Understanding Diabetic Foot Disorders
Preserving Life and Limb
Diabetes is a worldwide epidemic. Although the cause of diabetes is still unknown, we are learning more and more every day about this disease and the health problems it can create when not managed properly. According to the American Diabetes Association, nearly 7% of Americans have diabetes — that's 20 million people. Many don't even know they have it.
To understand diabetes is to understand a complex system of causes and effects — a lot like a row of dominoes standing on end. A person with diabetes cannot properly process food into energy. Their bodies just don't produce enough of the hormone insulin to convert sugar into energy. This results in high blood sugar levels that can compromise the body's intricate system of veins and arteries. The resulting poor circulation causes a host of serious conditions including the potential for blindness, kidney failure, heart disease and nerve damage, especially in the feet. Nerve damage desensitizes feet, leaving room for problems that go undetected so long that they cannot heal. In severe cases, the only option for some foot infections and other diabetic foot disorders is amputation.
How Can You Prevent the Domino Effect?
This website will answer some of the questions you may have about how diabetes may affect your feet and how you can help to protect yourself from serious foot problems. It also will help you better understand what to expect if you do develop foot disorders.
Why Focus on the Foot?
Normal, healthy feet will show wear and tear as we age. Our feet change over time, losing some of the padding that once cushioned our steps. For those with diabetes, there really is no such thing as normal wear and tear. If you or a loved one has been diagnosed with diabetes, you should be aware of potential problems and how to avoid them. Together, we can minimize the chances of a diabetic foot disorder from getting a "toehold" in your life.
What Are the Most Common Diabetic Foot Disorders?
Diabetes damages the nerves that help you detect sensations like pain. This nerve damage, or neuropathy, often affects peripheral body tissue first. Peripheral neuropathy may first appear as tingling or numbness in your fingers and toes. Over time, the nerve damage causes a lack of feeling in the toes and feet. The lack of feeling in the foot opens the door for many problems — ulcers of the foot tissue, infections, and, in severe cases, amputations of the toes, feet and legs.
As part of your diabetes management, be sure to have your physician carefully examine your feet every year. For some patients, feeling in the feet can be restored through new surgical techniques that alleviate pressure on compressed nerves.
Diabetic ulcers are sores that develop in the soft tissue of the foot usually as a result of minor skin trauma or cumulative trauma in patients with loss of sensation in the foot. The lack of normal feeling in the foot means that these sores can exist without your feeling them. Ulcers are a leading cause of diabetic infections that if unresolved can lead to amputation of the affected limb. These ulcers will not heal on their own. If left untreated, the resulting infection may progress and can lead to increasingly extensive amputation the longer it goes untreated. Unfortunately, in many patients an amputation on one leg is followed within just a few years by amputation of the other.
Early detection of these ulcers can be critical in helping to prevent these amputations. By regularly visiting your foot and ankle specialist, frequently checking yourself, and seeking quick treatment for ulcers, you will be helping to prevent foot ulcers from compromising your mobility and your quality of life.
When the feeling in your foot has been lost due to peripheral neuropathy, injuries may go undetected. Without being able to feel it, you could tear a ligament, damage a joint or break a bone without knowing it. Over the course of time, repeatedly walking on an injured foot may cause an injury to heal badly, creating deformities referred to as Charcot arthropathy or Charcot Foot. When not treated properly, Charcot Foot can lead to further complications: foot collapse, severe infection and amputation.
Your doctor may apply different treatment options depending on your particular injury and symptoms. Your doctor may immobilize your foot with a cast to help reduce stress on the joint. You'll be followed closely; having the cast changed every week or two until your foot and ankle improve. Or, your doctor may recommend a surgical approach as an option for reconstruction of the damaged, unstable joint. Today your physician has access to tools specifically designed to restore function and mobility, as well as some of your lost quality of life.
Peripheral Vascular Disease
Diabetes affects blood circulation by compromising the body's complex system of veins and arteries. Peripheral Vascular Disease (PVD), or poor circulation, prevents blood from flowing normally to all the tiny blood vessels at the ends of your extremities, like your fingers and toes. Without proper blood flow, those tissues do not receive the oxygen necessary to stay healthy. Left untreated, PVD may cause foot tissue to die, triggering gangrene (black skin with underlying dead tissue and bone), and possibly, the need for amputation. The American Diabetes Association estimates that one of every three diabetics over 50 has PVD.
