Shireen Abdullah: 00:02 

Podcasting from Dallas, Texas. I am Shireen and this is the Yumlish Podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type 2 diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

Shireen Abdullah: 00:34 

Most amputations are preventable. This episode breaks down what a diabetic foot ulcer is, the early red flags people miss, and the daily habits that protect mobility, plus a clear first 48 hours plan if a blister or cut appears. Stay to the end for simple actions. You can start today.

Shireen Abdullah: 00:52 

Dr. Allison K. Myers is a professor of medicine and associate chair for faculty mentoring and community engagement at Montefiore Einstein in the Bronx. She leads the system’s multidisciplinary diabetic foot ulcer clinic, uniting endocrinology, infectious disease, vascular surgery, podiatry, and behavioral health. Welcome, Dr. Myers. 

Dr. Alyson Myers: 01:13

Thank you for having me. 

Shireen Abdullah: 01:14

Such a pleasure having you on. My first question is, what don’t you do? No, I’m just kidding. 

Dr. Alyson Myers: 01:18

No, it’s a good question. Thank you.

Shireen Abdullah: 01:20 

Thank you so much for being here, Dr. Myers. First, we just want to get to know you. Could you tell us what inspired your focus on diabetes care and specifically on preventing sort of this lower extremity disease? Where did this come from? 

Dr. Alyson Myers: 01:34

So I feel like diabetes has been a part of my life forever, even though I personally don’t have diabetes. It’s been a part of my life due to my family members and friends.

Dr. Alyson Myers: 01:43

So I think my first experience with diabetic foot ulcers, but I didn’t really think about it until many years later, was with my aunt. So I used to go to North Carolina every summer to visit my aunt, Addie, who had diabetes. She also smoked and had a blood pressure and didn’t always have the best diet. She was an amazing cook. So she ate a lot of the typical Southern foods and cooked them really well. And unfortunately, her diabetes was not well controlled. So you have

Dr. Alyson Myers: 02:07 

Not the best control because of your diet. She was overweight. She smoked. And unfortunately, she developed some of the complications of diabetes. She had pretty bad neuropathy in her feet and poor blood flow, again, from the smoking and ended up having bilateral TMA. So in lay people’s terms, that’s when you lose all of your toes. So very often it starts with you losing one or two toes and then eventually things get worse and you end up losing all the toes. So pretty much you’re left with about half of your foot. And she ended up having it, unfortunately, on both of her feet.

Dr. Alyson Myers: 02:36 

And so I remember being around her and she wouldn’t be able to drive for long periods of time because the pain would be really bad. But again, I didn’t really make the connection between the diabetes, the smoking, the ulcers. At that time, I was probably 14, 15. She unfortunately passed away

Dr. Alyson Myers: 02:52 

when I was probably about 21. So it’s been a while since she’s gone on to her glory. But I think that was my first real experience of seeing the bad side of diabetes when you don’t take care of yourself and just how much it can wreak havoc on your lower extremities. 

Shireen Abdullah: 03:08

Thank you for sharing that personal story, Dr. Myers. From there, you know, after sort of seeing that within a loved family member, help us understand like what drew you to specifically looking at this as a career, right? And like focusing so much

Dr. Alyson Myers: 03:31 

So it wasn’t initially what I started out doing. I did my residency in a combined training program of internal medicine and psychiatry. So my first area of focus was diabetes and depression. Then over time, maybe about six, seven years ago, I started working with a vascular surgeon at my previous job. And she was like, there’s so much that we can do between the overlap of diabetic wounds, you being an endocrinologist, me being a vascular surgeon.

Dr. Alyson Myers: 03:55 

So we actually did a chart review looking at what are some of the variables that are associated with people who are coming to the hospital with a diabetic foot ulcer and having to be readmitted to the hospital. So it wasn’t surprising. Some of the things that we found people on insulin, because most people who are on insulin have had diabetes for a long time. Usually insulin is added because their sugar is not the best controlled. Also, we found that people who aren’t blood thinners, they tended to come back. People who went home and had a home care nurse come out to the house, because obviously a home care nurse is going to be a little bit more diligent about looking for certain signs of infection.

Dr. Alyson Myers: 04:24 

And so then when I switched jobs, one of my colleagues in infectious disease reached out to me and said, oh, we should do some work together and partner on this. So it just kind of became something that was a passion that I didn’t set out to make my passion. But sometimes you find things just when you meet the right people. Sometimes it’s just kind of that fate.

Shireen Abdullah: 04:42 

And it just brings you to it. You know, for our listeners, can you help us first just help us understand the work that you do? So for folks who may not be familiar, what exactly is diabetic foot ulcer and why is it so common and yet also preventable?

