tight elastic bands. Don't use garters.

Don't wear socks with holes or that have been darned. Phone your physician

immediately if you experience any injury to your foot. I consider even a

minor injury to be an emergency. Procrastination can be disastrous.

[Guest guest]

Hi,

Yes I go see one every 9 weeks and he said that my feet looks great.

Re: medical opinion on footcare for diabetics

While I am tempted to think Dr. Bernstein's advice is a bit extreme, it may

be just right for some. I am fortunate in that my feet are in very good

condition after 41 years of being a type 1 diabetic. I have very good

circulation, and for the record, I do not go bare foot!

I believe, as diabetics, visits to a podiatrist are covered by Medicare and

insurance plans beyond what they are covered for non-diabetics. Some may

want to look into that.

Dave

God doesn't hate sinners, just sin!

medical opinion on footcare for diabetics

I have copied below the opinion and recommendations of Dr. K.

Bernstein, M. D., who is a specialist for diabetes from his book Diabetes

Solutions,

Foot Care for Diabetics

Although it is not directly related to the normalization of blood sugars, I

have included this short but important section on foot care because of the

constant danger diabetes poses. The incidence of limb-threatening

ulcerations in diabetics is very high, affecting about one in seven

patients. Nonhealing " diabetic " ulcerations are the major cause of leg,

foot, and toe amputations in this country, after traumatic injuries such as

motor vehicle accidents. These ulcerations do not occur spontaneously; they

are always preceded by gradual or sudden injury to the skin by some external

factor. Preventing such injuries can prevent their sad consequences.

Virtually all diabetics who have experienced ongoing higher-than-normal

blood sugars for more than five years suffer some loss of sensitivity to

pain, pressure, and temperature in their feet. This is because elevated

blood sugars injure and can eventually destroy all sensory nerves in the

feet. Furthermore, the nerves that control the shape of the foot are

likewise injured, with a resultant deformity that includes " claw " or

" hammer " toes, high arch, and prominent bones at the bases of the toes on

the underside of the foot. The nerves that stimulate perspiration in the

feet are also affected. This results in the classic dry, often cracked skin

that we see on diabetic feet. Dry skin is both more easily damaged and

slower to heal than is normal moist skin, and cracks permit entry of

infectious bacteria.

Elevated blood sugar also causes impairment of circulation in the arteries

of the legs, as well as in the arteries and small capillary blood vessels

that supply the skin of the feet. In order to heal, injured skin can require

fifty times the blood flow of normal skin. If this increase in flow is

unavailable, the injury will deteriorate, becoming gangrenous, and

facilitate an infection that spreads up the leg. This infection may not

respond to antibiotics.

Blood circulation to the normal foot can readily increase one hundredfold,

if necessary, in order to conduct the heat of warm objects away from the

skin. Impaired circulation may make this impossible, and the resultant burn

may not even cause pain.

A deformed foot with bony prominences (knuckles of toes, tips of toes,

heels, and bases of toes at soles) may be continually rubbed or pressed by

shoes. This foot is frequently unable to perceive the extent of such

pressure and may not heal readily if injured. It can be burned at relatively

low temperatures.

The following guidelines are therefore essential for all diabetics, to

prevent foot injury and the potentially grave consequences that may ensue:

.. Never walk barefoot, either indoors or out.

.. Purchase shoes or sneakers late in the day, when foot size is the

greatest. Shoes must be comfortable at the first wearing and should not

require breaking in. Request shoes with deep toe boxes. Pointed-toe shoes

should not be worn, even if the tips are blunted (as in many men's styles).

Suitable, very comfortable shoes are manufactured by Rockport. A variety of

appropriate, dressy styles can be purchased at b in New York City. A number

of currently available brands of athletic shoes and walking shoes are

especially accommodating and even have removable insoles so that orthotics

(see below) will fit, without making the shoe too tight. If necessary, I

prescribe orthopedic or custom oxfords for certain of my patients.

.. Inspect the insides of your shoes daily for foreign objects, torn lining,

protruding nails, or bumps. Have them repaired if you find any of these.

