Top 5 Diabetic Foot Care Tips | Harry Cotler DPM

[vc_column_text Foot problems are among the many complications linked to uncontrolled diabetes. The disease creates high levels of blood glucose which affects the immune and nervous systems. Nervous system damage severely reduces feeling in the feet. These factors increase pressure on foot skin, joints, and bones, resulting in the skin breaking down and developing sores. Damage to blood vessels and the immune system makes healing foot wounds challenging. The feet are therefore susceptible to bacterial infections from ingrown nails and other problems.

 5 Diabetic Foot Care Tips

1. Inspect Your Feet Daily

Look at your feet every day. Nerve damage makes it difficult to know if you are experiencing foot pain or other problems. Contact your foot specialist or physician immediately if you notice breaks in the skin, sores, ingrown nails, tenderness, increased warmth, or changes in skin color.

2. Wash Your Feet Every Day

Gently wash your feet using warm water and mild soap and pat them dry. Do not rub your feet, as the skin could crack. Apply a high-quality lotion to prevent skin from breaking. Ask for help from a family member or friend if you have trouble washing your feet.

3. Invest in Quality Footwear & Socks

Purchase footwear featuring plenty of toe room, optimal coverage, and no inside seams that can rub your skin and cause blisters. Find seamless socks that control moisture levels. Our team of Certified Pedorthist can help guide you.  Visit our Next Step Insoles and Shoes page for more information

4. Don’t Forget Your Toenails

Trim your toenails straight across after your bathe. Toenails are softer following a bath or shower. Use a nail file to smooth the trimmed nails. If you experience trouble cutting your toenails, ask your Physicians Footcare Podiatrist to do it for you.

5. Promote Healthy Blood Flow

Keep the blood circulating in your feet. Prop them up when you are sitting instead of crossing your legs. The American Diabetes Association recommends moving your ankles up and down and wiggling your toes for five minutes two or three times a day.


An Overview of Diabetic Neuropathy | Harry Cotler, DPM

Diabetic neuropathies are a family of nerve disorders caused by diabetes. Diabetic patients are at risk for many related disorders including diabetic neuropathy. Over time, diabetics develop nerve damage throughout their entire body that affects the digestive, circulatory and nervous systems. Diabetic neuropathy may or may not produce any symptoms. 

It is estimated that about 65% of diabetics have diabetic neuropathy. The condition can develop at any time, without warning. Diabetic neuropathy seems to slowly progress and is prevalent in diabetics who have had the disease for 20 years or longer.

Diabetic neuropathy is also more common in diabetics who do not control their blood sugar. As a result this can diminish the capabilities of the patient to the point where they cannot care for themselves.


There are four main types of diabetic neuropathy. You can have one or more than one type of neuropathy. Your symptoms will depend on the type you have and which nerves are affected.

Usually, symptoms develop gradually. You may not notice anything wrong until considerable nerve damage has occurred. The symptoms of diabetic neuropathy will depend on the affected area of the body. 

Symptoms could include:

  • Indigestion or vomiting
  • Numbness of the extremities
  • Diarrhea or constipation
  • Weakness a severe drop in blood pressure after standing up (which results in severe dizziness or fainting). 

The symptoms are mild at first but increase in frequency and intensity over time. Diabetic neuropathy is a progressive disease that takes a long time to fully develop. It may take years for the symptoms to become severe enough to spur a trip to the doctor.

In general, diabetics should have annual visits with several types of physicians, including a podiatrist.This approach ensures that the patient gets a 360-degree view of their condition.


Damage to nerves and blood vessels

The exact cause likely differs for each type of neuropathy. Researchers think that over time, uncontrolled high blood sugar damages nerves and interferes with their ability to send signals, leading to diabetic neuropathy. High blood sugar also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.

However, a combination of factors may lead to nerve damage, including:

  • Inflammation in the nerves caused by an autoimmune response. The immune system mistakes nerves as foreign and attacks them.
  • Genetic factors unrelated to diabetes may make some people more likely to develop nerve damage.
  • Smoking and alcohol abuse damage both nerves and blood vessels and significantly increase the risk of infection.