Dr. Alyson Myers: 04:58

 So when we talk about common, about 10 to 30 percent of people with diabetes in their entire lifetime will have a diabetic foot ulcer. So usually what happens is

Dr. Alyson Myers: 05:07 

we have a couple of precipitating factors so one that i mentioned earlier is neuropathy so lay people’s term for neuropathy is when you have damage to the nerves and you can get one of two things you can get increased pain or you can actually get numbness in your feet so um when you don’t feel things very well or you’re too sensitive to how you feel things what can happen is you can step on something and not

Dr. Alyson Myers: 05:28 

realize it you could be wearing improper shoes that are causing rubbing and usually what will end up happening is you’ll get some sort of breakdown in the skin it may be something else like a blister or callus then unfortunately it can go from being you know just a basic ulcer to being infected and that’s when we have issues so the infection can be the result of your shoes are just dirty and you’re wearing shoes without socks it could be a matter of you walking around barefoot it could be again because you don’t feel you step on a nail or attack and it’s rusted

Dr. Alyson Myers: 05:55 

So there’s multiple ways that you can develop these, but there’s many more ways to prevent them. So you can be a part of that 70 to 90% that doesn’t get a diabetic foot ulcer. 

Shireen Abdullah: 06:05

So we’re talking about complications from diabetes that leads to neuropathy to begin with that, you know, you don’t have that feeling on your, you know, nerve endings. And that’s why when you’re stepping on a tack or a nail or something like that, or, you know, the shoes, like you mentioned, we just, we have no realization of that as well. Super helpful.

Shireen Abdullah: 06:22 

Which takes me to my next question. What are some of the earliest signs or symptoms patients should look for to catch such foot problems before they become serious? And are there any red flags that you can talk about here that often get ignored? 

Dr. Alyson Myers: 06:37

Absolutely. So one of the most important things is to check your feet every day. So that’s looking at the tops, the bottoms, the cracks between your toes. If you’re someone who has mobility issues, you cannot see your feet. You have two other options. You can ask your caregiver to look between your toes and at the tops and the bottoms.

Dr. Alyson Myers: 06:51 

Or else you can use a mirror. So you can put your foot up to the mirror, put a mirror on the ground and look at your foot on the under surface. You’re looking for cracks. You’re looking for blisters. You’re looking for calluses. It’s also important that you keep your feet well hydrated. For those of us who are in the Northeast right now, we’re getting killed with these really cold temperatures. So when the air is really dry because you’re running all this heat,

Dr. Alyson Myers: 07:12 

whether it’s from a radiator or a space heater or you have central air, that’s going to dry the air out and make your skin very dry. So winter feet tend to be very dry and prone to cracking. Also in the wintertime, because it’s cold, we take hotter showers, which is going to pull the moisture out. So the wintertime is a time where we’re going to be very susceptible to having dry skin and that can set us up for ulceration. So we really need to keep an eye on our feet as well as make sure we moisturize. The unfortunate thing is a lot of lotions that are sold here in America,

Dr. Alyson Myers: 07:40 

are water-based, so they’re not the strongest when it comes to moisturizing. So you need to use one of the usually more expensive lotions, unfortunately, like a Lubroderm, an Aquaphor, an Aveeno, Gold Bond for diabetics is another brand, because they tend to be a lot thicker. Some people also will use Vaseline. We often will prescribe ammonium lactate. You can’t get that over the counter. But these tend to be thicker creams, so they serve as better barriers for moisture retention in our feet.

Dr. Alyson Myers: 08:08 

So I would say check your feet daily and go use a good moisturizer, really important. But make sure you’re not putting it between your toes because if you’re doing it between your toes and they’re too moist, that can set you up for fungal and other types of infections. So I always say the tops and bottoms, not between the toes. 

Shireen Abdullah: 08:24

Okay, so moisture is key here. Sure.

Dr. Alyson Myers: 08:26 

So it starts with your socks and shoes. So there are socks that are called diabetic socks. So very often the socks we have have that elastic at the top, which can actually cause compression. I saw a patient the other day whose legs were really swollen and I was like, the socks are making it worse. So make sure you either cut the top off of the socks so the top elastic isn’t cutting off your circulation or you can buy diabetic friendly socks. They sell them most in local drugstores. You can find them online. But that’s something that’s really important is making sure that

Dr. Alyson Myers: 08:55 

that you’re getting socks that are not going to compromise your circulation. The other thing is making sure you’re getting proper fitting shoes. So for those of you who have Medicare, Medicare Part B entitles you to a free pair of diabetic shoes every year, as well as inserts. For a lot of folks from my community, we’re flat-footed. So wearing improper shoes will set you up for all types of bad things that can happen. So very often inserts or just good fitting shoes are really key. And also it’s important to let your shoes breathe.

