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Limb Wellness for Diabetes Patients

Andrew Cheng, DPM
Have you checked your feet lately? If you have type 1 or type 2 diabetes, you should–every single day. Even the tiniest cut could develop into a problem. Unfortunately, too many people with diabetes put off seeing a podiatrist.

Dr. Andrew Cheng heads the Podiatry Program at MarinHealth’s Braden Diabetes Center. In this podcast, he discusses the causes of diabetic foot issues, and the price of waiting too long to address them. Find out why you should see a podiatrist regularly. And learn what you can do to keep your feet healthy.

Bill Klaproth (Host): So, how common are foot conditions for people with diabetes and why are diabetes patients at risk for these types of foot complications and what can you do to take care of your feet to help prevent foot conditions? Well, let's find out what Dr. Andrew Cheng, a Podiatrist at Braden Diabetes Center.

This is the Healing Podcast brought to you by MarinHealth. I'm Bill Klaproth. Dr. Cheng, thank you so much for your time. It's great to talk with you. So, first off, can you give us a bit of background on yourself and share your credentials?

Andrew Cheng, DPM (Guest): Yeah, absolutely. I'm a Podiatric Surgeon. I went to California School of Podiatric Medicine for Medical School. Then underwent my surgical training at St. Mary's Medical Center in San Francisco. I'm on my way to get double board certified as I'm currently board certified with the American Board of Podiatric Medicine and Board Qualified with the American Board of Foot and Ankle Surgery.

Host: Got it. Well, thank you so much. So, let's jump into talking about foot conditions for patients with diabetes. So, how common are foot conditions for patients that are living with diabetes?

Dr. Cheng: That's a great question. So 25% of patients with diabetes will develop a foot ulcer in their lifetime, 25 of those patients who develop a foot ulcer will require an amputation. So, in California, one out of three adults either has pre-diabetes or diabetes and incredibly enough, the amputation rates in most of the counties in California have increased from 2010 to 2016.

Host: Wow. That's a higher rate than I would have thought. What do you account for this higher rate of amputations?

Dr. Cheng: I think it's maybe just education. I think we, as podiatrists, need to do a better job of doing podcasts like this, just to educate everyone that it is really important to have diabetics get their feet checked at least yearly.

Host: So you mentioned foot ulcers. What other types of foot conditions do you typically see for patients with diabetes?

Dr. Cheng: The most common complications we see are diabetic peripheral neuropathy and peripheral arterial disease. Peripheral neuropathy is when you lose sensation of your extremities, which is typically present with symptoms such as numbness, burning, tingling, cramping, balance issues and while peripheral arterial disease is when you have constant pain in your feet and lower extremities due to the lack of blood flow. Actually, peripheral neuropathy then opens the door to development of ulcers which then can get infected and eventually lead to an amputation.

Host: So peripheral neuropathy, that's the lead into potential amputation?

Dr. Cheng: That's exactly right.

Host: Got it. Can you explain to us why diabetes patients are at particular risk for these types of issues? And is it the same for Type 1 and Type 2 diabetes?

Dr. Cheng: Diabetes affects our eyesight, kidney function, vascular, nervous and immune systems. In our podiatric world, the nervous system is particularly important, like I said, because of the decreased pain receptors to the bottom of your feet, which results in peripheral neuropathy. So, if you can't feel the bottom of your feet and as you continue to walk, the microtrauma and the shearing forces of say a tennis shoe can lead to the ulcerations.

Also, you can't forget about how diabetes decreases our ability to fight off infections. So, this can lead to higher likelihood of infections. And if noticed too late, it can, unfortunately, again, lead to amputations. And to answer your second question. Yes. Both Type 1 and Type 2 diabetics are susceptible. What is important in either case is to ensure that we can control our blood glucose levels.

Host: So peripheral neuropathy, that's where you're losing the feeling in your extremities. Is that correct? In your feet?

Dr. Cheng: Correct.

Host: So then when we lose feeling in our feet, if we develop an ulcer, we don't really notice it, and that constant pressure from walking exacerbates that, and that's how we get an infection and the infection then leads to potential amputation?

Dr. Cheng: Correct. It's just this ongoing cycle.

Host: Is it tough to heal those wounds then those, is that the problem? You just, it's just not easy to heal those, those foot ulcers, if you will.