Diabetic neuropathy can cause a number of serious complications, including:

  • Loss of a toe, foot or leg. Nerve damage can make you lose feeling in your feet. Foot sores and cuts may silently become severely infected or turn into ulcers. Even minor foot sores that don't heal can turn into ulcers. In severe cases, infection can spread to the bone, and ulcers can lead to tissue death (gangrene). Removal (amputation) of a toe, foot or even the lower leg may be necessary.
  • Joint damage. Nerve damage can cause a joint to deteriorate, causing a condition called Charcot joint. This usually occurs in the small joints in the feet. Symptoms include loss of sensation and joint swelling, instability and sometimes joint deformity. Prompt treatment can help you heal and prevent further joint damage.
  • Urinary tract infections and urinary incontinence. If the nerves that control your bladder are damaged, you may be unable to fully empty your bladder. Bacteria can build up in the bladder and kidneys, causing urinary tract infections. Nerve damage can also affect your ability to feel when you need to urinate or to control the muscles that release urine, leading to leakage (incontinence).
  • Hypoglycemia unawareness. Low blood sugar (below 70 milligrams per deciliter, or mg/dL) normally causes shakiness, sweating and a fast heartbeat. But if you have autonomic neuropathy, you may not notice these warning signs.

Risk factors

Anyone who has diabetes can develop neuropathy, but these risk factors make you more likely to get nerve damage:

  • Poor blood sugar control. Uncontrolled blood sugar puts you at risk of every diabetes complication, including nerve damage.
  • Diabetes history. Your risk of diabetic neuropathy increases the longer you have diabetes, especially if your blood sugar isn't well-controlled.
  • Kidney disease. Diabetes can damage the kidneys. Kidney damage sends toxins into the blood, which can lead to nerve damage.
  • Being overweight. Having a body mass index (BMI) greater than 24 may increase your risk of diabetic neuropathy.
  • Smoking. Smoking narrows and hardens your arteries, reducing blood flow to your legs and feet. This makes it more difficult for wounds to heal and damages the peripheral nerves.


You can prevent or delay diabetic neuropathy and its complications by keeping tight control of your blood sugar and taking good care of your feet.

Blood sugar control

Use an at-home blood sugar monitor to check your blood sugar and make sure it consistently stays within target range. It's important to do this on schedule. Shifts in blood sugar levels can accelerate nerve damage.

The American Diabetes Association recommends that people with diabetes have the A1C test at least twice a year. This blood test indicates your average blood sugar level for the past two to three months. If your blood sugar isn't well-controlled or you change medications, you may need to get tested more often.

Foot care

Follow your podiatrist recommendations for good foot care. Foot problems, including sores that don't heal, ulcers and even amputation, are a common complication of diabetic neuropathy. But you can prevent many of these problems by having a comprehensive foot exam at least once a year, having your podiatrist check your feet at each office visit and taking good care of your feet at home.

Harry Cotler, DPM

Physicians Footcare, LLC

Time to See a Podiatrist | Harry Cotler, DPM

Time to See a Podiatrist

Like issues with other parts of your body, not every foot problem requires a trip to the podiatrist. Some may resolve with a little rest, ice, and over-the-counter pain medicine. But, if you have a persistent problem that won’t go away, then a trip to Physicians Footcare is necessary.

Here’s a list of the type of foot problems that warrant a trip to a podiatrist:

  • If you have one foot that has a flattened arch, it can be a sign of a tendon injury. Tendons that don’t function properly can lead to joint problems and misaligned bones. Prolonged tendon injuries can cause permanent damage to the foot, so the sooner you see your podiatrist the better.
  • If you have a sore on your foot that won’t heal, you must see a podiatrist. Those with diabetes are especially at risk for foot sores. And if left untreated, sores may lead to amputations. The best advice is to go to your podiatrist as soon as possible. The longer you have an open sore, the more prone you are to infection which can eventually travel into your entire body, requiring hospitalization or surgery.
  • If you’re experiencing foot or ankle pain that gets worse when you walk, you should see a podiatrist immediately. Many people try to live with the pain, which is not a good idea. Persistent pain may be a sign of a stress fracture. Your podiatrist can x-ray your foot to determine if a stress fracture exists.
  • If you have severe pain in your foot or ankle that lasts more than 24 hours, then you need to see your podiatrist. There are a variety of conditions that could cause severe foot and ankle pain including compartment syndrome, deep vein thrombosis, or a broken bone.
  • If you experience pain in your feet while they’re elevated, then you also need to see a podiatrist. For example: If you experience pain while resting your feet on an ottoman, and the pain goes away when you put your feet flat on the floor, then you may have peripheral artery disease or decreased blood flow. A Physicians Footcare podiatrist can quickly assess if you have these conditions and then refer you to the appropriate specialists for treatment.
  • If you experience discoloration on areas of the foot or ankle, then you absolutely need to see a podiatrist. Your feet should look the same. Redness may be a sign of injury or infection. Blue and purple coloration could indicate vein problems. Your Physicians Footcare podiatrist is the authority on everything foot related and can quickly assess what the discoloration of your feet means and offer a treatment plan.

