Diabetes is a disease that affects the body’s ability to use food properly which results in more sugar or glucose freely circulating in the blood.   If you have diabetes, you are 15% more likely to develop an issue with your feet at some point in your life. ^[1]  According to Diabetes Canada, over one third of Canada’s population is living with diabetes or prediabetes.

Diabetes & feet

It is possible to live a healthy and happy life with diabetes.  To do so, you must learn and follow proper diabetes management, which takes awareness, discipline, and commitment to your health and body.  If blood sugar is not well controlled, a person with diabetes will be more at risk for developing complications.  Complications commonly occur in the feet because the small blood vessels and nerves are more susceptible to damage from high sugar levels circulating in the blood.  Less than optimal circulation can affect a person’s ability to heal from even minor cuts and scrapes.  Additionally, the feet may not be able to sense injury when nerve sensation is affected.  This results in altered protective sensation which manifests as pins and needles, numbness and even hypersensitivity and pain.  If skin breakdown occurs from injury such as friction and pressure, this can lead to serious infection if left untreated.

Preventing complications in the feet

BioPed Footcare has lower limb clinicians who will assess your feet regularly for changes.  This includes completing a Diabetes Risk Assessment during an appointment to determine your risk for complications.  Many BioPed locations have Registered Chiropodists and Advanced Footcare Nurses who will safely treat your nails and skin and monitor your foot health for changes.  At BioPed Footcare, we make sure your footwear fits properly to support and protect your feet.  Custom foot orthotics to offload high pressure areas on the foot may be considered and education will be provided on what can be done at home to promote better foot health.

Tips for good foot health at home:

1. Inspect feet twice daily for scratches, blisters, redness, hot spots or any draining liquid
2. Always wear something on your feet for protection, such as indoor footwear
3. Wearing light coloured socks will make it easier to see blood or pus if an injury does occur
4. Ensure your shoes are empty before wearing them
5. Buy shoes later in the day as swelling can accumulate as the day progresses making feet bigger
6. Avoid smoking as it can decrease circulation to the legs and feet
7. Wash feet daily, including between the toes using a mild soap, and dry well afterwards
8. Apply moisturizer to the tops and bottoms of feet if the skin is dry avoiding in between the toes; dry skin cracks easily which could lead to an infection in the feet and legs
9. Avoid wearing socks or stockings that are too tight as this can restrict blood flow
10. If sock seams create an indentation in the skin, they can be turned inside out
11. Avoid putting anything sharp to the feet such as scissors or razors to remove callus or corns
12. Avoid use of medicated corn pads as they contain an acid that could harm healthy skin as well
13. As the colder weather months are nearing, it is best to not use items such as hot water bottles to reduce risk of burns

It is recommended that people who have diabetes be assessed by a lower limb clinician in addition to seeing their primary care practitioner on a regular basis to determine how best to improve and maintain foot health. Keeping blood sugar well-controlled in a healthy and consistent range is vital. If you have diabetes and want to start your journey to healthier feet, give your local BioPed a call today to make an appointment to be assessed!

^[1] https://my.clevelandclinic.org/health/diseases/21510-diabetic-feet

When you live with Diabetes there are very specific instructions you follow in many aspects of your life, to optimize your health and wellness. From diet and medication, to exercise and footwear, keeping healthy is essential; why not use all of the tools available to you to meet those active lifestyle goals for health and quality of life? One wonderful tool for improving quality of life, in relation to the lower limb, is the compression stocking.

Why should you consider compression if you have diabetes?

Often, along with Diabetes, comes peripheral vascular disease. If you happen to be affected by venous disease, you will experience edema or swelling of the lower limb, especially ankles and feet. This swelling can be debilitating when trying to keep moving for health, and can make it difficult to find proper fitting footwear. Compression socks for diabetic patients are available and BioPed clinicians can help assess, fit and recommend the compression therapy that is right for you!

Why is a clinical fit best?

