Diabetes
Diabetes and Foot Issues

What Are Diabetic Foot Problems?

If a doctor has ever said you had an elevated blood sugar level - even just once when you were pregnant - you are at risk for diabetes. Nervous system impairment (neuropathy) is a major complication that may cause you to lose feeling in your feet or hands. This means you won't know right away if you hurt yourself. The problem affects about 60 to 70 percent of people with diabetes. It is estimated that 15% of all diabetics will develop a serious foot condition at some time in their lives. With proper education and tools one can prevent the likely hood of foot health complications. Visit your local health care professional to get information on foot care, proper footwear and preventative action.

Causes

Poor circulation, neuropathy and decreased ability to fight infection create the grounds for a high risk foot type.

Neuropathy (Nerve Damage)

Neuropathy for some people have no symptoms at all. For others, numbness, tingling, or pain in the feet is often the first sign. A person can experience both pain and numbness. Often, symptoms are minor at first, and since most nerve damage occurs over several years, mild cases may go unnoticed for a long time. Neuropathy can also affect the muscles (motor neuropathy) causing muscle weakness and loss of muscle tone in the feet and lower legs, loss of balance and deformities in foot shape that can lead to areas of increased pressure.

Peripheral Vascular Disease (Poor Circulation)

Poor circulation is most commonly caused by a progressive blocking of the arteries in the leg (athersclerosis). Those with diabetes are more likely to develop poor circulation to the foot. Other risk factors for developing poor circulation include a lack of physical activity,smoking, high blood pressure and high cholesterol. The biggest affect of poor circulation on the foot, is that as problems (such as sores, infections, cuts, etc) develop, they do not heal as well as they should. In many cases they do not heal at all without special care. The reason for this is that the blood carries vital elements (eg oxygen) that the bodies tissues need for vitality and healing.

Some of the symptoms include:

• Claudication (this is a dull cramping pain in the calf muscle that comes on after walking a certain distance - it is relieved by rest).
  
• Numbness or tingling in the foot, or toes can occur.
  
• Changes in the color of the skin (it becomes more pale, bluish, or reddish).
  
• Changes in skin temperature (the foot becomes cooler. See cold feet).
  
• Skin breakdowns, infection and sores do not heal as well as they should.

Infection

Diabetes can slow down your body's ability to fight infection. High blood glucose leads to high levels of sugar in your body's tissues. When this happens, bacteria grow and infections can develop more quickly in people with diabetes. Early treatment of infections can prevent more serious complications.

While most infections in people with diabetes can be successfully treated, you must be able to recognize the symptoms of an infection in order to get proper and effective treatment. Notify your health care provider immediately if you have any of the following symptoms:

• Fever over 101 degrees F (38.3 degrees C)
• Sweating or chills
• Skin rash
• Pain, tenderness, redness, or swelling
• Wound or cut that won't heal
• Red, warm, or draining sore
• Sore throat, scratchy throat, or pain when swallowing
• Sinus drainage, nasal congestion, headaches, or tenderness along upper cheekbones
• Persistent, dry, or moist cough that lasts more than two days
• White patches in your mouth or on your tongue
• Nausea, vomiting or diarrhea
• Flu-like symptoms (chills, aches, headache, or fatigue) or generally feeling "lousy"
• Trouble urinating: pain or burning, constant urge, or frequent urination
• Bloody, cloudy, or foul-smelling urine

Ulcers of the Foot

As diabetic peripheral neuropathy progresses, various nerves are affected—and these damaged nerves can cause problems that encourage development of ulcers which can go unnoticed because of the neuropathy. For example:

• Deformities (such as bunions or hammertoes) resulting from motor neuropathy may cause shoes to rub against toes, creating a sore. The numbness caused by sensory neuropathy can make the patient unaware that this is happening.

• Because of numbness, a patient may not realize that he or she has stepped on a small object and cut the skin. 

• Cracked skin caused by autonomic neuropathy, combined with sensory neuropathy’s numbness and problems associated with motor neuropathy can lead to developing a sore.

Charcot Foot

Charcot foot is a progressive degenerative condition that affects the joints in the feet. It is associated with nerve damage (neuropathy) that decreases the ability to sense stimuli, including pain, and decreases muscular reflexes that control movement. As a result, the joints in the feet are subjected to repeated trauma and injury, causing progressive damage to the ligaments, cartilage, and bones.

Nerve damage causes muscle weakness and slack ligaments, which result in joint instability and subsequent subluxation and/or dislocation. Subluxation initiates the process of degenerative joint disease (arthropathy). The ends of misaligned bones grind against each other and fragments of bone and cartilage enter joint and often produce a coarse grating sound (audible crepitus) when the joint is moved.

Complications of Charcot foot include calluses and ulcers, which occur when bony protrusions (high pressure areas) rub inside the shoes and may become infected.

Shoes and Orthotics

Proper footwear is an important part of an overall treatment program for people with diabetes, even for those in the earliest stages of the disease. If there is any evidence of neuropathy, or lack of sensation, wearing the right footwear is crucial.

A custom made orthotic is very helpful in the prevention and management of foot ulcers. The orthotic redistributes pressure, through out the sole of the foot, to minimize high pressure areas that are at risk of ulceration.

By working with their physician and a foot care professional, such as a certified pedorthist, many patients can prevent serious diabetic foot complications.

Footwear and orthotics for people with diabetes should achieve the following objectives:

• Relieve areas of excessive pressure. Any area where there is excessive pressure on the foot can lead to skin breakdown or ulcers. Footwear should help to relieve these high pressure areas, and therefore reduce the occurrence of related problems.
• Reduce shock and shear. A reduction in the overall amount of vertical pressure, or shock, on the bottom of the foot is desirable, as well as a reduction of horizontal movement of the foot within the shoe, or shear.
• Accommodate, stabilize and support deformities. Deformities resulting from conditions such as Charcot involvement, loss of fatty tissue, hammer toes and amputations must be accommodated. Many deformities need to be stabilized to relieve pain and avoid further destruction. In addition, some deformities may need to be controlled or supported to decrease progression of the deformity.
• Limit motion of joints. Limiting the motion of certain joints in the foot can often decrease inflammation, relieve pain, and result in a more stable and functional foot.