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Sunday, April 11, 2010

Diabetes: Take Off The Other Shoe Principle

A wonderful patient whom I saw 22 years ago came into our very busy office with complaints of pain in her right Achilles tendon from walking her very big dog. She thought since she always held the leash with her right hand she must of pulled the right Achilles somehow. Very smart observation! She had only taken off her right shoe when I came into the room. I was very busy that day running late with all of my patients. After examining her Achilles, her diagnosis and treatment plan seemed straight forward. I turned to leave the room to get our physical therapist to put her on the proper icing and stretching regimen, but something told me to have her take off the other shoe. Golden Rule of Foot (for practitioners): Always look at both feet.

When she took off the other shoe, it was evident that she would never see the physical therapist that day. This patient turned out to be a brittle diabetic with an infected ulcer on the left big toe. We became good friends as I visited her twice daily in our hospital over the next 3 weeks. I still see her monthly. As an adult-onset diabetic, she never really owned/accepted her disease. Her blood sugars were terrible with the bacteria feeling very happy like kids in a candy store. On that day, the statistics for a diabetic to survive more than 5 years when presenting with an infected ulcer were very small. Statistically, she should have definitely lost her leg. 22 years later she is still going strong, both legs and all. See the link below for Diabetes Self Care and Footsmart catalog for ordering a floor mirror.

Having her take off the other shoe may have saved her life that day. But I hope this message of checking both feet saves thousands from amputations and death. Let's be very greedy. Diabetes is a killer, but owning your diabetes, can allow you to have a great life.

Golden Rule of Foot: Diabetics should daily exam the bottoms of their feet. I think back on that day almost every time I see this patient. Relatively new to the practice of medicine, I learned a valuable lesson. The rush of medicine nowadays will allow this scenario to play out over and over again in various forms. Patients must become more responsible for their own health.

I do not know why I took off the other shoe that day. I was in a rush, way behind. But I did and I am proud that I try to continue to take the extra time. Patients all have a story when they come through our doors. The stories add wonderful color to the practice of medicine. Let’s get better at listening to these stories.

Diabetic Foot Care Guidelines
Dec 18, 2009 ... Diabetes can be dangerous for feet; to avoid serious foot problems follow these guidelines. - Similar

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1 comment:

  1. Wow Rich, what a story! That is truly incredible, and you SHOULD feel good that you did the right thing and took the extra time to check her left foot. I never knew diabetes could be so scary.
    By the way a runner friend on Facebook thanked me for connecting her to you- she has been using your Walk/Run rehab for coming back from a knee injury.


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.