Health care professionals need to take control of diabetes management now to prevent a global pandemic from spreading, according to Katia Langton, CPed.

Langton, a former chiropractor who works as a pedorthist at Island Pedorthic Foot Care in Vancouver Island, Canada, spoke at the Pedorthic Footcare Association and American Podiatric Medical Association Combined Meeting.

Diabetes contributes to the death of approximately 4 million people each year and costs billions of dollars each year to treat, and the numbers continue to grow, Langton said. If diabetes were a country, it would be the third-largest in population size, coming after China and India but before the United States, she said.

“The number of diabetic patients globally is increasing at a staggering rate,” Langton said.

Early intervention is key to diabetes treatment, according to Langton.

“If we do not treat this disease differently, earlier in the progression … to keep the patients on the ground walking and mobile so they can manage their blood sugar and prevent complications, we are going to have a really big problem,” Langton said. “What we need to do is get ahead of [diabetes], because we will not have the resources to treat these ulcers and amputations with the staggering numbers coming in globally.”

Langton’s clinic offers a host of services for diabetic patients, including diabetic foot assessments, wound assessments, education on peripheral neuropathy, comprehensive foot exams and preventive foot care. But often, patients are sent in too late.

“Our allied health care professionals that were sending us patients were not sending them early enough. So, we talk to different groups — health care professionals [and] the general public,” Langton said. “It is really important that we talk to all our other health care professionals about treating this disease earlier.”

Langton said organizational change is needed in order to get diabetes under control.

“A lot of health care professionals do not quite understand the progression of the diabetic foot,” she said.

According to Langton, patients progress from a diagnosis of diabetes to an insensate foot, and then to limited joint mobility, peripheral vascular disease, ulcerations, Charcot foot, amputation and finally, death. Because 50% of patients who have undergone a diabetes-related amputation will die within 3 years, and approximately 1 million diabetes-related amputations are performed annually, the disease needs to be stopped before it progresses to that level, she said.

“We need to reframe the way that we are treating diabetic foot. If we can start at ground zero, teaching everybody around us the progression of the diabetic foot … if we can start front-end-loading our education and our resources and seeing these patients early, we have a chance to fight this disease and keep them walking and mobile,” Langton said.

Langton advised practitioners to take the urgency of diabetes back to their communities and move in the direction of treating this patient population earlier.

One of the primary stabilizing muscles of the foot is the Tibialis Posterior. When this muscle is working properly; it locks the foot, supports the arch and assists you in walking.
 
Sometimes the tendon of this muscle becomes damaged and then the arch will progressively collapse, giving you a “flat foot”. Often the progression of this problem is painless and can go unnoticed until the foot is quite deformed and walking is difficult. This condition is more common in women over the age of 50, but can occur in anyone. 

Being overweight, having Diabetes, and a history of previous surgery or Cortisone injections may also contribute to this condition. Once the condition develops it is common to have pain in various other parts of the foot, have difficulty with walking and standing on your toes. A specialized type of custom foot orthotic, worn in your shoe, can be very helpful in this condition and limit further arch collapse. 
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Please call us if you have questions about this or any other painful foot conditions limiting your mobility.

The Plantar Fascia is a ligament located on the bottom of the foot. It functions by attaching the ball of the foot to the front of the heel. It is important in maintaining arch height and providing stability to the foot when you walk. When there are problems with the way you walk, increased stress on the Fascia causes injury and subsequently pain. Biomechanical problems can include the big toe having too much movement, the foot over pronating (arch collapsing) or the ankle being restricted or stiff in its movement increasing stress on the Plantar Fascia.

Typically the Fascia will try to repair itself when you sleep or sit for extended periods. Once you stand up and put weight on the Fascia, you tear the ligament and thwart these attempts to heal the Fascia. This explains why pain is often worse first thing in the morning or after standing from sitting for longer periods of time.
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One of the more effective solutions is to support the arch with a custom foot orthotic. Custom orthotics in Nanaimo will limit the stretch on the Plantar Fascia. Once you limit the repetitive strain on the Fascia; the inflammation and the pain it causes will generally resolve over a period of 6-8 weeks. As you are correcting the biomechanics with custom orthotics, you will need to stretch the tight Achilles tendon and use cold laser, ice and ultrasound to decrease inflammation and speed up healing.
It’s Your Future, Be There Healthy…

INTRODUCING 

Central Vancouver Island Foot and Ulcer Protection Clinic
Referrals are now being accepted.

We are pleased to announce the opening of the Central Vancouver Island Foot and Ulcer Protection Clinic (CVIFUPC).

Our goal is to provide diabetic foot screening and risk assessment to all diabetic patients on an annual basis. This is a multi-disciplinary team approach with a focus on providing preventative foot assessments in the morning and biomechanical assessment and off-loading in the afternoon.   The clinic will be held at the Caledonian Medical Clinic, 340 Campbell Street, Nanaimo (see map below for directions) and will be open every Wednesday starting 29 April 2015 and will be staffed by: Dr. Pieter Boshoff, MD, MBChB(Pret), International Interdisciplinary Wound Care Certificate
Katia Langton, Certified Pedorthist, Certified in Lower Extremity Amputation Prevention & Comprehensive Management and Treatment of the Neuropathic Foot. Canadian Diabetes Association representative for Diabetic foot care
Melinda Franklin, BSc Pharmacist, Certified Diabetes Educator

Services provided include:

• Comprehensive Diabetic foot assessments including risk categorization for foot complications
• Chronic wound assessment, management and dressing changes
• Comprehensive foot exams for painful foot conditions limiting mobility including Plantar Fasciitis, Achilles Tendonitis, Bunions and Hallux Limitus etc.
• Preventative off-loading based on risk categorization due to neuropathy
• Patients will receive detailed education on monitoring and caring for the neuropathic foot in a preventative manner
• Diabetic medication optimization and injection assistance service
• Pedorthic assessment and treatment
• Assessment for custom orthotics
• Foot Care Nursing (Future proposed service)

Off-loading devices and custom orthotics may be covered by Social Services, Non-Insured Health Benefits (native affairs), extended benefits and DVA. We will attempt to access charitable donations through volunteer organizations.
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Reports will be provided to the patient’s primary practitioner annually updating the patient’s risk category for developing further foot complications. These reports can be used as part of the Chronic Disease Management program. Recommendations regarding follow up assessments will be made to the patient as well as the referring health care provider.

Access the PDF here.