The Right Steps: How Your Podiatrist Can Keep You Moving

 
 
The most fulfilling part about my career in podiatry is the variety of ways I'm able to improve the lives of my patients. From young children to the senior population, there's almost no one I'm unable to help in some way with a foot exam and screening. In the senior population, where foot care can become difficult to maintain on your own, my patients are often pleasantly surprised at the extent of services I'm able to provide for them. Many of these services are covered under conventional Medicare benefits, provided a detailed examination is documented.
 
Diabetic Foot Examinations
Firstly, and most urgently, it is standard that ​every​ diabetic needs to be seen regularly by a podiatrist. The number of Type 2 diabetics in the senior population in America has grown exponentially in the past few decades, and foot complications from this disease are among the most common reasons diabetics land in the hospital. It has been scientifically proven that even a single visit with a podiatrist can reduce your chances of forming open wounds and being hospitalized.
 
A diabetic foot exam only takes a few minutes, but it can set you up for years of prevention. The skin, nerves, circulation, and joints are examined for changes consistent with the disease. Based on what I find, my goal is to fit every new diabetic I meet into one of four categories, determining the preventative care they need:
 
Categories of Diabetic Foot Risk  (Based on 2015 Guidelines from the International Working Group on the Diabetic Foot)
 
Risk Category                                                              Check-ups                Treatments

Low (Normal nerve exam, Normal circulation)            1-2 times per year     As needed

Mild (Neuropathy found, Normal circulation)              Every 3-6 months      Protective shoes, Nails, Calluses

Moderate (Poor circulation and neuropathy)               Every 2-3 months     Protective shoes, Nails, Calluses

                                                                                                            Non-invasive vascular testing

Severe (Open wounds, history of open wounds)        Every 1-2 months      All of the above and wound care
 
Most diabetics in the senior population that I encounter fall in the mild to moderate risk category. Provided you have good control of your diabetes with your primary doctor, the majority of senior diabetics need only a few simple measures covered by most insurances to minimize the chances of developing open wounds and infections: regular visits to have your nails trimmed and calluses pared based on which category you fit into, and protective diabetic shoes and inserts once a year. The inserts are made of materials that mold to the individual shape of your foot as you walk on them, canceling out pressure points and spreading that pressure evenly to the surrounding surface of the foot. Many diabetic shoes are made by name brands now, and are simply modified versions of models they already make, and thus indistinguishable in public from regular shoes.
 
What If I’m Not Diabetic? If you or a loved one have toenails that are difficult to manage, causing pain in shoes, or impairing you from getting around, the odds are you are covered under your insurance to have them cared for regularly. Most commonly, aging brings about a decline in circulation that can be found on examination. So long as this is documented and the toenails are painful, regular services should be covered. In fact, there is a list of conditions apart from diabetes for which regular nail trimming and callus paring are covered. With these conditions, having them treated by a professional protects you from the risks of attempting to do so on your own:
 
- Peripheral Arterial Disease - Chronic Kidney Disease (patients on dialysis)
- Rheumatoid Arthritis - Raynaud’s disease - Quadriplegics and Paraplegics  - Peripheral Neuropathy from causes other than diabetes (vitamin deficiency, chemical exposure, trauma, alcoholism, etc.)
 
As a general rule, if you have a chronic nerve or circulation condition, the odds are you are eligible. Even if you don’t have a qualifying condition, most insurances will cover these services on an as-needed basis to relieve pain rather than regular visits. In short, difficulty in managing toenails and calluses are not things you have to live with, and there are trained professionals in just about every locale that are happy to help.  
 
Stopping Foot Pain From Cramping An Active Senior Lifestyle
 
Not all foot pain is a result of a disease condition. Our strides are shorter, our feet become slightly shorter and wider with loss of muscle tone, and we lose fat padding on the bottom of our balls and heels. These are benign age-related changes to the foot that we all experience over time that when painful can be treated by simple means.  
Let’s take something common like ​arthritis, for example. Arthritis gets into the small joints of the foot much like it gets into larger joints like the knee and the hip with age. However, the joints of the foot have far less native range of motion to begin with, and we utilize less of that motion as we age because our strides become shorter. Because of this, it becomes possible to treat arthritis of the smaller joints of the foot with a modified orthotic rather than with medication. In my opinion, if you are taking anti-inflammatory medication for foot arthritis, you should seriously consider the investment in these even if they are not covered by your insurance, as taking non-steroidal anti-inflammatory medications long-term (Ibuprofen, Aleve, Aspirin, etc.) can have adverse effects on your stomach and kidneys. A well-made orthotic with proper modifications should last 1-3 years or longer depending on how intensely it is used.

Another common condition I see in seniors is ​metatarsalgia, which is pain at the ball of the foot where your toes bend that comes about while walking. If you’ve only had pain here in your golden years, it’s possible that it’s not from a disease or deformity at all. We all have specialized fat cells under our balls and heels that pad us, and these cells shrink with age to afford us less cushioning. This condition can also be treated with an orthotic, but not the typical arch supports you see advertised. Your podiatrist can make what’s called an ​accommodative orthotic which instead of being rigid for support is molded from softer materials to absorb pressure and replace the lost cushioning. I also consider these worth the investment, as keeping your level of activity maintained has proven cardiovascular and mental health benefits.
 
If you have a nagging foot pain, or if you have any of the conditions listed above, I think you’ll be pleasantly surprised with the variety of treatments most podiatrists have to offer. Many are simple, non-invasive, and best of all teachable to minimize recurrences and future visits if diagnosed early.

 

John D. Schwerdt, DPM FACFAS

Yale Podiatry Group

Diplomate, American Board of Podiatric Medicine

Diplomate, American Board of Foot and Ankle Surgery

203-734-4806 (o)