The following article was submitted by Alan Coulson, M.D., a panel physician at the Sandhills Center for Wound Healing and Hyperbaric Medicine in Hamlet. He is board certified in hyperbaric medicine and a certified wound care specialist.
They called them “angel wings” because as the wasting disease advanced, the children’s shoulder blades would stick straight out — their back muscles were so weak they could no longer support them.
As the children got sicker, they developed a “fish-eye” stare. A hundred years ago, many of our children died like that. What they were dying of was hookworm, a parasite that makes a hole between the toes and then invades the body, and takes over.
That killer epidemic was stopped simply by teaching the children of North Carolina to wear shoes. Their feet were then protected from the killer worm.
Fast forward a hundred years: Now we are seeing cases of foot trauma followed by infection in diabetic patients who walk around with bare feet.
This is really a dangerous practice especially if your feet are numb. Just like the public health battle to prevent hookworm, I think we need an initiative to “Save Our Diabetic Soles” — a drive to raise consciousness and encourage diabetics to take care of their feet.
When your foot hits the ground, the pressure on the ball of the foot is 80 pounds per square inch. Compare this to the nitrogen pressure in NASCAR tires, which is a mere 44 pounds per square inch. If you have gained weight to, say, about 250 pounds, then the pressure of your footprint will be over 100 pounds per square inch!
And if you are walking bare foot, you are mashing your flesh with that pressure into “enemy territory.” I say that because dirt has literally one billion homeless bacteria in every teaspoon.
Imagine a collage of broken glass, roofing nails, fire ants and pointed rocks. In New York, this would be a million dollar piece of European “installation art” at the Museum of Modern Art. But here in North Carolina, it’s called the neighbor’s back yard.
And if you are walking through this with naked feet, it is a bit like driving the Titanic; eventually something bad is going to happen, and it’s going to happen to the soles of your feet.
Even in the house you are not safe. From bitter personal experience, I am convinced there is an international conspiracy to trip daddy, which secretly e-mails instructions to toddlers about where to position their toys for maximum effectiveness.
Small, wheeled objects are the most dangerous and for a basic refresher course on penetrating trauma, nothing beats the pain caused by stepping on a plastic stegosaurus. The song remains the same: If you have diabetes, you need to protect your feet at all times, even if you are just getting out of bed for a few minutes; if not by wearing shoes then at the very least diabetic slippers.
If we have diabetes, what can we do to help save our soles?
Firstly, start out by empowering ourselves. Develop a routine by making every day a Maundy Thursday: Wash your feet in lukewarm water and dry them gently. Unless you are an Olympic gymnast, this is difficult to do properly while standing in the shower.
For this reason, a basin or a tub is recommended. Then you need to lubricate the feet with diabetic moisturizing lotion, but not between the toes as this only encourages fungi to grow.
The next important thing to reach for is the shaving mirror so you can get a magnified view of the sole of your foot to look for signs of trauma. If the diabetes has impaired your vision, then the best thing is to get some other person to look for you.
If the sole searching checks out satisfactorily, put on your special diabetic socks, carefully smoothing out all wrinkles to prevent blisters. Before you insert your numb feet into your diabetic shoes, it’s important to do a scorpion check by banging shoes together.
Scorpions can be a real problem in Arizona whereas in Richmond County it’s more likely to be a nesting stegosaurus. Knocking shoes together also makes small stones fall out.
Then it’s time to put your hand in and feel for penetrating objects. Failure to do so caused Jim Sypult to get gangrene in his left big toe. He had a roofing nail sticking up through the sole of his sandal and his feet were numb so he didn’t feel the nail until it was too late. He wrote a good account of the consequences in the Fayetteville Observer on Friday, August 10, under the title, “Toe the line with your health.” He required an amputation.
If a hundred years ago children could be taught the importance of wearing shoes, then surely adult diabetics in this day and age can understand the importance of protecting their feet to prevent trauma and infection.