you this week on being well we're addressing diabetic foot care with podiatrist dr. Joseph for Jeannie a family foot care center we'll talk more about why diabetics need to pay special attention to their feet and how to take care of those minor problems before they turn into serious issues we've got a lot of great information for you coming up so stay right here production of being well is made possible in part by Sarah Bush Lincoln Health System supporting healthy lifestyles eating a heart healthy diet staying active managing stress and regular check-ups are ways of reducing your health risks proper health is important to all at Sarah Bush Lincoln Health System information available at sarahbush.org alphacare specializing in adult care services that range from those recovering from recent hospitalizations to someone attempting to remain independent while coping with a disability chronic illness or age-related infirmity alphacare compassionate professional home care additional funding by Jazzercise of Charleston dr. Joseph borghini joins me today from family foot care center and you have an office where in Charleston in Effingham alright well today we're talking about diabetic foot care I wanted to ask how big is your practice how many diabetics are you treating or what percentage I would honestly say that a majority of our practice is a diabetic population to say sixty eighty percent that would be a fair amount and in your time and being in a podiatrist that gone up over the years actually it's it's gone up over the years the sixty eighty percent is the most current number i'm going to say that it's probably gonna double that since it since i've been in practice we're going to get into some more statistics a little bit later as the show goes along but we just ask why do diabetics seem to have more problems with their feet than non-diabetics well the diabetic basically suffers from circulatory problems neurological problems they lose sensation to their feet the inability to heal wounds and the sugar builds up in the system and creates all kinds of issues with infection and so forth so what when someone comes into your office what's there what's the typical thing that you're seeing outside of the the common fair that we see the heel pain ingrown nails warts and things of that nature the diabetic population that we see is generally speaking coming in for what we would call at risk foot care that is the nail and calloused rim which you would think would be not an important thing but to the diabetic is very important we are able to provide palliative care and then we are able to assess any major problems that are occurring with that patient over time and eventually we're trying to stave off any complications that might occur we can identify any deformities that may lead to further problems down the road so is so like basic things even like trimming your toenails that can actually become dangerous for a diabetic absolutely diabetic who's suffering from loss of sensation to their feet poor circulation could inadvertently trim their nail cause it to bleed and create an infection I've seen that time and time again in my office so it's really not recommended a diabetic right any care to themselves regarding foot care and is there a big difference between the type 1 and the type 2 diabetes in terms of what foot issues the type 1 diabetic suffers from an insulin dependency so they have to have exogenously external insulin to not confuse the fact that type 1 is normally the childhood right onset diabetic the type to would be the adult on site diabetic normally they're the ones that are taking either Exantus insulin orally or injectable ok are they at risk for the same kind of foot issues yes see this new kinds of things and unfortunately the longer you have diabetes the higher your risk is for mortality ok well let's start back to the beginning sure just talk about some daily preventative things that you tell your patients diabetic patients and how to best take care of their feet here's a good thing that we tell patients by Amir ok put it on the floor examine your feet that way you can look actually on the bottom of their feet and the other thing I always tell them as look out for the scorpions in your shoes I am not kidding a diabetic will come in with something that they've gotten into their foot either because it was in the shoe or they didn't know it was there so it's important to examine their shoes not along with their feet so it's very important to to do the proper hygiene cleanliness is very important making sure you're clean between the toes also when you're in the shower or bath make sure you dry your feet off completely any excessive moisture between the toes can create problems such as athletes foot and so forth ok what about for you know women out there who are diabetic Singh they like to get pedicures and things like that is are there some risks for diabetics who go and get pedicures done just as I said with self-care you should be very careful when you're doing professional care outside of a doctor's office make sure that the instruments are clean and sterilized very important the Whirlpool's have a tendency to sometimes contain bacteria and fungus and those things should be cleaned out each and every time a person uses them so you really want to be observant too how that pedicurist is doing their job and how their office is set up okay let's talk about Footwear just what should what should diabetics be looking for in terms of shoes for everyday use and then we'll get into if you want to do some athletic things and exercise well it's a great question that you asked that because we provide