One of the issues with fitting compression for those living with diabetes is the conditions of peripheral arterial disease and peripheral neuropathy. Peripheral neuropathy is when there is numbness, in this case, in the feet. When experiencing neuropathy, diabetic patients, or anyone with this condition, cannot feel irritants or pain in the affected area.

This is dangerous, especially for the diabetic foot because even small friction tears, calluses or wounds can be long lasting and get much worse before they even begin to heal due to circulation issues that typically come with diabetes.

Due to peripheral neuropathy, seams and elastic in classic socks can cause irritations, friction and wounds to occur in diabetic feet that can become long lasting health issues. And if someone also has arterial concerns, these wound take a very long time to heal. It is imperative that the fit not be too small or creased, causing indentations in the skin and worsening the effects of swelling. It is also important that the socks are not too big, leading to folding over and falling down, rendering the compression garment ineffective.

Finally, if you are diabetic and have peripheral arterial disease, compression may not be right for you depending on how advanced your condition is. For this and the above reason, obtaining a clinical assessment and fit is important.

How can compression help?

Compression stockings help to improve circulation and blood flow, preventing pooling in the lower limb and reducing swelling. Compression stockings are typically graded compression, meaning it is strongest at the ankle to prevent pooling and weakest at the toes and the calf to prevent gripping or biting and allow blood to flow freely back to the heart.

Compression grades can be as low as 8-10 mmHg and also include 15-20 mmHG, 20-30 mmHg (which is medical grade), 30-40 mmHg and above (these are typically reserved for venous surgery recovery and severe blood clots). Although diabetes isn’t considered a contraindication for compression; it is important to consult your family doctor or nurse practitioner before deciding to use compression. You can always have your BioPed clinician refer you back to your doctor for a consultation, or communicate with them directly, as a prescription is always recommended for compression. If arterial deficiencies are suspected, further testing may be required to ensure compression is right for you.

Compression options for the diabetic patient

One of the premier companies we use for compression is Sigvaris. Their quality and fit are exceptional, and they have a variety of fabrics and styles to suit the needs of all patients, including if you are diabetic. Sigvaris has a diabetic compression sock that is cushioned at the toes and along the footbed to reduce pressure and increase comfort along with a flat seam at the toes to reduce irritation. The Cushioned Cotton option from Sigvaris is one that BioPed clinicians are proud to recommend to our diabetic patients. The breathability, sensitivity to the skin and increased padding on high pressure areas make this compression one of the best choices for diabetics with swelling. It also comes in 15-20 and 20-30 mmHg medical compression grades, making it more accessible for patients just starting out or in need of medical grade compression. Although other fabrics are available, discussions surrounding wounds, neuropathy and skin sensitivity can help rule out the ones that will aggravate the skin and irritate the sensitive diabetic foot.

Some compression is better than no compression. If the grade of compression is a concern for you or your doctor, you can start slow. We also offer donning and doffing devices, which help you get the socks on and off. Most notably is the rubber gloves that can help grip and slide the compression over the legs. Your BioPed clinicians go over different techniques for donning and doffing for ease of wear to fit your mobility and dexterity abilities. Patient education is something we at BioPed are passionate about!

Bring your diabetic compression questions to us in clinic or over the phone! Check out the BioPed location closest to you, schedule an appointment online or give us a call to book a consultation today and discuss your diabetic compression needs with our certified clinicians.

The symptoms of diabetes can be difficult to recognize, especially if you’re not familiar with them. Diabetes affects over 11 million Canadians, which makes it one of the most common diseases. Below, we’ll talk about what diabetes is and how to recognize the signs.

What is diabetes?

Diabetes is an autoimmune disease that affects the body’s ability to produce or use insulin. Insulin is a hormone that is created by your pancreas and helps to modulate the amount of sugar (glucose) in your body’s bloodstream at any given moment. Without the ability to regulate the amount of glucose in your body, serious health complications can arise.

There are 3 main types of diabetes:

• Type 1 – Your body cannot produce insulin. This type of diabetes often presents in the early years and requires injections or an injection pump to get insulin into the body.

