For most people, a bad shoe day means a blistered heel or painful arch that goes away quickly. But for people with diabetes, poor footwear can trigger serious problems, such as foot ulcers, infections, and even amputation.
Foot problems aren't inevitable, though. Ralph Guanci learned the hard way to pick his shoes with care and to stick with wearing them because they're good medicine for his feet.
Diabetes is a serious disease that can cause debilitating nerve pain.
Guanci, 57, a businessman in Carlisle, Massachusetts, was diagnosed with type 2 diabetes 25 years ago. For the first two decades, his feet seemed fairly normal, and he gave little thought to footwear. "I wore anything I wanted," he says.
But a few years ago, he developed foot trouble: a foot bone injury that prompted recurring, infected blisters on his sole. After doctors cured the problem with surgery and antibiotics, Guanci started wearing only one brand of comfort shoes called SAS that his podiatrist had recommended.
"The only times I've violated that, I usually regret it," he says. During one business trip, he ditched his podiatrist-recommended shoes for a fancier pair. "I wanted to look dressy, so I wore an expensive pair of shoes." He wasn't planning to walk much, but after dinner, his companions sprung a surprise plan: a two-mile stroll back to the hotel.
"When I got back to my room, my sock was full of blood and there was a huge blister on my foot," Guanci says. He flew home that night and went straight from the airport to his podiatrist's office. The blister, which was on the ball of his foot, forced him onto crutches and took four months to heal, he says.
Shoes for Diabetes: Double Trouble for the Feet
Why are diabetic feet so vulnerable?
Diabetes patients -- who number 17.9 million in the U.S. -- know that good blood sugar control reduces risk of complications. But poorly controlled diabetes delivers a double whammy to the feet.
Diabetes can cause nerve damage, or neuropathy, that lessens the foot's sensitivity to pain. Guanci's nerve damage is extensive. After years of "funny, tingling feelings in my feet" -- a sign of abnormal nerve function -- he has now lost all sensation in both feet, he says. "I broke a big toe once and the only thing I noticed was that my toe was swollen. I didn't feel a thing."
Doctors see many similarly affected patients: those who have stepped on broken glass, knitting needles, syringes, or nails and never felt pain to alert them to injury.
Nor can they sense foreign objects in their shoes. James McGuire, DPM, PT, director of the Leonard S. Abrams Center for Advanced Wound Healing at Temple University's School of Podiatric Medicine, described one patient who didn't feel a jack, the star-shaped plaything, inside his shoe. "He just put the shoe on, stepped down and drove the jack into his foot and walked around all day and ended up with an infection from that."
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