Diabetes is a systemic disease that can have a drastic effect on the feet. Wounds and ulcers that occur in diabetic feet can be very difficult to heal and are especially susceptible to infection, which can result in myriad problems. The major percentage of amputations not due to trauma are related to diabetes.

Since diabetes affects many millions of Americans, this problem is hardly isolated. Diabetics need to pay special attention to their feet because sensitivity in this area is often lost. A diabetic may not feel a stone in his or her shoe and may not notice a small sore that can become a wound. To complicate matters even further, healing is slow for diabetics. An ulcer could take two years or more to heal, and if it can't be healed, amputation may be recommended to avoid its spreading to the leg.

Fortunately, preventive measures and new methods of healing have been developed, offering hope to diabetics. One method utilizes surgery to stretch the Achilles tendon. By doing this, the force on the ball of the foot applied with each step is reduced. This lessens the likelihood of developing an ulcer and allows those that do develop to heal more rapidly. Another method uses tech- nology called "skin equivalent dressings" to shorten healing time. Podiatrists are an important part of a diabetic's health-care team when the problem of foot ulcers arises. Diabetics should seek podiatric help for routine foot care as well as foot problems directly related to their diabetes.

An Ounce of Prevention

Diabetics can help prevent foot wounds by taking the following precautions with their feet:

• Choose shoes that fit well and don't slide on heels or cramp toes.
• Check shoes regularly (and before putting them on) for foreign objects that could hurt feet.
• Never walk barefoot. Use water shoes that offer adequate protection while swimming.
• Inspect feet in the morning and at night. Look for sores, cracks, calluses, and red spots that could lead to ulcers.
• Seek podiatric help for routine foot care such as nail cutting, and for problems such as calluses.
• Of course, keeping blood sugar under control is essential for all diabetics and aids in foot health as well.