Foot problems

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Just like eye problems associated with diabetes, foot problems take more than ten years to develop and are preventable by good diabetes care. Although amputations are rare in children, the damage that leads to an amputation can start at a young age.

Make sure that your child has full sensation in his feet. It's up to you as the parent to check the young child if there's any question of loss of sensation. Here's what you must do:

i Examine his feet with your eyes and hands daily. If you notice redness, swelling, or a cut, be sure to call your doctor.

i Test the heat of water that he's about to enter for a bath to make sure that it isn't burning hot.

i Check his shoes for stones or other objects that he may not feel but that could cause damage.

i Make sure that he wears foot protection, like good sturdy shoes. (Flipflops aren't a good idea!)

i Keep his feet clean and moisturized.

The doctor should examine your child's feet at each visit, although you'll probably pick up any abnormality long before he does because you examine your child daily. Doctors usually have a 10-gram filament as well as a tuning fork that they use to detect loss of sensation in the feet.

You also want the doctor to do an ankle-brachial index test on your child every five years. This is done by measuring the systolic blood pressure at the ankle and in the arm (see the later sidebar "The meaning of blood pressure numbers" for an explanation of systolic blood pressure). The ankle reading is divided by the arm reading. A normal result is greater than 0.9, meaning the two readings are very close. A result of 0.4 to 0.8 means that the blood pressure is much lower in the leg than in the arm, suggesting a blockage somewhere in the leg. Below 0.4 indicates a severe blockage. If necessary, surgery can be done to open the artery. If severe obstruction is present, it may be treated by angioplasty, a procedure in which a balloon is inserted in the artery to open it up, or bypass surgery, in which the obstruction is bypassed with a piece of the patient's vein or a synthetic tube.

The ankle-brachial index is much worse in older people with T1DM if they're smokers, have high cholesterol, or have high blood pressure.

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