Dr. Alyson Myers: 09:23 

So if you wore a pair of shoes today, tomorrow you should wear a different pair. So I tell people you need to give your shoes 24 hours to breathe. Otherwise, they’ll just be a nasty petri dish full of bacteria and fungi. So you always want to let them just breathe for 24 hours or a day before you wear them again. So those are a couple of really important daily things. One other thing I’d like to add is not daily, but it’s also a part of a lot of people’s lives, both male and female. And that’s going to nail salons.

Dr. Alyson Myers: 09:48 

nail salons sometimes I’ve had patients tell me oh the tech told me that they specialize in diabetes so I always tell people unless if that tech has gone to podiatry school and has a doctor in podiatric medicine they are

Dr. Alyson Myers: 10:00 

not specialists in foot care. That’s not something that a tech is qualified to do. So I always tell people it’s really important that your podiatrist, yourself or a caregiver you trust should be the one that cuts your toenails. Nail salon should not be cutting your toenails. They should not be cutting your cuticles. They can push them back and they can help, you know, follow your nails down. But it’s really important that you’re not letting them cut because what can happen is if their equipment is not clean and they cut the cuticle, you can get an infection if the equipment is dirty. And that’s unfortunately a way I’ve seen people lose

Dr. Alyson Myers: 10:29 

their toes. And I even saw one man, for example, because he didn’t feel very well, he put his feet in the tub of water and he did not realize how hot that water was. And he ended up with second degree burns. So that’s the other thing. So it’s cutting of the skin and improper temperatures. Because again, if you have nerve damage, you may not feel how hot that water is. And he unfortunately not only developed burns, but he also developed an ulcer and ended up losing some of his foot.

Shireen Abdullah: 10:55 

Okay. And remember that one. That’s helpful. When it comes to daily prevention, what are the most important habits you want every patient with diabetes to develop that’s listening here today?

Dr. Alyson Myers: 11:07 

Yes. So the problem is, is if your diabetes is not well controlled, it can make your neuropathy worse. I’ve had patients that their, you know, blood sugars, their hemoglobin A1C, we use that every three months. For most patients, it should be under 7%. I’ve had patients, their A1C was running 11, 12, 13. Once it got down to that 6, 7 range, they noticed their neuropathy was not as bad.

Dr. Alyson Myers: 11:27 So there definitely is a correlation between having poorly controlled blood sugars and nerve damage and worsening neuropathic pain. So it’s really important that you’re controlling your sugars, prevent this from getting worse. It may not permanently go away, but it can potentially get better. Also for circulation purposes. So I mentioned earlier that my aunt was a smoker. Smoking narrows the vessels. It’s what we call vasoconstriction. So it makes the vessels smaller. If your diabetes is not well controlled, not only in your smoker,

Dr. Alyson Myers: 11:54 

Not only will you have a small vessel, but your vessels will be sticky because all that extra sugar will sit there. So even if you’re a non-smoker, your vessels may not be narrow, but they’re going to be sticky. And that’s the perfect way of getting some sort of clot. And that’s why people with diabetes are at increased risk of having vascular disease or circulatory disease if they’re not controlling their diabetes very well.

Shireen Abdullah: 12:15 

Oh, goodness, man, that is something. OK, well, thank you for providing that context and like how we should be thinking about foot care. How much of lower extremity disease is related to blood sugar management in particular versus other factors? You know, you talked about circulation or footwear for that matter. 

Dr. Alyson Myers: 12:34

And can I connect the dots on the vision? If you have poor vision, you’re not looking at your feet. So it all is going hand in hand.

Dr. Alyson Myers: 12:42 

So if you have really blurred vision because you have what we call retinopathy or damage to the vessels that are supplying your retina, you’re not going to notice those cracks in your feet. So to your point, it’s all coming together, unfortunately. 

Shireen Abdullah: 12:56

That’s helpful context because you think blood sugar, but it has implications on so many things. I mean, we’re talking nerves related to like vision, for instance. There’s so many complications of diabetes that folks don’t immediately understand or connect the dots on, but it’s all related right at the end of the day.

Shireen Abdullah: 13:12 

Just to go on a tangent here, they talk about how diabetes is a silent killer, and that is so true because it’s working behind the scenes. It’s not showing up in an explicit way. Like if you have a virus, flu, you know, something like that, it’s showing up. You’re seeing symptoms and, you know, you’re feeling the aches and pains and whatever, but this is silent. It is great.