.. Don't wear sandals with thongs.

.. Try to change to a different pair of shoes each day of the week.

.. Ideally, your feet should be examined daily for possible injury or signs

of excessive pressure from shoes - blisters, cracks or other openings in the

skin, pink spots, or calluses. Be sure to

check between your toes. Use a mirror or have another person inspect your

soles, if necessary. Contact your physician immediately if any of these

signs are found.

If the skin of your feet is dry, lubricate the entire foot. Suitable

lubricants include mink oil, olive oil, any vegetable oil, vitamin E oil,

and emulsified lanolin. Do not use petroleum jelly (Vaseline), mineral oil,

or baby oil, as they are not absorbed by the skin. Do not smoke cigarettes.

Nicotine causes closure of the valves that permit blood to enter the small

vessels that nourish the skin. Keep feet away from heat. Therefore no

heating pads, hot water bottles, or electric blankets. Do not place feet

near sources of warmth such as radiators or fireplaces. Baths and showers

should feel cool - not even lukewarm. Temperature should be estimated with

your hand or a bath thermometer, not with your feet. Water temperature

should be less than 92°F, as even this temperature can cause burns when

circulation is impaired. A bath thermometer is suggested.

Do not soak your feet in water, even if so instructed by a physician. This

causes macerated skin, which breaks down more easily and doesn't heal well.

When bathing or showering, get in, get washed, and get out. Don't soak.

Beware of rain, swimming pools, and any environment that may wet your feet

or your shoes. Do not put adhesive tape or other adhesive products like corn

plasters in contact with your feet. Fragile skin might be peeled off when

the tape is removed.

Do not put any medications in contact with your skin that are not prescribed

by your physician. Many over-the-counter medications, such as iodine,

salicylic acid, and corn-removal agents, are dangerous.

If the skin of your feet is dry, your cardiologist should try to avoid

medicines called beta blockers for hypertension or heart disease, as these

can inhibit perspiration that moistens the feet. Do not attempt to file

down, remove, or shave calluses or corns. This is dangerous. Do not permit

podiatrists, pedicurists, or anyone else to do so. If calluses are present,

show them to your physician. Ask him or her to arrange for your shoes to be

stretched, prescribe new shoes, or supply you with appropriate orthotic

inserts. Your physician may instruct you in the use of a shoe stretcher or

" ball and ring " to modify ill-fitting footwear.

' Do not trim your toenails if you cannot see them clearly. Ask a friend or

relative, podiatrist, or your physician to do this for you. If the corners

of your nails are pointed, you can file them with an emery board or have

someone else trim them. If you have thickened toenails, ask your physician

to have clippings tested for fungus infection. If infection is present, he

should prescribe tincture of fungoid. This solution must be applied twice

daily to the nails to be effective. It must be used for about twelve months

to effect a cure.

Don't wear stockings or socks with tight elastic bands. Don't use garters.

Don't wear socks with holes or that have been darned. Phone your physician

immediately if you experience any injury to your foot. I consider even a

minor injury to be an emergency. Procrastination can be disastrous.

[Guest guest]

Thank you for this very good info. This is one article I am going to keep.

Terrie wiht Eunice and Shandar. Jade came home.

contact info below:

Windows live: shineydog@...

list email: devendawg@...

private emails: shineydog@...

medical opinion on footcare for diabetics

I have copied below the opinion and recommendations of Dr. K.

Bernstein, M. D., who is a specialist for diabetes from his book Diabetes

Solutions,

Foot Care for Diabetics

Although it is not directly related to the normalization of blood sugars, I

have included this short but important section on foot care because of the

constant danger diabetes poses. The incidence of limb-threatening ulcerations in

diabetics is very high, affecting about one in seven patients. Nonhealing

" diabetic " ulcerations are the major cause of leg, foot, and toe amputations in

this country, after traumatic injuries such as motor vehicle accidents. These

ulcerations do not occur spontaneously; they are always preceded by gradual or

sudden injury to the skin by some external factor. Preventing such injuries can

prevent their sad consequences.