diabetic shoes to our patients it's actually through the Medicare system but other insurances will reimburse for that as well but the shoe is specifically designed to the diabetic it's an extra depth shoe what it like DEP what does that it means that the the shoe is extra depth for the purpose of an extra type of insert that's going to go in the shoe that's going to modify the amount of friction that's occurring on the foot can reduce that friction and heat and so forth down the foot then you can prevent the chance of getting ulceration or breakdown of the skin callous patients that have deformities that are diabetic such as a bunion or a hammer toe that's a deformity that can generally speaking cause irritation so you want a high toebox you want materials that are natural stay away from the nylons anything that doesn't wick away moisture you want to be careful of those of those types of things in the shoes that you buy okay so what about women who want to wear some high heels or in the summer flip-flops or sandals not well again again even if you're not diabetic it's important to understand that those are what i would call a special type shoe that you don't need to be wearing daily I see this all the time patients will come in they're continually wearing the flip flat as a everyday shoe a women that want to wear the high heel that's fine but it's not an everyday type thing so you just have to be cautious and careful and as we tell patients anytime you're buying shoes buy them at the end of the day and when your feet of the most swollen it's very very important so should diabetics be wearing shoes all day I mean they obviously have to wear them when they're at work but what about when they come home so they take those shoes off and walk around I would definitely take the shoes off it's acts as well examine their feet but it's important to put something on I would not necessarily walk barefoot through the house again I'm always fearful that diabetic that doesn't have the sensation that we would normally expect to have in our feet and it's important to protect them so slipper some kind they actually make a diabetic slipper that's extra depth and has an insert so you really have to be cautious of the types of shoes you wear and when you wear them okay so have you had cases where something like a simple blister or a wart on a diabetic foot has escalated into something much worse yes I have and unfortunately it's a situation where the diabetic has left it unattended and has not sought care and creates a problem okay and that problem can turn into an ulceration or opening and in the bottom of the foot okay so really some of those simple things for the rest of us can relate for diabetics lead to much worse correct right so what are some of the early signs that someone should if they're watching this show and they go get their mirror then look at it foot like hmm I see something on the bottom of my foot when should they see their doctor their podiatrist if there's a area of redness or irritation callus anywhere on the bottom of their foot get it examined skin condition abnormally cracked or dried skin on the bottom of their feet also look at their nails toenails particularly fungus type toenails that can fungus nails there's those are those are really important to make sure that you're doing everything you can to prevent that fungal condition from spreading okay so something you may think of it's just dry skin it's winter you're not a big deal eczema could be the problem okay so how does it usually work if someone does find that they have something on their foot do they see their primary care physician or provider person then they get referred to you some patients directly come to me or podiatrist others may see their primary doctor and they may refer to that podiatrist so that's usually how the patient traffic pattern flows it's been that way for years and we just tell patients if you're seeing your primary doctor tell them that we're seeing you if not we communicate through letter okay that's good to know so we talked a little bit about everyday shoes as we all know it's good for all of us to exercise even diabetics what about what kind of shoes did they need when their start maybe they're going to do a walking program or interesting weightlifting or something what kind of shoes and again without using brand names again we want to make sure that that shoe is properly fitted a lot of times patients will go into the to the shoe store and say oh I'm just a size 7 or size 8 or whatever but make sure you get sized that's the first thing the next thing you want to make sure is that is that shoe deep enough to accommodate any sort of insert that you're putting the shoe is the toe box high enough to accommodate in deformities around the toes okay mrs. Blackstock the high high high to the front of the shoe okay because you don't want your toes that the top of the shoe pressing downing right when i found was interesting is that the slip-on type shoot a lot of patients like to wear are wearing them too big okay and so that slippage can cause some friction problems okay so what is the friction caused problem that's he that he can create skin breakdown eventually a blister and a possible ulcer let's just start smaller yeah that's good absolutely what about what do you recommend in terms of exercise activities that are good for diabetics I know it to the diabetic but to most patients i recommend walking okay alright and running is fine but if you're not doing it as a as a everyday type thing i would probably stay away from walking actually can make you be very healthy and the recommendation and people think it's it's a