Shireen Abdullah: 13:28

creeping from foot to eyes, your kidneys, all the way through. And it’s just, the damage is like nicking at all these different body parts. And if you’re not on top of it, it can really get bad. But thank you for that perspective, Dr. Myers. As we move forward in this podcast, next I wanna talk about some of the biggest misconceptions. I’m sure you hear that from patients all day. There are lots of misconceptions around this from patients or even from caregivers that they have about their diabetic foot health. What do you hear? What do you see?

Dr. Alyson Myers: 13:56 

Yeah, so I mentioned the nail salons, but I think another big part of this is that people think if they have a small little cut or lesion, they can manage it on their own. I remember taking care of a truck driver who had developed a callus and he thought that he could just pick it on his own, put some benzoyl peroxide on it and…

Dr. Alyson Myers: 14:17 

that would, you know, heal it. And he did it for about a week. And unfortunately, rather than healing it, it made things worse. And he developed a really bad pus pocket underneath the skin that he didn’t see. And he unfortunately ended up losing his foot. So what can happen is things like Baxatracin,

Dr. Alyson Myers: 14:34 

alcohol, peroxide, if we use them, you actually sometimes can make things worse because you’re destroying the good bacteria that you need to help heal a wound. So what I always tell people is little things become big things. So rather than trying to do it on your own, whether it’s your primary care doctor, the nurse practitioner you see, the endocrinologist, you should always show things to your doctor. I’ve had people who were like, oh yeah, I don’t think it’s a big deal. And I can’t even get the sock off because there’s a big nasty ulcer sitting there.

Dr. Alyson Myers: 15:01 

Or I smell it. I had one patient who came in, he couldn’t even put his shoes on because his foot had swollen up so badly. And he walked in wearing four pairs of socks on his bad foot and a shoe on his other foot. And it smelled like a dead animal. And he had gangrene. Thankfully, he didn’t have poor circulation and his nerve damage was there, but it wasn’t all the way there. So he didn’t lose his toe, but he had lost a toe a couple of years ago. So really, the earlier you seek care, the better. That’s really the take home.

Dr. Alyson Myers: 15:26 

And so many people I’ve met will be like, I really regret not coming in sooner. 

Shireen Abdullah: 15:30

Because by the time it’s showing up in that way, it’s already getting to be too late. So you can’t sort of ignore those, especially at that point when it is that obvious. Which takes me to my next question. So we’ve been talking about examine your foot, look at signs, look at puss, look at blisters. Let’s say a person listening to this episode today did find something of concern. What is like the immediate thing they should do? What are the next 48 hours, let’s say, look like for them?

Dr. Alyson Myers: 15:51 

The nice thing is we have stages of, you know, what’s quasi bad and what’s really bad. So the things where you go, like, I would say straight to the emergency department is if you have a fever, because that means the infection is probably throughout your body systemic. It’s not just contained in your foot. If you’re seeing pus expressed. So it’s normal when you have a wound to have like some clear, maybe slightly bloody fluid. But if it looks like pus where it’s pure white, you need to go to the ER.

Dr. Alyson Myers: 16:15 

If you notice that it smells really bad, that probably suggests gangrene. Again, I would go straight to the ER. If you have severe pain, I would also say you probably need to go straight to the ER. Where it could be you might be able to get away with urgent care going to your doctor is if you have some mild swelling, some mild redness. It may be more superficial in the skin where you can get away with doing antibiotics at home.

Dr. Alyson Myers: 16:38 

home. But those other things were suggestive of systemic, so like the fever or chills, increased heart rate above 100, severe pain. That’s more suggestive of infection in the blood or even into the bone. So that’s a little bit more worrisome, in which case you’re more likely to need IV antibiotics. The pills won’t be efficacious.

Shireen Abdullah: 16:57 

So I appreciate that. So that’s the game plan for, you know, what we see. And again, go see someone. Do not, do not ignore it. As we wrap up the episode here, Dr. Marais, what challenges are often overlooked when facing the prevention, again, prevention of lower extremity disease? And how can the healthcare system better support them?

Dr. Alyson Myers: 17:17 

One of the things we take for granted is the shoes that we wear. And again, Medicare will cover you for diabetic shoes. But if you have commercial insurance or Medicaid, not necessarily so. It’s not across the board. It can vary. So I think the unfortunate thing is if you look at the sneakers that are recommended by our podiatric colleagues, they’re great. And the issue is they tend to be really expensive.

