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Diabetic Feet
What are diabetic foot problems?
Foot problems are a leading cause of hospitalization for the eight million
persons in the United States who have been identified as having diabetes
mellitus. Expenditures related to diabetic foot problems total hundreds of
millions of dollars annually. It is estimated that 15% of all diabetics will
develop a serious foot condition at some time in their lives. Common problems
include infection, ulceration, or gangrene that may lead, in severe cases, to
amputation of a toe, foot or leg.
Most of these problems are preventable through proper care and regular visits to
your podiatric surgeon. This physician can provide information on foot
inspection and care, proper footwear, and early recognition and treatment of
foot conditions.
Causes
Foot problems in persons with diabetes are usually the result of three primary
factors: neuropathy, poor circulation, and decreased resistance to infection.
Also, foot deformities and trauma play major roles in causing ulcerations and
infections in the presence of neuropathy or poor circulation.
Neuropathy (Nerve Damage)
Your ability to detect sensations or vibration may be diminished. Neuropathy
allows injuries to remain unnoticed and untreated for lengthy periods of time.
It may cause burning or sharp pains in feet and interfere with your sleep.
Ironically, painful neuropathy may occur in combination with a loss of
sensation. Neuropathy can also affect the nerves that supply the muscles in your
feet and legs. This 'motor neuropathy' can cause muscle weakness or loss of tone
in the thighs, legs, and feet, and the development of hammertoes, bunions, and
other foot deformities.
Poor Circulation
Persons with diabetes often have circulation disorders (peripheral vascular
disease) that can cause cramping in the calf or buttocks when walking. The
symptoms can progress to severe cramping or pain at rest, with associated color
and temperature changes (the feet may turn bright red when hanging down and
constantly feel cold). Also, the skin may become shiny, thinned and easily
damaged. A reduction in hair growth and a thickening of the toenails might also
be present.
Poor circulation, resulting in reduced blood flow to the feet, restricts
delivery of oxygen and nutrients that are required for normal maintenance and
repair. Healing of foot injuries, infection or ulceration is affected.
Peripheral vascular bypass operations may avert lower extremity amputation.
Infection
Persons with diabetes are generally more prone to infections than non-diabetic
people. Due to deficiencies in the ability of white blood cells to defend
against invading bacteria, diabetics have more difficulty in dealing with and
mounting an immune response to the infection.
Infections often worsen and may go undetected, especially in the presence of
diabetic neuropathy or vascular disease. Often, the only sign of a developing
infection is unexplained high blood sugar, even without fever. The combination
of fever and high blood sugar often warns of a severe infection requiring
hospitalization. Lesser degrees of infection are often treated on an outpatient
basis.
Foot Deformities
Foot deformities such as hammertoes, bunions, and metatarsal disorders have
special significance in the diabetic population. Neuropathy places the foot at
increased risk for developing corns, calluses, blisters and ulcerations. If
these are left untreated, serious infections may result.
Special deformities can occur in persons with neuropathy and very good
circulation. A Charcot joint, resulting from trauma to the insensitive foot,
causes the foot to collapse and widen. This destructive condition is often first
heralded by persistent swelling and redness, mild to moderate aching, and an
inability to fit into your usual shoes. If this occurs, it is important to stay
off the foot and see your podiatric surgeon immediately.
Toe with inflamed corn with ulceration
Rocker bottom Charcot Foot
Ulcers of
the Foot
An ulceration or ulcer is usually a painless sore at the bottom of the foot or
top of the toes, resulting from excessive pressure at that site. Ulcers
frequently underlie a pre-existing corn or callus that was allowed to build up
too thickly. Trauma from heat, cold, shoe pressure, or penetration by a sharp
object are also potential causes. Neuropathy allows the lesions to develop
because the normal warning sense of pain has been lost and they go unrecognized.
Continued pressure or walking on the injured skin creates even further damage
and the ulcer will worsen. The open sore will frequently become infected and may
even penetrate to bone.