Dr. Cheng: Yeah. So when it comes to healing the ulcers, we always try to ensure that they get their yearly checkups, if not sooner. We as podiatrists, we have a specialty in limb preservation. So we try to ensure to do everything in our power to preserve the limb. So, we work up each patient and cover what their underlying condition may be.

And so causes that may prevent healing are superficial infections, lack of blood flow, increased pressure to that area due to bony prominences. And once we uncover that reason, that's preventing the patient from healing, we will correct it. And in most cases, we get the ulcers to heal.

Host: Right. Okay. So that's great to know. So, then let's talk about prevention, what should diabetes patients do to best take care of their feet and prevent complications like this?

Dr. Cheng: Yeah, that's a great question. And one of the simplest things we ask a patient to do is to monitor their feet daily. That helps us catch the issues early. If you have calluses, fungal or ingrown toenails, I would say, see a podiatrist and don't try to treat yourself. What also helps is to keep working with their primary care physician to manage their diabetes and to keep their blood glucose levels under good control.

This will help prevent the progression of things like peripheral neuropathy and peripheral vascular disease. And lastly, diabetic patients should have at least a yearly checkup with us. And so we can monitor the progression of your podiatric problems.

Host: Right. So you said examine your feet daily. What are some of the initial symptoms that patients should watch out for if they're examining their feet? What are we looking for?

Dr. Cheng: The patient should initially watch out for any open wounds or ulcers. A simple thing a patient can do is wear white socks. With white socks, any drainage can be easily visible. It can signal you to come right away to our office. Any wound or cut of the foot and ankle, in a patient with diabetes that should be definitely a sign to come see us as soon as possible.

Host: Right. So, we've already briefly talked about foot ulcers as one of the main problems, so is amputation always necessary. I'm sure you treat it before it gets to that point. What are the treatment options?

Dr. Cheng: Yeah, no, no, no. Amputations are largely preventable, as long as we see the patient in time. The problem is that patients usually delay presenting to the doctor. And this is something that we work hard in educating our patients. If we can see patients regularly, we can prevent 80 to 90% of these amputations.

Host: Wow, 80 to 90%. So this early prevention is key.

Dr. Cheng: Exactly.

Host: So I mean, it's great that early prevention then really can help prevent amputation. So, and you talked about regular screening, checking your feet every day. And I hear you're going to be offering podiatry screenings and basic podiatry services for patients with diabetes at the MarinHealth Braden Diabetes Center. Can you tell us a bit about the services you'll be offering?

Dr. Cheng: Absolutely. We will be starting a clinic on December 6th, 2021. And we will be present every Monday. So, we will be offering fullscope podiatric foot and ankle care for the patients of Braden Diabetes Clinic and so like we were saying before, ulcers, fungus, ingrown toenails, any sort of musculoskeletal problems to dermatologic. We cover basically everything from the ankle down.

Host: Got it. And then how can existing Braden Diabetes Center patients go about making an appointment?

Dr. Cheng: Yeah, so you can call the number 415-925-7370, and ask to be scheduled with the podiatrist and you'll get me.

Host: Great. I love it. We love it. That they go right to you. That's awesome. So, then what about others in the north bay who may not already be MarinHealth patients? Can they make an appointment as well?

Dr. Cheng: Absolutely. We accept all forms, insurance, and we don't just deal with diabetic foot and ankle issues, like I said earlier. We can do it all.

Host: That's great. Well, As we wrap up, Dr. Cheng, thank you so much for your time. What would you say to someone suffering from Type 2 diabetes, worrying about foot conditions. What else would you like to add or say to them?

Dr. Cheng: I would say this isn't something you have to deal with alone. We're always here to help you, as well as your primary care. And so as a team, collective team, we can help solve this issue and make it as painless as possible.

Host: Absolutely. And I think certainly in my notes here is don't delay if you think there is a problem with your feet. Go and have a checked right away. Right. Don't put it off for months. Cause that could kind of get you into the danger zone. Is that true?

Dr. Cheng: A hundred percent true.

Host: Well, Dr. Cheng, thank you so much for your time today. This has really been informative. Thanks again.

Dr. Cheng: Thank you for having me. It's been a pleasure.

Host: And that's Dr. Andrew Cheng. And to learn more, please visit And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is the Healing Podcast brought to you by MarinHealth. I'm Bill Klaproth. Thanks for listening.