Your doctor may treat your peripheral vascular disease with medication, stents or a vascular bypass procedure, if necessary. If you have developed gangrene, your doctor may prescribe medication to fight infection. In some cases, your doctor may recommend surgery to remove any dead tissue.
When is Surgery the Best Option?
If you already are speaking with your physician about surgical options, your diabetic foot condition likely has reached an advanced stage. You already may have received more conservative therapies, including medication and casting. You may be following your doctor's advice for diet, exercise and rest. Despite your best efforts, your foot condition has not improved enough…or it has gotten worse. The primary goal of a surgical approach will be to stabilize the joint damaged by disease, stop the progression of the problem, and may help you regain some of your lost function.
Stabilizing a damaged joint.
Whether your ankle requires stabilization (arthrodesis) or repair, your foot and ankle specialist has access to specially designed high-tech equipment, supplies and materials that can be used to correct the condition.
Getting back on your feet.
Your foot and ankle specialist will likely allow you to begin using your foot and ankle when it's the right time for you. Although your foot and ankle may be splinted and bandaged for the first few days, a physical therapist may work closely with you as you learn special exercises designed to promote healing and help you work toward restoring lost mobility. Be sure to follow your doctor's instructions for the care of your sutures and incision site.
How Do I Take Care of My Feet?
By now you understand that taking care of your feet could save your life. And, by seeing your physician you already have taken a big step toward caring for your feet. Together, you and your physician will decide on a course of treatment that's most appropriate for you, your diabetes and your very precious feet. Your physician likely will recommend a few basic guidelines that will help you make foot care a routine part of your day for many healthy years to come.
Your doctor likely will recommend the following:
Manage your diabetes and other risk factors.
Your surgeon likely will advise you to take good care of yourself — eat right, exercise as recommended, don't smoke, take your medications as prescribed, monitor your blood sugar, see your physician regularly and reduce stress.
Keep a lookout for potential problems.
Your surgeon likely will advise you to inspect your feet daily. Check for sores, blisters, calluses, bruises and cuts. Ask a loved one, or use a mirror if you can't see the heels, soles and sides clearly. Don't do it yourself. See a foot and ankle specialist regularly for routine foot care such as toenail trimming and callus treatment.
Your doctor likely also will recommend the following:
Wear comfortable shoes.
Ill-fitting shoes cause lots of problems for people with diabetes. Be sure to get your feet measured properly each time you buy a new pair of shoes. Make sure the shoe has a roomy toe box and a low heel. Remember, well-fitting shoes will be comfortable from the start. And, of course, always be sure to wear socks without seams to prevent rubbing your feet the wrong way.
Keep your blood circulating.
Make sure that you take a few minutes throughout the day to elevate your feet. Wiggle your toes. Rotate your ankles. Use common sense to avoid behaviors that restrict blood flow, like crossing your legs, wearing tight socks or shoes, and smoking. Be more active if you can. Ask your physician to help you plan an exercise routine that works for you. Swimming, walking and cycling may be good, low impact options worth considering.
Nothing beats a little TLC.
Wash your feet in warm, soapy water every day. (Test the water with a sensitive hand or elbow, or enlist the help of a family member.) Dry them with a clean towel — taking special care to dry between the toes. Apply a small amount of moisturizing lotion to your feet, avoiding the spaces between your toes (which might trap moisture). Apply a little powder between the toes if you like.
Protect your feet from the extremes of weather. Do not walk barefoot, especially at the beach or across pavement. Avoid placing your feet close to radiators, fireplaces or heating pads. Wear sunscreen on the tops of your feet if they're exposed outdoors. Make sure that you don't put your feet at unnecessary risk for injury.
Keep in touch with your doctor.
Even if you follow all the precautions, you still may develop problems that you cannot see. Be sure to see your foot and ankle specialist regularly for a thorough check-up and routine care. Discovering potential problems early is the best way to avoid them becoming limb-threatening.