Treatment relies on early recognition of the ulceration by a podiatric surgeon,
avoidance of weight bearing activities such as walking, avoidance of wearing
"closed-in" shoes, and early intervention. Besides local wound care, dressings
and antibiotics, other measures may be necessary to adequately relieve pressure
on the area. When use of crutches, a wheelchair, or rest is not feasible,
plaster casts, braces, healing sandals, or orthoses (special shoe inserts) can
be used to protect the foot while it heals. If circulation is inadequate to
allow healing, your podiatric surgeon may refer you to a vascular surgeon for
appropriate evaluation and possible vascular reconstructive surgery.
Once an ulcer has healed, it is important to continue to see your podiatric
surgeon regularly. Special footwear and inserts may be recommended to protect
your feet and prevent new or recurrent lesions from developing.
Foot Surgery in the Diabetic Patient
Realizing the potential danger of foot deformities in the diabetic patient,
corrective foot surgery is an option when you are in generally good health and
have good circulation. Most deformities progressively worsen over time as do the
effects of neuropathy and vascular or circulatory disease. When foot deformities
cannot be managed effectively with conservative care, surgery may be indicated.
Podiatric surgery is often "same day" surgery under local anesthesia to minimize
potential complications. In some cases, such as in the presence of an active
ulceration, hospitalization may be necessary to properly monitor your
postoperative progress.
Surgery may also be required to heal an ulceration or to eradicate some
infections, especially those involving the bone. Your cooperation is an
important part of your care. You must guard against injury and provide the daily
care necessary to maintain the health of your feet.
Footwear Guidelines
Shoes must always fit comfortably and have adequate width and depth for the
toes. Leather shoes easily adapt to the shape of your feet and allow them to
"breathe." Athletic shoes, jogging shoes and sneakers are usually excellent
choices if they are well fitted and provide adequate cushioning. Your podiatric
surgeon may recommend "extra depth" shoes, custom molded shoes to adapt to your
particular needs, or orthoses to provide cushioning and support.
Always check your shoes for foreign objects or torn linings before putting them
on. You should wear two or three pairs of shoes each day so that one pair is not
worn for more than four to six hours. New shoes should be worn for only a few
hours at a time, and you should take care to inspect your feet for any points of
irritation.
Socks should be well fitted without seams or folds. They should not be so tight
as to interfere with circulation. Well-padded socks can be very protective if
there is an abundance of room in your shoes.
Avoid wearing open-toed shoes or sandals until you have discussed this with your
podiatric surgeon. Above all else, do not walk with bare feet.
Footcare Guidelines
- Inspect your feet daily for blisters, bleeding, and lesions between
your toes.
- Use a mirror to see the bottom of your foot and heel.
- Do not soak your feet unless the temperature of the water is
lukewarm, not as hot as you can stand it. (95°-100° Fahrenheit).
- Avoid temperature extremes - do not use hot water bottles or heating
pads on your feet.
- Wash your feet daily with warm, soapy water and dry them well,
especially between the toes.
- Use a moisturizing cream or lotion daily, but avoid getting it
between the toes.
- Do not use acids or chemical corn removers.
- Do not perform "bathroom surgery" on corns, calluses, or ingrown
toenails.
- Trim your toenails carefully and file them gently. Have a podiatrist
treat you regularly if you cannot trim them yourself without difficulty.
- Contact your podiatric surgeon immediately if your foot becomes
swollen or is painful, or if redness occurs.
- Do not smoke.
- Learn all you can about diabetes and how it can affect your feet.
- Have regular foot examinations by your podiatric surgeon.
While these are some of the most commonly
prescribed treatments for Diabetic Foot Disorder, others may be used.
Schedule an appointment to visit with Aloha Foot
and Ankle Associates, Inc. to determine which treatment is likely to be the most
successful in your case.
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Aloha Foot and Ankle Associates, Inc.
26732 Crown Valley Parkway, Suite
317 • Mission Viejo, California 92691
• (949) 364-2525 • www.AlohaFootAndAnkle.com |
