Diabetes and Your Feet

Footworks November 2009
By Dr Alexandra Buk

Diabetes is a serious disease that can develop from the lack of insulin production in the body or due to the inability of the body’s insulin to perform its normal, everyday functions. Insulin is a substance produced from the pancreas gland that helps process the food we eat and turn it into energy.

Diabetes is a chronic disease that affects the lives of nearly 24 million people in the United States, nearly 6 million of whom are unaware that they even have the disease.

25% of these diabetics will develop foot problems related to the disease. Diabetic foot conditions arise from a combination of causes including poor circulation and neuropathy.

Diabetes often leads to peripheral vascular disease that inhibits a person’s blood circulation. Poor circulation contributes to diabetic foot problems by reducing the amount of oxygen and nutrition supplied to the skin. This causes poor healing of the injuries. Poor circulation can also lead to swelling and dryness of the feet. If untreated, poor circulation can lead to ulcers, infection and amputation.

Dealing With Diabetic Neuropathy

Diabetic neuropathy is the impairment or damage of nerve function due to the increased blood sugar of diabetes. Signs of neuropathy include muscle weakness and pain, tingling, burning or numbness in the feet and hands. Decreased pain sensation and loss of feeling may also occur. Many of these symptoms are more severe at night.

Diabetic neuropathy can cause severe complications including disability and limb loss. Because neuropathy masks pain, you may not notice a cut, blister or even a bone fracture. This may lead to serious infection, ulceration or foot deformity.

The only way to prevent diabetic neuropathy is to maintain good blood sugar control. This can be achieved through proper use of medication, diet and exercise. If you already have diabetic neuropathy, check your feet daily. Look at the tops and bottoms of your feet, heels and between the toes. It may help to use a mirror or ask somebody to check for you.

Feel for changes in skin temperature: cold could mean circulation is being cut off and hot could mean infection or injury. Look for cracks or breaks in the skin and color changes. Immediately report any changes to your doctor.

What Is Charcot Foot?

Charcot foot is a sudden softening of the bones in the foot that can occur in people who have neuropathy. The bones are weakened enough to fracture. With continued walking the foot eventually changes shape. As the disorder progresses, the arch collapses and the foot takes on a “rocker bottom” shape, making it very difficult to walk.

Charcot foot is a very serious condition that can lead to severe deformity, disability and even amputation. Because of its serious nature, it is important that patients with diabetes take preventative measures and seek immediate care if signs or symptoms appear.

The symptoms of Charcot foot can appear after a sudden trauma or even a mild repetitive trauma, such as a long walk. The symptoms are similar to those of infection: warmth, redness, swelling and pain.

Charcot foot develops as a result of neuropathy, which decreases sensation and the ability to feel temperature, pain or trauma. When neuropathy is severe, there is a total lack of feeling in the feet. Because of neuropathy, the pain of an injury goes unnoticed and the patient continues to walk, making the injury worse.

Treatment for Charcot foot consists primarily of immobilization. Because the foot and ankle are so fragile during the early stages of Charcot, they must be protected so the soft bones can repair themselves. Complete non-weight bearing is necessary to keep the foot from further collapse. Shoes with special inserts may be needed after the bones have healed to enable the patient to return to daily activity. Bracing is required in cases of severe deformity. A modification in activity level may be needed to avoid repetitive trauma. In some cases, a surgical procedure may be necessary.

Preventing Foot Ulcers

Foot ulcers are a serious complication associated with diabetes. A diabetic foot ulcer could start out as a small and seemingly insignificant blister or small cut. But if neglected, it can lead to gangrene and amputation.

Due to diabetic peripheral neuropathy, minor and sometimes even major injuries can go unnoticed, undiagnosed and untreated for months. A lack of prompt treatment can turn them into chronic or non-healing ulcers.

Blood flow plays a large part in the recovery from an injury. Good blood flow will rush the infection-fighting white blood cells and red blood cells that carry oxygen to the site of the wound and help in the healing process. But for diabetics, blood supply to the feet may be reduced, leading to slow healing and an increased risk of infection.

Preventing diabetic foot ulcers is certainly easier than treating them. Lifestyle changes such as controlling your diabetes, exercising, avoiding smoking and maintaining a healthy body weight are extremely important for diabetic. Many ulcers can be prevented by making sure that any cut, sore, bruise or blister is noticed early and treated quickly.

Even if you feel no pain in your feet, examine them carefully on a daily basis. Use a hand-held mirror or enlist a family member to help. Check for sores, cuts or blisters, redness and swelling, infected or blackened toenails and corns or calluses.

Follow a regimen of good foot care:

Wash your feet in warm water, dry well between the toes, moisturize with a high quality lotion if necessary and apply sunscreen when needed.
Keep your toenails trimmed by clipping straight across or smooth with an emery board. If your nails are thick or yellowed, have a podiatrist trim them for you.
Never walk barefoot, even indoors.
Do not use hot water bottles or heating pads.
Do not use over-the –counter products to remove calluses because the chemicals in them can damage your skin.
Wear diabetic socks specially formulated for sensitive skin.
Be sure shoes are comfortable and well-fitted from the start. Consider shoes that are part of the Medicare Therapeutic Shoe Program. Your podiatrist can fit the shoes professionally in the office.
Most importantly, make sure a medical professional examines your feet at least once a year.