Dr. Virginia Parks is a board-certified podiatric surgeon with the Mid-Atlantic Permanente Medical Group. She sees patients at the Kaiser Permanente Tysons Corner and Caton Hill Medical Centers.
For people with diabetes, foot care is extremely important. In addition to regularly seeing a podiatrist, checking their feet at home and wearing well-fitting shoes, patients with diabetes now have another way to keep up with their foot health: remote monitoring.
Kaiser Permanente now has a remote foot monitoring program designed to catch signs of diabetic foot complications before they threaten limbs. Participating patients receive a smart mat that reads their foot temperature. A sustained increase in temperature suggests inflammation from friction and pressure that could lead to a new ulcer.
Diabetes and Your Feet
According to the U.S. Centers for Disease Control and Prevention, more than 37 million people in the United States have diabetes, and 96 million people have prediabetes. Diabetes can affect several systems in the body. As a podiatric surgeon, I see patients with diabetes who have challenges with their feet because of changes to skin and nails, decreased immune function, decreased circulation, and numbness in their feet.
Patients with poorly managed diabetes and patients who have had diabetes for many years are at high risk for developing peripheral neuropathy, which is caused by damage to the nerves. Symptoms of neuropathy can include tingling and burning sensations, as well as numbness. Pain is an important protective mechanism that lets us know when something is wrong and needs medical treatment. With peripheral neuropathy, individuals often do not feel pain and may not realize there is a problem, such as a blister, ulcer, or infection. Left untreated, these issues can rapidly escalate and lead to the risk of amputation.
Other diabetic foot complications include the following:
- Decreased circulation. Blockages in the arteries can lead to poor wound healing or gangrene (tissue death).
- Skin changes. People with diabetes are more prone to dry skin on the feet, which can lead to cracks, fissures, and calluses.
- Decreased joint mobility. Over time, tendons lose elasticity and become contracted. This can lead to hammertoe deformities (stiff, curled toes) and tight calf muscles. This can lead to persistent pressure on the tips of the toes or balls of the feet, and that can increase the risk for an ulcer to form.
- Weakened immune function. Diabetes can affect immune function, making the body more susceptible to infections. As a result, infections can spread very rapidly and cause significant tissue damage or loss, if not treated in a timely manner.
I encourage all patients with diabetes to prioritize daily foot care. Anyone with diabetes, and particularly those with decreased circulation and/or neuropathy, should check their feet daily, including the bottoms of their feet and between their toes, to monitor for any redness, swelling, blisters, ulcers, or drainage. If mobility is a challenge, ask a family member for help perform a foot check, or purchase a mirror with an extended handle to helpsee the feet.
Patients with diabetes should not walk around barefoot, even indoors. Wearing protective footwear helps reduce pressure on the feet and reduces the chances of stepping on an object that could cause a wound or infection.
Moisturizing is an essential step to prevent cracks and fissures. Callus management is important: Patients without neuropathy can try a pumice stone to smooth out calluses; those with neuropathy should talk to their podiatrist about management and treatment options.
Patients with diabetes who have neuropathy, decreased circulation, or a history of prior foot ulcer or amputation should talk to their physician about prescription shoes and insoles to help prevent complications.
Anyone with diabetes should take steps to control blood sugar to help decrease risks of ulcers and infections. Eating a healthy diet, exercising, avoiding smoking, and complying with diabetes medications can help prevent diabetic foot complications.
Remote Foot Health Program
Physicians at Kaiser Permanente can prescribe patients at high-risk of foot complications a foot mat that remotely monitors foot temperatures. This at-home foot monitoring program, which uses thermography technology, is designed for patients with a history of diabetic foot ulcers and/or amputations.
Patients are instructed to place their feet on the mat – they don’t even need to stand – for 20 seconds. The mat reads the foot’s temperatures, and that data is sent via a built-in modem for review. Fluctuations in foot temperature from day to day can be a sign of inflammation. An area with higher temperature may be at risk of developing an ulcer.
If there are concerning results, or if a patient is not performing the daily exam, Kaiser’s team will proactively reach out to patients to discuss next steps and schedule timely appointments. Patients may need an in-office visit to remove a callus, try different shoes or insoles, or try an offloading device that redistributes foot pressure.
Catching foot problems early is key to preventing complications, such as wounds and infections, which could lead to amputations. The goal is to minimize frequent office visits, decrease hospitalizations, and prevent amputations; we want our patients to be healthy, active and able to live independently.
We know remote foot monitoring works: In 2017, we enrolled 80 high-risk patients in a proof-of-concept research study to assess the technology’s benefits. In 2020, we published results in the BMJ Open Diabetes Research & Care. The results showed a 71 percent reduction in amputations and a 52 percent reduction in hospitalizations.
When to Talk to Your Doctor
People with diabetes who have any concerns about their feet should reach out to their primary care physician or podiatrist. Concerns may include neuropathy, calluses, blisters, bruising, dark discoloration to toes, new redness and swelling, ulcers, drainage, or foul odors. Early treatment is vital to prevent serious complications. If you are interested in remote monitoring, talk to your doctor about whether the program is right for you.
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