Proper footcare especially crucial for diabetics


The average person walks hundreds of miles a year and many thousands of miles in their lifetime. That’s a lot of wear and tear on the feet. Since there is no such thing as switching them out for a new set, it is important to get treatment for disorders of the feet so they can continue carrying you through life’s journey.

Dr. Keith Kalish, a Vero Beach podiatrist, has treated just about every foot problem imaginable, including the special problems diabetics face with foot diseases and disorders.

“Diabetics are more at risk of developing severe foot problems than the general population, so it’s very important that they pay close attention to their feet,” Dr. Kalish said.

“A lot of what we see with diabetics starts with something as simple as a callous. Callous formations are nature’s defense mechanism and usually caused by a bony abnormality underneath that area. Callous formations in a diabetic are more problematic because they may have vascular problems where they don’t have adequate blood flow to their lower extremities, or they have neuropathy where they can’t feel their feet as well as they should. Where a non-diabetic will have a callous and feel pain, the diabetic may not feel the pain and continue to ambulate until the callous progresses to a more severe problem like an ulceration.

“The ulcer is basically a hole in the skin and the skin is the No. 1 barrier against infection,” Dr. Kalish continued. “An open ulcer can lead diabetics down a cascade of events that lead to more serious problems like a bone infection. In severe cases, it can lead to amputation, and if you get one amputation the chance of getting additional amputations goes up. If we can prevent these problems from the start, we can save them more problems down the road.”

A little more than 10 percent of the U.S. population – 34.2 million people – have diabetes, according to the Centers for Disease Control and Prevention, and about half of them have some kind of nerve damage.

While you can experience nerve damage in any part of your body, the nerves in the feet and legs are most often affected. Some people with foot nerve damage have numbness, tingling or pain, but others have no symptoms at all. This damage, called peripheral neuropathy, can literally cause a diabetic to lose all feeling in their feet.

While living without pain in the feet may sound good, it comes at a high cost. Pain is the body’s way of telling you something is wrong and needs to be addressed. Small problems like a cut, blister or sore can escalate to a serious problem if not treated early.

“I tell my patients with neuropathy to trust what you see and not what you feel,” Dr. Kalish said. “What you feel may not register, but if you see redness or drainage or something that looks unusual, you should see your foot doctor. This is especially true if you have a wound that will not heal.”

One of the most important things doctors do to get diabetic wounds to heal is offload the patient by utilizing a boot or surgical shoe to take the weight off the affected area. You can put a wound care product on the affected area, but if someone is putting a lot of weight on it, an ulcer or other wound will not heal. By getting the pressure off, the wound will heal quicker.

Once the ulcer is healed, your doctor can fit you with a diabetic shoe and schedule diabetic foot care on a regular basis to prevent a reoccurrence. Medicare has a diabetic shoe program that covers most of the cost of diabetic footwear.

Most people with diabetes can prevent serious foot complications with regular home care and occasional podiatric doctor checkups.

Interestingly enough, foot doctors oftentimes are the first ones to notice a patient may have diabetes. The foot is the furthest body part from the heart, so if there is a problem with circulation, that often is where it first appears.

That said, proper foot care is imperative for everyone, not just diabetics. Check your feet every day for cuts, swelling, sores, blisters, corns, calluses or any changes to the skin or nails. Wash your feet daily and dry them completely. Never go barefoot.

Wear shoes that fit. Trim your toenails. Don’t remove corns and callouses yourself since some over-the-counter products could burn your skin. Get your feet checked at every healthcare visit.

Keep the blood flowing with exercise and proper diet. Avoid smoking.

“I can’t stress enough the importance of wearing socks,” Dr. Kalish continued. “Living in Florida socks are even more important than shoes because they cut down on bacterial and fungus infections by lowering the moisture content on your skin and nails.

“The hotter it is, the more important socks are because you sweat more. You can remove a sock and put on a fresh sock, but you can’t do that with sandals. Any sock is better than no sock and white socks are preferable to colored socks, which have dye in them. Take care of your feet and they’ll take care of you!”

Besides diabetic foot problems, Dr. Kalish treats “everything from skin problems to bone problems, to muscular problems to neurological problems with the foot and ankle. We do everything from wart removal to reconstructive surgery that takes care of anything that is a bony problem. We basically take crooked bones and make them straighter. Pain is not normal. If your feet don’t work properly, you’ll go nowhere fast.”

Some of the more common issues he treats include orthopedic/bone issues such as fractures, pain and bone deformities associated with bunions, hammertoes, metatarsal pain, heel spurs and diabetic foot care.

Dr. Kalish received his medical degree from the Ohio College of Podiatric Medicine in Cleveland and attended Straith Memorial Hospital in Michigan for residency training. He is board certified with the American Board of Podiatric Surgery and the American Board of Podiatric Orthopedics.

Dr. Keith Kalish established his private practice at Kalish Foot Care in Vero Beach in 1987 and prides himself on having long-term, personal relationships with his patients. He can be reached at 772-567-0111.

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