Dance and Diabetic Neuropathy
Kane, Nancy, JOPERD--The Journal of Physical Education, Recreation & Dance
During the spring of 2006, just before the AAHPERD National Convention and Exposition in Salt Lake City, I was incorrectly diagnosed with type 2 diabetes. I dutifully purchased a blood-sugar monitor, testing supplies, and pills and followed all of my doctor's guidelines for diabetic monitoring, diet, exercise, and weight management--except one. My doctor did not tell me I should not go barefoot.
In my work as a modern dance professor, dancing barefoot is the norm. The calluses, blisters, occasional skin rips, and painful cracks between the toes are commonplace and come with the territory. It never occurred to me that my feet might become seriously infected (or gangrenous) or that I was at risk for possible amputation due to the side effects of my career mixed with diabetes.
It was only after my sister, a nursing student, casually mentioned that diabetics are discouraged from walking barefoot that I began to research further. In the case of diabetes-related neuropathy (nerve damage), the consequences of ignorance are serious enough to spark discussion among dance educators, dancers, and health professionals, so I am going to present some of the facts and issues here with the hope of initiating responses and further study.
Currently, there are approximately 14.6 million diagnosed cases of diabetes in the United States, of which five to 10 percent are type 1 (previously called "juvenile" diabetes; in this form the body does not produce insulin). Most diabetics are type 2, meaning that the cells have trouble using the insulin. An additional 6.2 million cases are undiagnosed, which means that the people who have diabetes do not know they have it. Without insulin, the blood cannot get sugar into the body's cells, so energy is depleted and tissue damage can result, including neuropathy (American Diabetes Association [ADA], "All About Diabetes," n.d.).
Hyperglycemia is the "primary risk factor for diabetic neuropathy," and it may lead to as much as 75 percent of amputations that are required for reasons other than trauma. Elevated blood-sugar levels can cause damage to nerve and other body tissues and can impede healing of wounds and fractures (K. Forrestal, personal communication, March 5, 2008). Peripheral neuropathy--especially in the legs and feet--affects about half of all patients with diabetes. Small fiber damage symptoms include "numbness, burning, tingling, itching, and pain" (Sieggreen, Ficorelli, & Edelman, 2005, p. 37). Large fiber damage affects key dance sensory tools such as vibratory perception (which enables hearing-impaired dancers to "hear" the music when speakers are turned toward the floor). That type of damage also affects proprioception and deep tendon reflexes. In addition, muscular deterioration or weakness in the feet may cause gait changes (Sieggreen et al., 2005). Finally, the blood flow to extremities can become restricted causing the sweat glands in the feet to reduce output or stop working altogether, and "dry, cracked, atrophic skin" can become callused and insensitive to cuts, ulcers, and punctures (Sieggreen et al., 2005, p. 37).
The onset of neuropathy is rare in children with diabetes who are under five years of age. However, children over the age of five who have a longer duration of diabetes have a greater incidence of abnormal nerve conduction velocity in the peroneal nerve, which is the nerve leading to the foot (Eng, Hung, August, & Smokvina, 1976). Younger type 1 patients need to learn to examine their feet regularly during dance classes and to develop the lifelong habit of monitoring for injuries and checking shoes for foreign objects or pressure-causing bumps and ridges. The untreated diabetic foot ulcer can invite many types of infections, which can eventually lead to a need for surgery and possible amputation. People with type 2 diabetes may even be counseled by their physicians to limit their bare-foot dance activities, which raises an issue in modern dance classes, rehearsals, and performances. …