• Type 2 – This is the most common type of diabetes, accounting for roughly 90% of all diabetes cases. With Type 2 diabetes the body is unable to use insulin properly or is simply not making enough.

• Gestational – Diabetes that onsets during pregnancy and is temporary. Gestational diabetes mimics type 2 in that the body just is not producing enough insulin.

One other type to make note of is Prediabetes. This state is when the blood sugar levels are abnormally high but don’t cross the threshold to be classified as type 2 diabetes. It is often an early indicator of an eventual Diabetes diagnosis.

How do I recognize if I might be diabetic?

There are many different signs and symptoms of being diabetic. Below, we’ll talk about the more common signs and complications of diabetes. Please note if you suspect that you might be diabetic, reach out to your family physician or nurse practitioner.

Diabetic peripheral neuropathy – This term refers to pain or numbness in the extremities as a result of nerve damage due to high blood sugar levels. With peripheral neuropathy, the body can become less sensitive to temperature changes or feeling things such as small pebbles in a shoe. As peripheral neuropathy gets more severe the ability to feel moderate to severe pain diminishes and numbness can start to take over. This puts a person at risk for developing a sore on their foot.

Lack of energy – As the body is not producing or using insulin correctly, sugar you put into your body isn’t being used efficiently. This often can present as being hungrier and more tired as your body is not optimizing nutrition usage.

Slow healing wounds – As blood sugar rises, the body’s ability to heal wounds can become impaired. This can result in cuts that stay around for a long time and never properly heal.

Other signs and symptoms to make note of; urinating frequently, rapid weight gain or loss, increased thirst.

What can I do if I am diabetic?

It’s important to lower and stabilize your blood sugar levels. Also, you will want to follow closely with your family doctor/nurse practitioner. Finally, it is important to have routine eye and foot exams. Come see us for all your diabetic footcare needs!

Did you know that at BioPed we offer clinical foot assessments where we use a Diabetic Risk Assessment Screening Tool? This tool helps us and your physician/nurse practitioner assess your lower limb risk level and recommend when to come back for another assessment. Utilizing this tool is key in monitoring your foot health long term.
Foot and lower limb health is crucial for people who suffer from diabetes as otherwise small problems can become big ones if not addressed quickly. There are many different products and services that we provide that can help.

Socks This might seem small but a great quality sock can make all the difference. Whether it’s a simple diabetic crew sock from SimCan or a medical grade compression device from Sigvaris, making those toes happy is critical.

Footwear is another tool at your disposal to combat the effects of diabetes and lower limb pain. Having a properly fitted shoe is important in reducing pressure points on your feet. Good shoes make your feet more efficient at managing the pressure you put on them daily.

Even orthotics can make a huge difference! Whether you are experiencing general leg and foot pain, a wound, or just a callus…no matter what the issue is, our BioPed clinical team can address it all with orthotics.

If you’re suffering from lower limb pain that limits you from doing what you love, please book an appointment today! At BioPed Footcare, whether it’s socks, orthotics, footwear or skin & nail care – we are here to help you. Meet with one of BioPed’s lower limb clinicians to see how we can keep your feet and legs healthy!

Whether you have Type 1 or Type 2 diabetes, or know someone who does, it affects every aspect of your life, making mundane activities and occurrences more important to take note of, especially when it comes to foot health. The question you may be asking is: how can BioPed Canadian Certified Pedorthists help care for my feet?

The answer is simple: we have the knowledge, skills, and products to make sure your feet are kept happy and more importantly, healthy.

• Neuropathy – this is a condition where the nerves in the feet become affected by high blood glucose levels. It may present as tingling and/or burning, or cause numbness in your feet. When this happens, you can’t always feel what’s going on, such as areas of pressure or pain from tight shoes. Due to the lack of nerve communication to the brain these concerns can quickly turn into much larger issues; couple that with the slower healing rate of diabetic clients and an avoidable area of high pressure can go unnoticed and untreated until it becomes a more serious problem.

