Dana H. Waters, DPM - Diabetic Foot Care [video]

DIABETIC FOOT PROBLEMS:

Foot problems are leading causes of hospitalization for the 16 million persons in the United States with diabetes mellitus accounting for expenditures of hundreds of millions of dollars annually. It has been estimated that 15% of all diabetics will develop a serious foot problem at some time, which can potentially threaten their limb or even their life. The most common of these problems are infection, ulceration, or gangrene (death of the tissue) which can lead , in the most severe of cases, to amputaton of a toe, foot, or leg.

The good news is that most of these problems can be prevented through regular podiatric visits, patient education, daily foot inspection and care, proper footwear, and early recognition and treatment of any suspected trouble areas. This can only be accomplished with active participation in your own care along with the help and guidance of your foot specialist.

People with diabetes can develop a variety of foot problems. Even ordinary problems can quickly get worse and lead to serious complications. Foot problems most often happen when there is nerve damage in the feet or when blood flow is poor. Inspect your feet every day, and seek care early if you do get a foot injury. Make sure your health care provider checks your feet at least once a year-more often if you have foot problems. Your health care provider should also give you a list and explain the do's and don'ts of foot care. (See below)

What Causes Foot Problems in Diabetes?
It is well established that the longer a person has the disease, the greater is the incidence and severity of complications of diabetes mellitus. Although good control of blood sugar and blood pressure are extremely important in maintaining your optimum health, other factors can be important in the development of diabetic foot disorders.

Foot problems in persons with diabetes are usually the result of three primary factors : Neuropathy (diminished sensation), Poor circulation, and a decreased resistance to Infection. Additionally, Foot deformities and Trauma play major roles in causing ulcerations and infections in the presence of neuropathy or poor circulation.

Neuropathy can generally be defined as a loss of sensation or alteration in sensitivity in the feet and legs. There may be a diminished or absent ability to detect painful sensations such as a pinprick or the heat of sand at the beach in the Summer or hot water. Your ability to detect the tightness of a shoe might also be affected. Neuropathy can prevent the recognition of injuries to the feet and permit them to remain untreated for lengthy periods of time. Continued walking on the injured or infected foot results in further trauma and injury.

Sometimes neuropathy can be painful and quite distressing, especially at night when you are trying to sleep. Painful neuropathy usually causes burning or sharp shooting pains in the feet. It is even possible for some people to have painful neuropathy in combination with an actual loss of external sensation as described above.

Neuropathy can also cause muscle weakness in the legs and feet. This might give rise to such conditions as "foot drop", where the foot cannot be raised at the ankle when walking. Other common deformities associated with this might be hammertoes or bunions; these are often also associated with corns or calluses.

Poor circulation
People with diabetes often have varying degrees of circulation disorders to their legs and feet due to atherosclerosis and blockage of arteries. Common symptoms of peripheral vascular disease are cramping in the calf or buttocks when walking. Temperature and color changes in the feet, in addition to loss of hair and thickening of toenails, might also be attributed to circulatory changes.

Poor circulation results in reduced blood flow to the feet. Adequate delivery of oxygen and nutrients, which are required for normal maintenance and repair, is then restricted. This becomes critical when the foot is injured, infected, or ulcerated, since healing will be impaired or will not occur at all. Long a major cause of lower extremity amputation, peripheral vascular disease can now be frequently corrected by vascular bypass operations in the legs. This is similar to those operations performed in the heart for blocked arteries.