Dr. Alyson Myers: 17:40 

So brands such as like Brooks, New Balance, Hoka, Asics, just to name a few. And I’m not trying to say other brands are not good, but I’m just, you know, those are some of the ones that I think about. Because again, I have flat feet. And so these are some of the more comfortable sneakers for somebody like me. Those tend to be a bit more expensive. They can easily run you well over $100. And for like my patient population in the Bronx, spending $150 on one pair of sneakers is a lot.

Dr. Alyson Myers: 18:06 

So I tell people, you know, whether it be looking for the outlet, looking for sales, because people do have sales, it’s definitely advantageous. I mean, I bought a pair of one of the brands I just mentioned. I got them on sale from Dick’s Sporting Goods and it was still $110. But for me, $110 is not the same for someone who’s living paycheck to paycheck or on a fixed income. The sneakers were originally, I think, $170. And based off a principle, I was like, I’m not paying that much for one pair of shoes. I know they’re comfortable, but that’s a lot for one pair of shoes in the grand scheme of things.

Dr. Alyson Myers: 18:35 

So I think that it’s really important that people know the importance of getting good fitting shoes and understand that they can sometimes use their insurance benefits to defer some of this cost. But it’s like my mom always said, the cheapest is the dearest. So if you wear cheap, poor fitting shoes, you’re going to be at risk for things like hammer toes, blisters. And that’s even if you don’t have diabetes. I don’t have diabetes.

Dr. Alyson Myers: 18:58 

And I have to be really careful about the shoes that I work because, like I said, I don’t have great arch support naturally. But a lot of our patients with diabetes do have foot deformities, whether it’s being flat footed, high arches, hammer toes, bunions. So making sure that they’re wearing proper footwear is something that we as the providers need to teach people. But even the folks in the shoe stores, they need to do a good job of showing people how to buy the right pairs of shoes, not trying to just make a sale.

Shireen Abdullah: 19:22 

Very helpful. And, you know, to our listeners, take this, understand this, and, you know, try to find ways to apply this for yourself. Because, you know, like you said, Dr. Myers, if you have a concern, you have to protect yourself. And ideally, it’s a covered benefit for you. So we’ll be able to utilize that benefit. With that, Dr. Myers, we are toward the end of the episode. At this point in the episode, I’d like for you to perhaps tell us how listeners can connect with you, learn more about your work, just learn more about this space.

Dr. Alyson Myers: 19:48 

Yeah, so I have some video content on my Instagram, Dr. Save a Limb. So it’s D-R. Save, S-A-V-E-A-L-I-M-B. It’s Dr. Save a Limb. Some really great videos where I’m talking

Dr. Alyson Myers: 20:00 

about diabetic foot ulcers. Also, I would say another great resource always is like the American Diabetes Association. They have a lot of great work. APMA, that’s my podiatry colleagues. You can look up what type of shoes they highly recommend that are good for use. Again, I just named a few of the brands. And just because I named their brand doesn’t mean it’s the exact shoe. So each brand,

Dr. Alyson Myers: 20:18 

will have shoes that they’ll recommend depending on what type of foot issues you may have. Some people over protonate. That’s when your foot rolls outwards. Some people have the opposite where their foot rolls inwards. So you have to look and see what is your foot issue and they’ll tell you which type of sneaker they recommend within each brand.

Dr. Alyson Myers: 20:33 

So, you know, it’s not all Hoka’s, it’s not all Brooks, it’s not all New Balance, it’s not all Nike, it’s not all of these. They’ll tell you certain ones of sock and whatever. So I highly recommend that. And that’s for lay people. You don’t have to be a physician or a podiatrist to look that up. 

Shireen Abdullah: 20:46

Super helpful. Dr. Myers, thank you so much for sharing that and for all the insights that you’ve provided here today.

Shireen Abdullah: 20:52 

To our listeners, thank you for listening to another episode of the Yumlish podcast. Head over to our Facebook, our Instagram, which is @Yumlish and comment below this podcast post to tell us what is one healthy habit you found helpful in managing your diabetes or diabetes for a loved one or one that you want to start building.

Shireen Abdullah: 21:13 

today for yourself we’re hoping that this episode has inspired you to make some changes again for yourself or a loved one so head over to again at Yumlish on facebook on instagram and again tell us what is that one healthy habit you found helpful in managing diabetes for yourself or for your loved one and one you want to start building sooner than later thank you so much for your presence here Dr. Myers and for the insights that you’ve shared thank you

Shireen Abdullah: 21:39 

Thank you for listening to the Yumlish podcast. Make sure to follow us on social media at Yumlish underscore on Instagram and Twitter and at Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspective.

Shireen Abdullah: 21:59 

You can also visit our website, Yumlish.com, for more recipes, advice, and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week’s show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we’ll see you next time. Remember, your health always comes first. Stay well.

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