Diabetes represents several diseases in which high blood sugar levels over time can damage the nerves, kidneys, eyes, and blood vessels. When diabetes is not well controlled, damage to the organs and impairment of the immune system is likely. Foot problems commonly develop in people with diabetes and can quickly become serious. With damage to the nervous system, a person with diabetes may not be able to feel his or her feet properly.
CAUSES
Several risk factors increase a person with diabetes chances of developing foot problems and diabetic infections in the legs and feet.
Footwear: Poorly fitting shoes are a common cause of diabetic foot problems. If the patient has red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new properly fitting footwear must be obtained as soon as possible. If the patient has common foot abnormalities such as flat feet, bunions, or hammertoes, prescription shoes or shoe inserts may be necessary
Nerve damage: People with long-standing or poorly controlled diabetes are at risk for having damage to the nerves in their feet. Because of the nerve damage, the patient may be unable to feel their feet normally. Also, they may be unable to sense the position of their feet and toes while walking and balancing. With normal nerves, a person can usually sense if their shoes are rubbing on the feet or if one part of the foot is becoming strained while walking. A person with diabetes may not properly sense minor injuries (such as cuts, scrapes, blisters), signs of abnormal wear and tear (that turn into calluses and corns), and foot strain. Normally, people can feel if there is a stone in their shoe, then remove it immediately. A person who has diabetes may not be able to perceive a stone. Its constant rubbing can easily create a sore.
Poor circulation: Especially when poorly controlled, diabetes can lead to accelerated hardening of the arteries or atherosclerosis. When blood flow to injured tissues is poor, healing does not occur properly.
Trauma to the foot: Any trauma to the foot can increase the risk for a more serious problem to develop.
Infections: Athlete’s foot, a fungal infection of the skin or toenails, can lead to more serious bacterial infections and should be treated promptly. Ingrown toenails should be handled right away by a foot specialist. Toenail fungus should also be treated.
Smoking: Smoking any form of tobacco causes damage to the small blood vessels in the feet and legs. This damage can disrupt the healing process and is a major risk factor for infections and amputations. The importance of smoking cessation cannot be overemphasized.
TREATMENT
There are basically three stages to the treatment of diabetic foot.
The first step is debridment: This is the process of removing all the dead and dying tissue from the area. It also involves cleaning the area well and cleaning out any pus that may be present.
The second step is drainage: This is mainly for wounds that have pus in them. It has been found that only treating the wound with antibiotics does not help indiabetic. Proper and timely drainage has helped a number of people retain their limbs.
The third step is bandaging and infection control: This is the process of bandaging the wound properly and treating the patient with appropriate antibiotics.
After this procedure the patient is required to take care of the wound till it heals. It is adviced that a patient does not put any weight on the region, this can cause further spread of the condition.
There are times when a small ulcer on the foot can become gangrenous. This is a condition where the wound becomes infected and the skin and tissue starts to die due to the infection.
This condition comes about if the patient has ignored a non healing ulcer for a long time. In such cases a doctor may suggest amputating the limb. The extent to which the limb will be amputated depends on how far the gangrene has spread.
Tips For Foot Care When You Have Diabetes
The experts at the Joslin-Beth Israel Deaconess Foot Center provide superior, cutting-edge care to patients with diabetes, and can help reduce your problems and improve the long-term health of your feet.
For people with diabetes, practicing proper foot care is an important step towards successful diabetes management.
According to Joslin Clinic’s Dr. Richard A. Jackson, one in four people with diabetes will develop foot complications. That means that making foot care a part of your daily diabetes regimen is essential for avoiding serious complications such as neuropathy, vascular disease, and injury. When it comes to implementing a comprehensive foot care plan, a little effort goes a long way in preventing problems.
Inspect. Check your feet two times a day, ideally in the morning and at night before you go to bed. Look for anything out of the ordinary, such as areas of redness, blisters, or cuts. If you discover a wound, treat it and cover it with a bandage immediately. Pay close attention to the wound during subsequent foot inspections to be certain it is healing properly.
Protect. Washing your feet every day with mild soap in tepid—not hot—water is your first line of defense against problems with your feet. After washing, dry your feet thoroughly and apply a lotion made for people with diabetes, or one that your doctor has approved. Moisturizing your feet will protect against the creation of fissures in the skin, which can serve as a breeding ground for infection.
Prevent. Elevated blood glucose (blood sugars) puts people with diabetes at risk for neuropathy, or nerve damage, which can cause loss of sensation in the feet, leading to other serious complications. Good control will help you prevent these complications. You can also reduce or even prevent the risk of injury to your feet by selecting comfortable footwear.
Consult. If you are very physically active or if you have other foot problems, it is important to find a doctor to examine your feet on a regular basis to avoid any complications that may arise. All other patients with diabetes must have a foot exam at least once a year, according to Dr. Jackson.
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