The Diabetic Foot
The early symptoms of a Diabetic Foot include pain, discoloration, loss of sensation, poor balance, and a “pins and needles” feeling. As the disease advances, there is an ever-increasing vulnerability to soft-tissue wounds that develop into nonhealing ulcers and infections.
At their worst, chronic infections like these can lead to gangrene and amputations. Concurrent to the soft tissue vulnerability is a very high rate of notably severe foot deformities such as hallux valgus, bunions, corns and calluses, and hammer toes. The central issue is the progressive loss of the oxygenation that is necessary for tissues to heal. Over time, the diabetic foot follows the sequence of venous stasis, poor circulation, capillary breakdown, and, ultimately, soft tissue necrosis.
Dr. Sam Dubé discusses the diabetic foot
Learn about the symptoms, causes, and benefits of different treatment options.
Uncorrected, poor foot mechanics contribute to a worsening of diabetic foot symptoms.
Early-phase, poor foot function is primarily caused by the long-term use of footwear, especially footwear that restricts or interferes with the foot’s natural, optimal dynamic movement.
As poor foot mechanics become more dysfunctional over time, the foot’s soft tissue and bone structures become increasingly incapable of managing the forces imposed on them by day-to-day activities. Over time, poor function becomes the maladapted norm.
Lower leg muscle function, which is essential for venous blood return, is poor to absent in maladapted feet. Healthy lower leg muscles normally act as muscular ‘pumps’ for venous blood return.
Maladapted foot function also exhibits an inefficient and unstable arch system. Instability increases excessive foot movement in a shoe, which imposes inappropriate pressure at localized points along with rubbing and friction to generate “hot spots” that are the precursor to the formation of ulcers.
When poor foot function is present, especially concurrent with the metabolic vulnerabilities of diabetes, the serious consequences of deformity and soft tissue necrosis are almost inevitable.
Modern science has identified that the nervous system plays a critical role in stabilizing the feet and ankles when walking or running. It is now understood that poor foot mechanics are a symptom of inefficient neuromuscular function caused by conventional footwear use. In fact, conventional footwear use causes poor neuromuscular function throughout the feet, legs, hips, and back, when:
the soles of the feet don’t receive the subtle, varied stimulus that the nervous system requires for healthy function, and
snug toe boxes, stiff midsoles/outsoles/uppers and tight lacing restrict healthy foot movement.
To learn more about how your footwear affects function and performance, click HERE.
The best way to prevent and address the poor foot mechanics that exacerbate diabetic foot problems is to retrain optimal neuromuscular function and to use footwear that is soft, flexible, and roomier in the forefoot.
Conventional treatment methods for the diabetic foot
Since the late 1890s, the standard treatment for poor foot mechanics has been to artificially support the arches with an orthotic. Other conventional diabetic foot treatment options include:
Meticulous cleaning, drying, nail trimming
The use of rigid ‘protective’ footwear
Avoidance of barefoot walking
Modern science has transitioned away from using long-term support and cushioning on any body part because it causes a progressive weakening of the body part being supported or cushioned.
The modern approach to treating the diabetic foot
Science has shown that merely challenging the body to “do its job” is the best way to restore and enhance function.
The modern approach to address poor neuromuscular function is to employ a “Proper Technique” rehabilitative therapy to regain healthy function. This approach is extensively used pre- and post-surgery and is also the foundation of virtually all sports training/rehabilitation programs. By employing a therapeutic approach, the feet become stronger and more stable, thereby addressing the cause of the poor mechanics that contribute to diabetic foot problems. Proper Technique therapies employ exercise that focuses on safely training healthy neuromuscular function, i.e., optimal mobility, muscle strength, stability, and alignment.
Proper Technique therapies require both Right Stimulus and Right Movement.
Right Stimulus occurs when the information that the brain receives from the senses triggers an efficient protective reflex function or Right Movement. The nerve endings in the soles of the feet play a critical role in providing the brain with the information required for optimal Right Movement throughout the feet, legs, hips, and back. When the brain receives insufficient or inaccurate information from the soles of the feet, the protective reflex function Right Movement will be ineffective or absent altogether. This is what happens when conventional footwear is worn. For more information on Right Stimulus and Right Movement, click HERE.
To therapeutically address the cause of the poor foot mechanics that contributes to diabetic foot problems and to prevent them from reoccurring, do the following:
- Walk barefoot on natural terrain such as grass or sand as much as possible. The natural terrain should be free of hazardous materials and use assistance for balance if necessary. Gradually reduce balance aids if possible. This provides the optimal Right Stimulus and allows for the Right Movement required for healthy neuromuscular function.
- Use Biopods® Stimsoles® Footwear or Insoles. Biopods Footwear provides the ultimate Proper Technique shoe environment. Biopods Insoles improve the stimulus in your conventional footwear. Use in loosely laced, soft, flexible footwear with ample toe room that allows your arches and toes to rise easily for best results.
- Consult with your healthcare practitioner to ask about employing soft tissue mobilization therapies to address the fibrotic scar tissue that may have formed prior to using Biopods.