Virtually all diabetics who have experienced ongoing higher-than-normal blood

sugars for more than five years suffer some loss of sensitivity to pain,

pressure, and temperature in their feet. This is because elevated blood sugars

injure and can eventually destroy all sensory nerves in the feet. Furthermore,

the nerves that control the shape of the foot are likewise injured, with a

resultant deformity that includes " claw " or " hammer " toes, high arch, and

prominent bones at the bases of the toes on the underside of the foot. The

nerves that stimulate perspiration in the feet are also affected. This results

in the classic dry, often cracked skin that we see on diabetic feet. Dry skin is

both more easily damaged and slower to heal than is normal moist skin, and

cracks permit entry of infectious bacteria.

Elevated blood sugar also causes impairment of circulation in the arteries of

the legs, as well as in the arteries and small capillary blood vessels that

supply the skin of the feet. In order to heal, injured skin can require fifty

times the blood flow of normal skin. If this increase in flow is unavailable,

the injury will deteriorate, becoming gangrenous, and facilitate an infection

that spreads up the leg. This infection may not respond to antibiotics.

Blood circulation to the normal foot can readily increase one hundredfold, if

necessary, in order to conduct the heat of warm objects away from the skin.

Impaired circulation may make this impossible, and the resultant burn may not

even cause pain.

A deformed foot with bony prominences (knuckles of toes, tips of toes, heels,

and bases of toes at soles) may be continually rubbed or pressed by shoes. This

foot is frequently unable to perceive the extent of such pressure and may not

heal readily if injured. It can be burned at relatively low temperatures.

The following guidelines are therefore essential for all diabetics, to prevent

foot injury and the potentially grave consequences that may ensue:

. Never walk barefoot, either indoors or out.

. Purchase shoes or sneakers late in the day, when foot size is the greatest.

Shoes must be comfortable at the first wearing and should not require breaking

in. Request shoes with deep toe boxes. Pointed-toe shoes should not be worn,

even if the tips are blunted (as in many men's styles). Suitable, very

comfortable shoes are manufactured by Rockport. A variety of appropriate, dressy

styles can be purchased at b in New York City. A number of currently available

brands of athletic shoes and walking shoes are especially accommodating and even

have removable insoles so that orthotics (see below) will fit, without making

the shoe too tight. If necessary, I prescribe orthopedic or custom oxfords for

certain of my patients.

. Inspect the insides of your shoes daily for foreign objects, torn lining,

protruding nails, or bumps. Have them repaired if you find any of these.

. Don't wear sandals with thongs.

. Try to change to a different pair of shoes each day of the week.

. Ideally, your feet should be examined daily for possible injury or signs of

excessive pressure from shoes - blisters, cracks or other openings in the skin,

pink spots, or calluses. Be sure to

check between your toes. Use a mirror or have another person inspect your

soles, if necessary. Contact your physician immediately if any of these signs

are found.

If the skin of your feet is dry, lubricate the entire foot. Suitable

lubricants include mink oil, olive oil, any vegetable oil, vitamin E oil, and

emulsified lanolin. Do not use petroleum jelly (Vaseline), mineral oil, or baby

oil, as they are not absorbed by the skin. Do not smoke cigarettes. Nicotine

causes closure of the valves that permit blood to enter the small vessels that

nourish the skin. Keep feet away from heat. Therefore no heating pads, hot water

bottles, or electric blankets. Do not place feet near sources of warmth such as

radiators or fireplaces. Baths and showers should feel cool - not even lukewarm.

Temperature should be estimated with your hand or a bath thermometer, not with

your feet. Water temperature should be less than 92°F, as even this temperature

can cause burns when circulation is impaired. A bath thermometer is suggested.

Do not soak your feet in water, even if so instructed by a physician. This

causes macerated skin, which breaks down more easily and doesn't heal well. When

bathing or showering, get in, get washed, and get out. Don't soak. Beware of

rain, swimming pools, and any environment that may wet your feet or your shoes.