These are just some of the signs that you need to see a podiatrist. If you’re experiencing symptoms that persist for more than 24 hours, a visit to Physicians Footcare is warranted. As podiatrists, we’re the authority on feet and ankles. We can quickly assess your feet, treat your condition, and help get you back on your feet and back to what you love to do.


How to Know When to Replace Your Running Shoes | Natalie McCoy, CPED

You often hear people say “you should listen to your body”. Your body will give subtle hints when you need new running shoes. Over time, your running shoes lose shock absorption, cushioning, and stability. If you run in worn-out shoes, it increases the stress and impact on your legs and joints. When this occurs, it causes overuse injuries such as: fatigue, shin splints, joint/heel pain, or even achy knees. All of these ailments are the result of an over worn shoe. The symptoms listed above are great indicators that you need new running shoes. If you are experiencing pain, even if your shoes are relatively new, you may want to consult with a professional, at a specialized shoe store. Speaking to a professional will help determine if you are wearing the correct shoe for your foot type or activity.

One of the biggest “RED FLAGS” that your running shoes need replacing is if the tread on the soles are worn-out. The rubber in the soles of your shoe will last longer than the shoe’s cushioning and shock absorbency. If you notice any uneven, wear pattern in the tread and it is favoring only one side, then this could be a possible gait issue. Making adjustments to your running form may help but it could ultimately be the shoe.

Talking to an expert at a local shoe store that offers gait evaluations is a way to help you find a correction, or help you understand your unique wear pattern. Alternatively, your shoes may require additional support, depending on your unique foot type. No two feet are the same. To test of the integrity of your shoes, follow these 3 easy steps listed below:

  1. If you hold your running shoe at both ends and twist the shoe, an old shoe or one that does not have proper support will twist easily, like twisting a wet rag.
  2. While holding the toe and heel of the shoe, bend the shoe upwards. If the shoe folds easily in the half, it needs to be replaced.
  3. Check the tread on the soles of your shoe. Flip the shoe over and view the bottom. If the tread is worn, consider getting a replacement.

Instead of wearing the same pair of shoes every day, consider buying at least two pairs of shoes. When you own multiple running shoes, it gives time for the damp/wet shoes to fully air-dry between runs. You can also separate the activities performed in your running shoes. For instance, if you wear a sneaker to work, your second pair of sneakers could be used for running. You should never run in shoes that have worn down soles.

Save the broken down shoes for working in the garden, or mowing the lawn. If you are currently wearing a pair of running shoes that you have any questions or concerns about, please feel free to bring the shoes with you to a local specialized shoe store. During your visit, a professional will help you decide if your running shoes are ready to be replaced, and if you need additional support in your shoes.

Listening to your body daily is one of the best ways to live a healthy active life.

How to Prevent and Battle Bunions | Sabina Abbasova, DPM

Patients often come into the office reporting that they have bunion growing like a “golf ball” by the great toe. While it is true that there is spurring that is happening around the joint at the later stages of bunion development the circular ball like bone, we are feeling through the skin did not grow out but moved out.

What are bunions and why do we get them? The diagnosis is called hallux abductovalgus deformity (HAV) which explains that the great toe moves away from the center of the body and the first metatarsal, the long bone behind the great toe rotates. This rotation causes the joint at the base of the great toe to dislocate moving the circular head of the metatarsal and creating an illusion of a “ball” that gets larger as the deformity becomes more severe and the joint continues to dislocate.