• Corns and Calluses – These present as small areas of thickened skin, either with a pinpoint head or just as a general area of toughened Corns and calluses occur wherever there is high pressure or friction and the skin is trying to protect itself by thickening and hardening, but this can cause larger issues if left untreated. In someone with diabetes, the danger is that these callused areas can quickly become wounds due to a breakdown of skin. Any breakdown of skin can become infected and lead to further concerns.

• Diabetic Ulcers or open/slow healing wounds – when friction in the shoe is left untreated, or you happen to injure yourself (step on something sharp, stub your toe, or break a nail), it may not take a significant amount of time to heal if you otherwise have zero health concerns. However, it takes longer for most diabetic clients. If a diabetic ulcer or wound develops on the foot, it is a lengthy process to heal and recover, especially when the initial cause is left unaddressed. Bandages and wound care can only go so far in ensuring the foot heals, but offloading the pressure on the wound and giving it the time and space to recover is key!

• Swelling – as previously mentioned, sometimes blood flow can be affected by diabetes. Venous insufficiency can cause swelling and blood pooling in the lower limb and foot, making it difficult to find proper fitting shoes, especially if bandages and wound care are required on top of a distended foot. This often leads to footwear being worn that is too large, which in turn can cause rubbing and sliding in the shoe early in the day before swelling has set in.

How can a BioPed Certified Pedorthist help diabetic patients?

In short, a pedorthist can assess the foot for sensation, as well as biomechanical and structural issues. They offer proper shoe fitting assessments and orthotic care to take the pressure off painful or high-pressure areas. Pedorthists ensure proper fitting footwear meets the wearer’s needs with a variety of tools and offerings.

Custom Made Orthotics – Orthotics made for diabetic patients are much more accommodative. Key features often include a light-coloured incredibly soft top cover in order to see any residue from wounds and off load high pressure areas. Softer materials are used throughout the fabrication process to ensure no ridges or pressure that would cause friction against the foot, therefore negating the possibility of developing sores or blisters. Cushion is truly key, and the custom orthotics are able to be moulded around the contours of your feet, ensuring full contact and full cushioned support.

Over the Counter (OTC) Orthotics are generally not recommended for diabetic patients; usually they are made of firmer materials and have limited moldability to fit the exact shape and contours of the foot. However, when an OTC orthotic is in the hands of a BioPed Pedorthist, modifications can be made for improved foot structure, comfort and mobility.

Footwear for the diabetic foot

This can be a real doozy! When swelling, neuropathy, wound care and pain are all against you, finding a shoe that can handle all the daily struggles of the diabetic foot is a tall order. Where there is neuropathy present, it is important that the shoe not be fitted too tight or have seams that can rub against the foot or cause pressure; often diabetic patients will want a tighter fit to ensure they can feel their footwear when their neuropathy kicks in, but doing so can cause other issues, such as blistering, indentation, bruising from seams and callusing to occur. When selecting footwear for those living with diabetes the current condition of the foot and potential risks of what can happen to the foot need to be addressed. BioPed clinicians are trained to help you find the best fit for your foot.

A shoe style often recommended for a patient living with diabetes is the Saucony Echelon. This style of shoe has many benefits for the diabetic foot including coming in various widths, and being more stable and roomy throughout. It is a laced shoe, making the opening (throat) adjustable to ensure ease of donning and doffing by minimizing friction.

Footwear modifications

If you’re not in the market for a new shoe, but have a suitable, well-fit pair yourself that needs a few simple modifications to make it comfortable and appropriate for your foot, BioPed Pedorthists can make that happen! With our on-site labs, shoe modifications are another solution we offer you to complete the treatment plan necessary to keep your feet healthy.

Common footwear modifications for diabetic patients include, but are not limited to:

• Spot/ Full Shoe stretching: This entails leaving the shoe in our care for 48 hours where we place a shoe stretcher inside to stretch the upper material to make more room for your foot, or apply a ball stretcher to a specific spot that may need to be softened and stretched to relieve a point of pressure, such as at the side of a bunion.

