Stride Orthopaedics and Footwear

 

Diabetes and Stride

Diabetes is a serious disease that can develop from lack of insulin production in the body or due to the inability of the body's insulin to perform its normal everyday functions. Insulin is a substance produced by the pancreas gland that helps process the food we eat and turn it into energy.

Diabetes affects approximately 2.5 million Canadians and is classified into 2 different types: Type 1 and Type 2. Type 1 is usually associated with "juvenile diabetes" and is often linked to heredity. Type 2, commonly referred to as adult onset diabetes, is characterized by elevated blood sugars, often in people who are overweight or have not attended to their diet properly.

Many complications can be associated with diabetes. Diabetes disrupts the vascular system, affecting many areas of the body such as the eyes, kidneys, legs, and feet. People with diabetes should pay special attention to their feet.  In conjunction with the Canadian Association of Wound Care, Canadian Certified Pedorthists have helped develop an online resource.

This can be found at http://www.cawc.net/index.php/public/feet/

Also available en francais at http://cawc.net/fr/index.php/public/feet/

Neuropathy

Of the 2.5 million Canadians with diabetes, 25% will develop foot problems related to the disease. Diabetic foot conditions develop from a combination of causes including poor circulation and neuropathy. Diabetic Neuropathy can cause insensitivity or a loss of ability to feel pain, heat, and cold. Diabetics suffering from neuropathy can develop minor cuts, scrapes, blisters, or pressure sores that they may not be aware of due to the insensitivity. If these minor injuries are left untreated, complications may result and lead to ulceration and possibly even amputation. Neuropathy can also cause deformities such as Bunions, Hammer Toes, and Charcot Feet.

It is very important for diabetics to take the necessary precautions to prevent all foot related injuries. Due to the consequences of neuropathy, daily observation of the feet is critical. When a diabetic patient takes the necessary preventative footcare measures, he or she reduces the risks of serious foot conditions.


Peripheral Vascular Disease

Peripheral vascular disease means narrowing of the lumen of arteries in the legs, causing a reduction in circulation. It can occur in individuals without diabetes but is more common and more severe in people with diabetes. Why this is the case is not clear, but it is well established that smoking makes peripheral vascular disease much worse.

Although both big and small blood vessels can be affected by diabetes (known as macrovascular and microvascular disease respectively), in diabetic peripheral vascular disease it is blockage of the larger arteries in the thigh and leg which causes most of the clinical problems. Peripheral vascular disease can affect both legs but is often more severe on one side (contrast with peripheral neuropathy which affects both feet symmetrically).

If it is mild, peripheral vascular disease can be completely without symptoms. However, as blood supply becomes progressively inadequate, it can cause claudication, rest pain or vascular ulceration:

Claudication is development of pain in the calf after walking for a distance or up an incline or stairs. The distance a person can walk before such pain occurs is referred to as claudication distance. The leg and foot look and feel normal as long as the person is resting. As claudication distance becomes shorter and shorter, physical activities become more and more restricted. Cessation of smoking is most important before one gets to this stage. Regular exercise by walking through the pain threshold can sometimes increase the claudication distance.



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