SYMPTOMS

Symptoms of foot deformities may vary depending on the exact condition. However, several signs may indicate that you have a potentially serious foot problem. Any redness, swelling, or increased skin temperature of the foot or ankle, or a change in the size or shape of the foot or ankle could mean you have a foot deformity. Any pain in your legs while at rest or while walking could indicate a circulation problem that can contribute to foot problems. Any open sores with or without drainage, no matter how small, or any nonhealing wounds, ingrown toenails, corns or calluses, or skin discoloration could be due to a foot deformity and require immediate attention. If you have Charcot's joints, you may not feel pain in your foot, but you may notice a coarse, grating sound when you move your foot.

WHAT TO DO

If you notice any of the symptoms associated with foot problems, contact your doctor or foot specialist right away. Although it is not an emergency situation, you should be examined as soon as possible. Foot ulcerations can be extremely slow to heal, so the earlier you seek treatment, the better. Some foot deformities, such as Charcot's joints, can rapidly progress to a point where damage is irreversible. Any change in the shape of your foot, especially if there is any redness, swelling, or pain, should be taken seriously. If you continue to use your foot, you could permanently disable it. If you notice these signs, you need to stop bearing weight on your foot immediately and see your foot care specialist at once. Any foot problems should be evaluated and treated as soon as possible.

TREATMENT

Your exact treatment will depend on the nature of your problem. Certain conditions, such as Charcot's joints, may require a specially fitted cast or splint to prevent further damage to the joint and to allow any existing fractures to heal. In some situations, and depending on your general state of health, foot surgery may be recommended to correct a deformity. For example, surgery might be advised to correct a hammertoe to relieve the pressure beneath a metatarsal head or over a prominent toe. Your doctor may also suggest surgery to treat hallux limitus, especially if it leads to ulcers under the big toe. This type of surgery increases the range of motion of the big toe and relieves the pressure on the toe to help the ulcer heal. However, surgery can only be performed if you have good circulation to the legs and feet.

If you have diabetes, properly fitting footwear is essential. For many patients, a good-fitting pair of athletic shoes with plenty of cushioning may do the job. But if you have any sort of recognizable foot deformity or loss of feeling in your feet, you may need therapeutic shoes. These shoes differ from normal shoes in that they are prescribed by a foot specialist and specially designed to accommodate your particular foot problem. Your therapeutic shoes should offer relief of pressure, should accommodate any deformities you have, should provide support for your foot, and should limit joint motion (if needed).

You should first see a podiatrist who is specially trained in the treatment of diabetic foot disorders. Your podiatrist will measure your feet and evaluate your foot structure and your particular problem. Your podiatrist can write a prescription for therapeutic shoes if you need them. You can then take the prescription to a place that sells this type of shoe. Most likely, you will visit a special therapeutic shoe store, or you may be referred to a special foot clinic or orthotic-prosthetic facility to have your shoes fitted. There, you will probably see a pedorthist, who is specially trained in fitting therapeutic shoes. You may also need to see an orthotist, who is trained to fit prostheses. It is usually necessary to make an appointment to have your shoes fitted.

There are several things to keep in mind in fitting any shoes, but these are especially true if you are buying therapeutic shoes. Have your feet measured for size every time you buy a new pair of shoes. The length, width, and shape of your foot may change. Also make sure to have both feet measured. Don't be surprised if they are different sizes. Try to schedule your appointment in the afternoon or near the end of the day. Your feet have a tendency to swell as the day goes on. If you have your shoes fitted in the morning, they may be too tight for you in the afternoon. By having them fitted in the afternoon you can be assured that they will fit all day long.

Don't pay attention to the size of shoe marked on the box. Sizes of shoes, even therapeutic shoes, can vary according to the manufacturer. Make your decision by how the shoe feels on your foot. When you put the shoes on, you should have 3/8 to 1/2 inch of space between your longest toe and the tip of the shoe while you are standing. Also, make sure that the ball of the foot fits well into the widest part of the shoe. Finally, walk around in your shoes to make sure they feel comfortable. They should not be too tight. Don't count on them stretching out as you wear them. Make sure they fit you at the time you buy them. Also make sure the heels don't slip too much. If they don't feel 100% comfortable, don't buy them.

Most likely, your pedorthist will have shoes on hand that will suit your needs. About 85 percent of people seeking therapeutic shoes can be properly fitted with off-the-shelf shoes. However, your pedorthist may need to make adjustments in your shoes to ensure that they fit right. You may need to have the uppers stretched, you may require additional padding or lifts, or you may need to have wedges and flares added to the soles for greater stability. Rocker soles or metatarsal bars can also be added to reduce pressure on certain areas of the foot. You may also need to have special inserts called orthotics placed inside your shoes to accommodate any special foot problems. You are better off with a softer orthotic to avoid any sort of rubbing or damage to your feet. If your pedorthist cannot find a pair of shoes in stock to suit you, you may need to be fitted for a pair of custom-made shoes. These can take 3 to 6 weeks to be made and delivered.

If you do need therapeutic shoes or inserts for your regular shoes, you may be able to get reimbursed for part of the cost by Medicare or your insurance company. Check with your specific plan to see if you are covered. Your primary doctor will need to fill out a form that certifies you are in a comprehensive plan of diabetes care, have evidence of diabetic foot disease, and need therapeutic footwear or orthotic devices.

PREVENTION

Foot deformities can be difficult to prevent. Your best bet for the long term is to keep your blood glucose levels under control. This will help prevent the neuropathy that underlies diabetic foot disease. Also take steps to keep your circulatory system healthy. This means eating a balanced diet that is low in fat and stopping smoking. Foot problems can be exacerbated when your feet must support excess weight. If you are overweight, try taking steps to reduce your weight now.

You will also need to see a foot care specialist on a regular basis. You should have an annual exam to assess the degree of physical sensation in your feet, evaluate blood circulation to your feet, and check for any foot deformities or other problems that may put you at risk for ulcers

and infections of the foot. If you have any particular foot problems, or are at risk for developing a foot problem, you should see your podiatrist more often.

Above information is from the book The Diabetes Problem Solver available form the American Diabetes Association.