• Addition of padding to elements of the shoe: Another common modification we make to diabetic footwear is the addition of padding along seams, the tongue, the heel and even the shoe’s insole to relieve pressure.

Additional diabetic footcare solutions

Diabetic socks – A company called Simcan and other diabetic socks are tailor made for the diabetic patient. They have no elastic at the top of the sock to ensure there is no digging in the ankle or calf, and they typically have no seams in the toe area that could otherwise cause indents or pressure, particularly in those who have neuropathy.

Medical Footcare – Most BioPed clinics have a Footcare Nurse or Chiropodist on site to serve your medical footcare needs, such as toenail trimming and corn and callus removal.

BioPed Pedorthists and the entire BioPed team are trained and ready to assist you with your Diabetic footcare needs from orthotics and shoes to medical footcare. The care doesn’t stop at the door! We suggest regular follow up appointments for our diabetic patients to ensure treatment is progressing appropriately, allowing us to change and adapt as needed to ensure your feet are healing and healthy. If you or someone you know has diabetes, foot health is incredibly important to their quality of life and impacts their lives daily. Relieving discomfort is what we do, so find a BioPed location near you or give us a call to book an appointment today. Good foot health is essential for all, especially those who have compounding health conditions. Let’s take care of our feet together and build a sustainable and comfortable life from the ground up.

It’s National Diabetes Awareness Month in November, and communities across the country are working together to raise awareness about the disease.

According to Diabetes Canada, over one third of Canada’s population is living with diabetes or prediabetes. Managing your blood glucose can help prevent many other health problems that can often occur as a direct result of uncontrolled diabetes.

Diabetes can affect almost every part of your body.

Common diabetes complications include,

How can diabetes affect the feet?

When blood sugar is elevated, internal organs are more susceptible to damage and the risk for complications involving the feet is more likely. The lower legs and feet are particularly at risk as they are farther away from the body’s core. Before a person even knows they have diabetes, they may start to experience pins and needles in the toes and feet, this is known as peripheral neuropathy and can result from uncontrolled diabetes. It impairs your ability to sense an injury or your protective sensation. In other words, if you step on something sharp or if your shoe is causing a blister, you may not be able to sense something is wrong. As a result, skin can break down.

Diabetes can also negatively affect blood circulation. The small blood vessels in the feet can be affected by excess sugar circulating in the blood. Less than optimal blood flow can affect a person’s ability to heal from even minor cuts and scrapes. Additionally, if the immune system is compromised, untreated skin breakdown and wounds can lead to infections, amputation and can even be life-threatening. The nails and skin of the feet are at risk for infections such as fungal toenails or cellulitis. These issues require prompt and proper care to reduce the chance of further complications.

Preventing complications takes a team!

If you have diabetes, it is imperative to stay in regular contact with your Family Doctor or Nurse Practitioner and possibly an Endocrinologist, to make sure your blood sugar is under control and your overall health is monitored.  Part of your diabetes care team includes the Medical Footcare Team at BioPed. BioPed clinics are made up of multidisciplinary teams of lower limb clinicians who share a common goal. Certified Pedorthists, Registered Chiropodists and Footcare Nurses all strive to improve the health and comfort of their clients by working together with them and the rest of their diabetes care team to prevent diabetes-associated complications.

Having consistent and regular footcare by one of our Registered Chiropodists or Footcare Nurses will keep your skin and nails in good shape and address any issues that may arise. Your BioPed team will spend time with you to ensure you know what to look for and how you can monitor your feet at home.  They will discuss effective and beneficial treatment options catered to you and your lifestyle. If you have pain or discomfort in your feet, BioPed’s Certified Pedorthists and Registered Chiropodists can assess your lower body mechanics, including the way you walk. You may benefit from custom foot orthotics that will offload high pressure areas on your feet and new footwear that fits you well and is appropriate for you and your activities of daily life.

Call us today, we are looking forward to seeing you!

If you’re suffering from lower limb pain that limits you from doing what you love, please book an appointment with a BioPed Clinician to see how we can keep your feet and legs healthy!