The type of dislocation and joint destruction will all depend on the biomechanics of the foot. Both nature and nurture contribute to development of bunion deformities. Looking at your grandparents and parents’ feet, you may recognize late stages of the deformities that you are beginning to face as alignment of the bones and flexibility of the joints that we are born with will largely determine the fate.

Does this mean that there is nothing we can do to stop the deformity and progression? We can slow the process and avoid much of the pain by wearing the proper shoes for the foot type and if necessary, getting custom foot orthotics. Consulting your local podiatrist and working with a pedorthist can educate you and provide you with the conservative treatment as well as medical devices to realign the biomechanics and slow the progression of the bunion deformity.

If the conservative treatment fails, the appropriate surgical procedure for the deformity can be discussed and considered. The extent of the deformity evaluated on x-rays as well as patient’s life style contributes to the decision-making process.

You don’t have to live with discomfort and pain and with conservative or surgical intervention there is a treatment option available to get you back to what you love to do.

Pedicure Do's and Dont's | Jamelah Lemon, DPM

Sunshine! Beaches! Swimming Pools! Vacation! These are the sights and sounds of summertime.

Now that the weather is getting hotter, we have our toes out and are getting them groomed at our favorite nail salons or spas. While pedicures are a fun way to unwind and relax you must be careful as some pedicures can cause harmful infections especially if you have diabetes.

Here are the Do’s and Don’ts for a safe & healthy pedicure.

DO schedule an early appointment. In the morning, the foot baths are usually cleaner and if you are the first customer of the day there is less chance that other customers have not contaminated the foot bath. If you can’t arrive early sure the technician cleans the tub and the filter before your service.

DO bring your own pedicure utensils. Bacteria and fungus can move easily from one person to the next if the salon is not sterilizing the instruments properly.

DO have your nails trimmed straight across. Make sure your technician trim them straight across and does not dig into the sides or try to trim out ingrown toenails; this can lead to infections and be very painful. If you have an ingrown nail schedule an appointment with one of our podiatrist at Physicians Footcare.

DO watch for signs of infection. If your skin bleeds or gets nicked at the salon, make sure to carefully clean the area. If you notice signs of infection such as redness, swelling, discoloration, drainage or warmth at the area please make an appointment with one of our podiatrist.

DON’T shave your legs before your pedicure. When your legs are newly shaven, you leave small cuts in your skin allowing an opening for bacteria to enter.

DON’T use blades. Never allow a technician to touch your feet with a blade, cheese grater instrument or razor to remove dead skin. The use of sharp instruments can result in permanent damage and easily cause infection.

DON’T apply nail polish to cover up discolored nails. Thick and discolored toenails could be a sign of a fungal infection. Nail polish locks in moisture and does not allow the nail bed to breathe. If you think you have a toenail infection, schedule an appointment with one of our podiatrists at Physicians Footcare.

Physicians Footcare Welcomes Three New Podiatrists

Physicians Footcare is excited to announce the addition of three podiatrists to our team in August:

Dr. Jessica Fink will be seeing patients at our Florence and Hartsville locations.

Dr. Matthew Engelthaler will be seeing patients at our Aiken location.

Dr. Harold Cook will be seeing patients at our new location in Newberry.

Foot Odor Causes and Treatments | W. H. Singleton, DPM

A common problem that podiatrist are often consulted about is foot odor. Patients often say “I’m clean, I shower daily. So why do my feet stink?” There are many causes of this problem, and we hope to offer multiple treatments in our blog.  

First think of this: most of us wear shoes and some type of hosiery (socks or shear hose as nylons). With shoes the period of time that they are on our feet may range from 4 to 16 hours or more per day. Remember the normal body temperature is 98.6 degrees Fahrenheit. With shoes on we trap that heat and in-turn create “mini-ovens” on our feet. This produces sweat (prespiration) and the perfect environment for the growth of bacteria and fungus. Even with open shoes as sandals we still sweat. The most common cause of foot odor is bacteria and or fungal laiden sweat. Foot odor is medically termed bromhidrosis. While excessive sweating is hyperhidrosis.   