long way but a good mile walk a day is is very very good to do so you're diabetic patients that exercise are they are you finding them better off health absolutely yes a good recommendation yeah absolutely okay i looked up this term called neuropathy and that's associated with diabetes what is that again i think we kind of alluded to what neuropathy is neuropathy is actually the loss of sensation to the feet or abnormal sensations to the feet okay it's actually a breakdown of the insulation around the nerve that allows that nerve to operate the way it should that is the speed of that signal traveling from the brain to the from the foot back to the brain is slowed down okay or can get lost and so that insulation is kind of like the insulation around a wire okay think of it as the insulation around a wire prevents the heat from building up in the wire well the same thing happens with a nerve as that insulation starts to unravel is that sugar starts to break down that insulation the nerve lose its ability to function properly and provide the sensations back to your brain to let you know what's going on okay does that neuropathy only happen in diabetics or does it happen as people age it can happen in as you age but there's certain diseases that are relative for that type of condition years ago syphilis alcoholism was the big thing beat the deficiency vitamin B deficiency but diabetic neuropathy is that probably the biggest thing that we see the biggest thing that we see is the pain that's associated with it okay which is if the nerve is sort of yeah why do you get pain pain is related to the fact that the nerve is sending a signal that the brain doesn't know what to do with okay and there's a substance that's released it's actually called substance P and it's released and it causes pain and it's uncontrollable pain okay almost it's almost like you're you're injured typing okay so we're how do your patients describe that pain a shooting stabbing tingling sharp knives type type sensation in the bottom in the bottom of their feet sometimes in effect the whole foot up the leg okay so it do you see that in later stage diabetics or can it have I see it more in the diabetic that's out of control with their sugar that is they're not managing their diet properly they're not taking their medications when they should they're not checking their diabetes the way they should by seeing a doctor it's the diabetic that's just not where they need to be with control and staying on top of their condition okay and it has to do with a denial factor if you have a condition of that crime icity you start to say I don't have it do you find that you have people like yes absolutely why do you think any it's human nature you have it can dition you ignore it I think it'll just go away unfortunately diabetes doesn't go no it doesn't know because one of the things we talked about can happen he says starts off with this small spot or whatever what happens next and it's kind of la custard well as the the blister breaks down if you don't get a ulcer you eventually will if you're not treated and that ulcer could turn into an infection and possible amputation okay so what what are the what's the likelihood if someone has this untreated ulcer that they're going to seek infection can lead to hospitalization hospitalization requires long-term antibiotics wound care that wound care requires usually debridement it's a that's a big word but that's actually cleaning up the wound allowing it to try to heal lots of money is spent to do that so it's a situation where they're going to do everything they can in medicine and as well as our field to save the limb in the foot as I tell patients if you have a diabetic ulcer that as a whole or an opening in your foot your diabetes has gotten malignant and statistics show that you have a greater risk of death if you're a female if you had breast cancer you have a less chance of dying if you have a male and you have prostate cancer you have less chance of dying if that diabetic ulcer occurs Wow just from something on the bottom of your foot so what kind of treatment do you provide for foot ulcers and for wound care and things like that won't care we're generally seeing them on a weekly basis providing removal of the bad tissue trying to provide topical remedies to allow that to heal taking the patient off weight-bearing that's the gold standard try to get their foot off the ground sometimes we'll cast them put them in a total contact typecast diabetic shoes is a preventative measure eventually we want to get that to heal sometimes the surgery has to be done to take away any of the deformity that's in the foot and conditions can occur where there's actually breakdown of the foot that has collapsed completely collapse foot called a shark whole foot and that unfortunately is a severe case but we do everything we can in a preventative way to keep that patient having the digit the limb and that part of their body to stay on them as long as possible so what would you say if someone has some kind of ulcer what stage I don't know if you can identify what stage could it be at that you could actually cure it and take care of it and have it go away usually the earlier the better okay the faster they come in with it the better the chance of its healing as tissue start to be exposed and not to alarm your viewers but if we start to see any fatty tissue or muscle or actually bone exposed that that becomes a severe serious problem yeah because that I can't imagine that gets infected and we're we're talking about something they catch every bug there is okay every bacteria so if it's just looks at this stage like maybe a