Do not put adhesive tape or other adhesive products like corn plasters in

contact with your feet. Fragile skin might be peeled off when the tape is

removed.

Do not put any medications in contact with your skin that are not prescribed

by your physician. Many over-the-counter medications, such as iodine, salicylic

acid, and corn-removal agents, are dangerous.

If the skin of your feet is dry, your cardiologist should try to avoid

medicines called beta blockers for hypertension or heart disease, as these can

inhibit perspiration that moistens the feet. Do not attempt to file down,

remove, or shave calluses or corns. This is dangerous. Do not permit

podiatrists, pedicurists, or anyone else to do so. If calluses are present, show

them to your physician. Ask him or her to arrange for your shoes to be

stretched, prescribe new shoes, or supply you with appropriate orthotic inserts.

Your physician may instruct you in the use of a shoe stretcher or " ball and

ring " to modify ill-fitting footwear.

' Do not trim your toenails if you cannot see them clearly. Ask a friend or

relative, podiatrist, or your physician to do this for you. If the corners of

your nails are pointed, you can file them with an emery board or have someone

else trim them. If you have thickened toenails, ask your physician to have

clippings tested for fungus infection. If infection is present, he should

prescribe tincture of fungoid. This solution must be applied twice daily to the

nails to be effective. It must be used for about twelve months to effect a cure.

Don't wear stockings or socks with tight elastic bands. Don't use garters.

Don't wear socks with holes or that have been darned. Phone your physician

immediately if you experience any injury to your foot. I consider even a minor

injury to be an emergency. Procrastination can be disastrous.

[Guest guest]

Thank you for this very good info. This is one article I am going to keep.

Terrie wiht Eunice and Shandar. Jade came home.

contact info below:

Windows live: shineydog@...

list email: devendawg@...

private emails: shineydog@...

medical opinion on footcare for diabetics

I have copied below the opinion and recommendations of Dr. K.

Bernstein, M. D., who is a specialist for diabetes from his book Diabetes

Solutions,

Foot Care for Diabetics

Although it is not directly related to the normalization of blood sugars, I

have included this short but important section on foot care because of the

constant danger diabetes poses. The incidence of limb-threatening ulcerations in

diabetics is very high, affecting about one in seven patients. Nonhealing

" diabetic " ulcerations are the major cause of leg, foot, and toe amputations in

this country, after traumatic injuries such as motor vehicle accidents. These

ulcerations do not occur spontaneously; they are always preceded by gradual or

sudden injury to the skin by some external factor. Preventing such injuries can

prevent their sad consequences.

Virtually all diabetics who have experienced ongoing higher-than-normal blood

sugars for more than five years suffer some loss of sensitivity to pain,

pressure, and temperature in their feet. This is because elevated blood sugars

injure and can eventually destroy all sensory nerves in the feet. Furthermore,

the nerves that control the shape of the foot are likewise injured, with a

resultant deformity that includes " claw " or " hammer " toes, high arch, and

prominent bones at the bases of the toes on the underside of the foot. The

nerves that stimulate perspiration in the feet are also affected. This results

in the classic dry, often cracked skin that we see on diabetic feet. Dry skin is

both more easily damaged and slower to heal than is normal moist skin, and

cracks permit entry of infectious bacteria.

Elevated blood sugar also causes impairment of circulation in the arteries of

the legs, as well as in the arteries and small capillary blood vessels that

supply the skin of the feet. In order to heal, injured skin can require fifty

times the blood flow of normal skin. If this increase in flow is unavailable,

the injury will deteriorate, becoming gangrenous, and facilitate an infection

that spreads up the leg. This infection may not respond to antibiotics.

Blood circulation to the normal foot can readily increase one hundredfold, if

necessary, in order to conduct the heat of warm objects away from the skin.

Impaired circulation may make this impossible, and the resultant burn may not

even cause pain.

A deformed foot with bony prominences (knuckles of toes, tips of toes, heels,

and bases of toes at soles) may be continually rubbed or pressed by shoes. This

foot is frequently unable to perceive the extent of such pressure and may not

heal readily if injured. It can be burned at relatively low temperatures.