Ways to decrease foot odor: 1. Wash and dry feet thoroughly every day. This includes going between the toes. 2. If wearing shoes more than 8 hours a day, allow the feet time out of shoes may be during your lunch break. 3. Wear hose that use anti-bacteral materials and will wick, or pull sweat away from you. 4. Wear clean hose daily. 5. Rotate shoes, try not to wear the same shoes two days in a row. Allow them to dry out. Also, spray them with a disinfectant to kill bacteria and fungus.  If the shoes have liners repace them regularly, disinfect them after each use. Orthotics should also be cleaned on a regular basis. 6. For more intense cases of foot odor a topical antiperspirant may be prescribed. 

Additional treatments for foot odor are available. Please contact our office for information. 

Hot Take On “The Toe Bro” | Aaron Haire, DPM

As a person who does not spend much time out of my busy day watching network tv, I happened to find out about the A&E show through patients that would come in my office talking about A&E’s Toe Bro. After that I watched a few of the episode via Youtube. For those that don’t know “The Toe Bro” is a show which chronicles the daily care and interesting foot cases that come into the office of Chiropodist Johnathan Tomines.

Johnathan Tomines, a Chiropodist and podiatrist of today like myself differ and are the same in a few ways. Chiropodist mostly work from their office and handle pathology of nails, soft tissue and foot biomechanics (natural foot function). Podiatrist of “today” undergo a 4 year medical school training, train in a hospital setting for 3-4 years for surgical training/general medical care, some even get advanced skills training in a 1-2 year fellowship program. At the end of all that school and training todays podiatrist is able to treat conditions and injuries of all aspects of the foot and ankle in a hospital or office setting via general medical care or by surgical means.

After watching a few episodes of this show I am in total support of anything that will help get awareness out about foot problems and will help direct people in need to get care from a trained professional. Knowledge about foot issue and the importance of proper foot care is very important as the US population suffers from new cases of diabetes at an alarming rate. Diabetics are at the greatest risk of limb loss and death from preventable foot issues than any other demographic of people. Often times people neglect to get care they need until it’s too late.

Lumps and Bumps: What Do They Mean and How to Treat Them | Heather D. Driessen, DPM

Well it’s almost summer and it’s time for your feet to come out of hiding. I recall a popular movie in the 1990’s of a guy who was obsessed with the appearance of women’s feet. In fact, if there were any “lumps” or “bumps” either visible on her person or on her shoes, she would not get a second date. It may sound petty, but the above example may make some people (not just women) afraid to show their feet.

Discovering lumps or bumps on your feet can be a bit scary, even intimidating. Such questions may run though one’s mind: what is that? Is that normal?  Can I get rid of it? I will tell you the answer may vary depending on what the “lump” or “bump” is. So let’s go over some common abnormalities one may find:

Bunion: A mild to severe bony prominence on the outside of the big toe joint or small (baby) toe joint. They often have a hereditary link in which one develops the “foot type” from a parent. You may notice mom or dad or even a grandparent has a “bunion.” They are typically benign (non-cancerous) but may cause discomfort while wearing closed in shoes or while walking. Treatment usually involves wearing wider shoes, steroid injections, or in more severe and/or painful cases, surgical removal.

Hammertoes/Calluses: Contracted toes with or without callus (hard skin). They are caused by a tendon imbalance on top or bottom of the toes. The friction created from shoes and direct pressure (i.e. standing, walking, running) can cause painful calluses. They can involve a single toe or multiple toes. They can present in low- or high-arched feet. Often causes pain in certain closed fitting shoes. One can get pain relief with corn pads, toe separators, or surgical correction.

Plantar Fibroma(toses): Benign round soft tissue lesion(s) found on the bottom of feet within the arch. They grow relatively slowing but progressively. Plantar fibromatoses can be painful if located on the weightbearing surface of the foot arch. Treatment includes steroid injections, padding, medicated creams, or arch supports. Surgical correction may be necessary if painful or debilitating.

Exostosis (Extra Bone Formation): Exostoses are often described as a “knot” on top of the foot, usually overlying a joint. They are most commonly found overlying the midfoot joints but can theoretically be anywhere bone is. They are sometimes painful with shoe and/or direct pressure. Treatment includes extra-depth shoes, padding, or surgical removal.

The above examples are just a few “lumps” or “bumps” that can occur. So, no more hiding. If you suspect any abnormality with or without pain, consult your local podiatrist for further evaluation. Your feet will be glad you did.