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What
are Diabetic Foot Problems? |
 Foot
problems are a leading cause of hospitalization for patients
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. |
15%
of diabetics experience serious foot problems.
They
are the leading cause of hospitalizations
for these
patients.
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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. |
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Toe with inflamed corn
with ulceration |
Rocker bottom
Charcot Foot |
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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. |
COMMON
FOOT PROBLEMS IN DIABETICS:
• |
Infection |
• |
Pus
formation |
• |
Ulcerations |
• |
Gangrene |
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CUSTOMIZED
FOOTWEAR FOR DIABETIC PATIENTS
WITH FOOT INJURIES
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