The following guidelines are therefore essential for all diabetics, to prevent

foot injury and the potentially grave consequences that may ensue:

. Never walk barefoot, either indoors or out.

. Purchase shoes or sneakers late in the day, when foot size is the greatest.

Shoes must be comfortable at the first wearing and should not require breaking

in. Request shoes with deep toe boxes. Pointed-toe shoes should not be worn,

even if the tips are blunted (as in many men's styles). Suitable, very

comfortable shoes are manufactured by Rockport. A variety of appropriate, dressy

styles can be purchased at b in New York City. A number of currently available

brands of athletic shoes and walking shoes are especially accommodating and even

have removable insoles so that orthotics (see below) will fit, without making

the shoe too tight. If necessary, I prescribe orthopedic or custom oxfords for

certain of my patients.

. Inspect the insides of your shoes daily for foreign objects, torn lining,

protruding nails, or bumps. Have them repaired if you find any of these.

. Don't wear sandals with thongs.

. Try to change to a different pair of shoes each day of the week.

. Ideally, your feet should be examined daily for possible injury or signs of

excessive pressure from shoes - blisters, cracks or other openings in the skin,

pink spots, or calluses. Be sure to

check between your toes. Use a mirror or have another person inspect your

soles, if necessary. Contact your physician immediately if any of these signs

are found.

If the skin of your feet is dry, lubricate the entire foot. Suitable

lubricants include mink oil, olive oil, any vegetable oil, vitamin E oil, and

emulsified lanolin. Do not use petroleum jelly (Vaseline), mineral oil, or baby

oil, as they are not absorbed by the skin. Do not smoke cigarettes. Nicotine

causes closure of the valves that permit blood to enter the small vessels that

nourish the skin. Keep feet away from heat. Therefore no heating pads, hot water

bottles, or electric blankets. Do not place feet near sources of warmth such as

radiators or fireplaces. Baths and showers should feel cool - not even lukewarm.

Temperature should be estimated with your hand or a bath thermometer, not with

your feet. Water temperature should be less than 92°F, as even this temperature

can cause burns when circulation is impaired. A bath thermometer is suggested.

Do not soak your feet in water, even if so instructed by a physician. This

causes macerated skin, which breaks down more easily and doesn't heal well. When

bathing or showering, get in, get washed, and get out. Don't soak. Beware of

rain, swimming pools, and any environment that may wet your feet or your shoes.

Do not put adhesive tape or other adhesive products like corn plasters in

contact with your feet. Fragile skin might be peeled off when the tape is

removed.

Do not put any medications in contact with your skin that are not prescribed

by your physician. Many over-the-counter medications, such as iodine, salicylic

acid, and corn-removal agents, are dangerous.

If the skin of your feet is dry, your cardiologist should try to avoid

medicines called beta blockers for hypertension or heart disease, as these can

inhibit perspiration that moistens the feet. Do not attempt to file down,

remove, or shave calluses or corns. This is dangerous. Do not permit

podiatrists, pedicurists, or anyone else to do so. If calluses are present, show

them to your physician. Ask him or her to arrange for your shoes to be

stretched, prescribe new shoes, or supply you with appropriate orthotic inserts.

Your physician may instruct you in the use of a shoe stretcher or " ball and

ring " to modify ill-fitting footwear.

' Do not trim your toenails if you cannot see them clearly. Ask a friend or

relative, podiatrist, or your physician to do this for you. If the corners of

your nails are pointed, you can file them with an emery board or have someone

else trim them. If you have thickened toenails, ask your physician to have

clippings tested for fungus infection. If infection is present, he should

prescribe tincture of fungoid. This solution must be applied twice daily to the

nails to be effective. It must be used for about twelve months to effect a cure.

Don't wear stockings or socks with tight elastic bands. Don't use garters.

Don't wear socks with holes or that have been darned. Phone your physician

immediately if you experience any injury to your foot. I consider even a minor

injury to be an emergency. Procrastination can be disastrous.