Home  |  Contact Us  |  Site Map  |  Staff Tools  |  Classes  |  Newsroom

  Chat Transcript
Open Q & A and Foot Care - Dr. Gruttadauria, Unity Wound Care Center, October 8, 2013

Joy at Unity:
Welcome to the Unity Diabetes Online Community! I’m Joy Valvano, a certified diabetes educator at Unity Diabetes & Endocrinology Services, and I’ll be hosting today’s chat. We have a special guest tonight: Dr. Gruttadauria, Podiatrist from the Unity Wound Care Center. I’m glad you could join us today. We’re excited to answer all of your questions.
Joy at Unity:
Before we get started let me just tell you how I’ll address your questions and comments today. I answer questions one at a time, in the order that they are posted to the site, and there might be a slight delay as I respond to each question. It may take a few minutes for me to type answers to your questions, so please stay logged-in to the chat to see my response, even if it takes a few minutes. And you might need to refresh every few minutes to keep up with the latest posts in the chat if you switch to another application on your computer. Let’s get started.
Dr. Gruttadauria:
Thank you, Joy. I am looking forward to answering any questions.
sassy35:
If you have diabetes – how often should your doctor check your feet?
Joy at Unity:
Dr. Gruttadauria, perhaps you could tell us a little bit about common foot issues you see with people with diabetes and some prevention recommendations.
Dr. Gruttadauria:
At least once per year, however more frequent if loss of feeling or circulation problems. You should also check more frequently if you have history of ulcers, callus or foot deformity.
Dr. Gruttadauria:
Some common diabetic foot problems include fungal infections of the nail or skin, neuropathy (nerve pain or loss of feeling) and ulcers (wounds).
Dr. Gruttadauria:
Some require aggressive treatment, such as foot ulcers, to reduce risk of infection and amputation and should be evaluated once they are noticed.
wadelyman:
What do you suggest if you have a nail fungal infections?
Joy at Unity:
What are some of the warning signs/symptoms?
Dr. Gruttadauria:
Prevention includes daily self-foot exams to check for pressure areas, blisters or callus. Also appropriates shoes and socks.
Dr. Gruttadauria:
For nail fungus there are several topical medications which have limited success. Oral medications have greater success with more risk to the body. Often people elect to manage nail infections by having their nails cut and thinned which is acceptable treatment.
sassy35:
What can be done if you have numbess in your feet?
Dr. Gruttadauria:
There are some newer studies evaluating laser treatment for nail fungus, although to my knowledge it is not available locally.
Joy at Unity:
Do the over the counter creams help for the nail fungus, or are prescription medications necessary?
Dr. Gruttadauria:
Numbness in the feet may be due to diabetes, but should be evaluated further to rule out many other possible causes. It is paramount to protect your feet with diabetic shoes if there is loss feeling to reduce risk of ulcers.
Dr. Gruttadauria:
Both over the counter creams and topical prescription medications have poor results for nail fungus.
Joy at Unity:
What do you recommend/how is nail fungus treated? Is there a cure?
Dr. Gruttadauria:
There has been some increased success with combining topical antifungals with topical nail softeners for nail fungus.
Dr. Gruttadauria:
Cures are primarily through prescription oral medications, however not everyone (given health status and other medications) is a candidate. It is important to have your nails cut and thinned to reduce the risk of pressure and wound to the nail bed (especially for those with loss of feeling).
Joy at Unity:
Are there other common issues regarding the feet that people with diabetes should be aware of?
Dr. Gruttadauria:
Keeping feet hydrated with moisturizer is important especially as the weather gets colder. Feet tend to dry and crack which can lead to infection, but you should avoid moisturizer between the toes.
Joy at Unity:
Do you recommend that people have their nails trimmed by a podiatrist instead of doing at home themselves?
Dr. Gruttadauria:
Yes – if they have neuropathy, with loss of feeling or circulation problems. Or if they have thick nails that are difficult to cut, then they should be seen by a podiatrist. Those who have good sensation, circulation and normal nail quality can generally safely cut their nails.
Dr. Gruttadauria:
It is still important to have at least once yearly foot exam.
Joy at Unity:
That is good to know, what does a yearly foot exam include?
sassy35:
Do you need a referral to see a podiatrist?
wadelyman:
Are nail softeners over-the-counter or by prescription?
Jane@Unity:
A guest in my class asks, "Is there a specific cream for dry skin?"
Dr. Gruttadauria:
A yearly foot exam would include assessing for risk factors for foot ulcers to include circulation, sensation, foot deformity and range of motion as well as skin quality. Recommendations for shoe gear can also be made.
Dr. Gruttadauria:
Nail softeners are available by prescription. They help soften the keratin of the nail plate and allow the anti-fungal medication better penetration.
Dr. Gruttadauria:
For dry skin, I recommend Am lactin, Kerasal or CeraVe on an over-the-counter basis.
Dr. Gruttadauria:
Some insurances require a referral for podiatry, but Medicare does not.
Jane@Unity:
A student from my class asked, “If you have numbness and pain in your feet and you get your diabetes under control will feeling return and pain decrease?”
Dr. Gruttadauria:
Not always, but controlling blood glucose is one of the treatments. There is also a correlation between length of time someone has had diabetes.
Joy at Unity:
That’s all the time we have for today. I’ve really enjoyed our conversation and hope that I was able to provide some insight for you. If we didn’t get to your question today or if you think of another question later on – feel free to jump into the conversation in the forum, or submit a question using our “Ask an expert” feature. Be sure to join us for our next chat on Tuesday, October 22 at 8 p.m. with Karen Gesell, C.D.E. Karen will be holding an open Q&A session to answer all of your diabetes questions and chatting about dining out with diabetes!
Joy at Unity:
Thank you Dr. Gruttadauria! Your expertise and info provided tonight has been very helpful!
Joy at Unity:
We appreciate you taking the time to participate in our chat!!
Dr. Gruttadauria:
Thanks for all the great questions
 
 
 
Diabetes events and classes to help you get the support you need. Diabetes classes and diabetes events
December 22, 2014
5:30 p.m. - 7:30 p.m.

 
Monday – Friday, 8:00 a.m. - 4:30 p.m.
Phone: (585) 368-4560
© 2013 Unity Health System, Rochester, N.Y.