red spot or a blister that's very important to get it looked at okay yeah so do you recommend that diabetics have their own it seems like the feet are one of the first things one of the biggest problems that they have that they have a podiatrist or a regular person that they can see they should be seen by a podiatrist minimum of every six months okay minimum that's twice a year and we see the actual geriatric patient probably four or five times a year for foot care in general but it's important that you minimally see that podiatrist every six months just as well as you take care of your eyes as a diabetic you should take care of your yeah I've heard diabetics need to have their eyes checked more than non-diabetics too because that's the other area that seems to be problematic are there just some other things that you'd like to tell people out there as far as their foot care if they're diabetic give us out of a list of what dr. Bohr genie says again kind of review it's important that you're examining your feet on a daily basis it's important that you have proper shoe gear don't keep wearing the same shoe over and over and over just as a runner would replace a shoe every 300 miles I would replace that shoe that you're wearing probably every three to six months okay and it's important that you're seeing that is the podiatric profession to have that routine examination even if it's just a look-see doesn't that actually have to be a hands-on treatment it's important that they do that foot care in general is an important thing regarding nail and Cal is trimming so anything that you have suspect about get it looked at whether it be by myself podiatrist in the community or your medical doctor and get it and get it looked at okay very important all right well we're all out of time I want to thank you for stopping by the show to that I thank you very much love your jacket thank you thank you Merry Christmas a diagnosis of rheumatoid arthritis or RA can be pretty scary that's because the chronic condition can cause painful damage to your joints Vivien Williams introduces us to doctors at Mayo Clinic who say an early diagnosis and an aggressive approach to treatment may help more people get there ra under better control at first Pam cynic rope thought her knee pain was from overdoing it on the tennis court I thought oh it's just you know typical sports injury then she hurt her other knee and then I injured my left shoulder then pain and stiffness in her wrists and fingers that would come and go Pam was diagnosed with rheumatoid arthritis so yeah I was scared I thought my life was basically over so what is rheumatoid arthritis so this is an autoimmune inflammatory disease and when we say autoimmune it's really the immune system attacking oneself dr. John Davis says the joint capsule has a lining of tissue called the synovium the synovium makes fluid that keeps the joint lubricated when you have rheumatoid arthritis your immune system sends antibodies to the synovium and causes inflammation this causes pain and joint damage especially in small joints and fingers and hands but it can affect any joint so and you find out you just have to just let go and express your feelings cry do whatever you need to do let the emotions out and then get into problem-solving mode well I call it my own personal yogurt for Pam that means controlling what she can she eats a very healthy diet researches to learn about ra and she began treatment fast the current monitor is so-called treated target so we want to initiate a treatment we would then want in a fairly short period of time measure if it's working and doing something or not and if not did begin making changes in sort of an assertive fashion over time I'm on methotrexate and low-dose prednisone prednisone taken short term to calm inflammation and methotrexate long term to keep the RA in control if those treatments are not enough they can be combined with water all biologic treatments that the majority of people with our current techniques and with using combination of medications together get good control and can get back to their usual functions the majority of the time dr. Davis says patients like Pam may soon benefit from research at Mayo Clinic that explores new therapies and how a person's genes might tell doctors which medications work best they're searching for new ways to give each individual patient exactly the care they need Pam knows RA is a lifelong condition flare-ups may happen and she has to pace yourself sometimes but treatment is working I feel great I feel better than I've felt in probably 10 years for the Mayo Clinic News Network I'm Vivien Williams there is no cure for RA and some patients continue to struggle with significant symptoms but with aggressive and prompt treatment dr. Davis says most RA patients can get control of the disease well thank you for joining us this week on being well look for past and present episodes on our youtube channel that's youtube.com slash WEEI you will see you next time production of being well is made possible in part by Sarah Bush Lincoln Health System supporting healthy lifestyles eating a heart healthy diet staying active managing stress and regular check-ups are ways of reducing your health risks proper health is important to all at Sarah Bush Lincoln health system information available at sarahbush.org alphacare specializing in adult care services that range from those recovering from recent hospitalizations to someone attempting to remain independent while coping with a disability chronic illness or age-related infirmity alphacare compassionate professional home care additional funding by Jazzercise of Charleston you