Diabetic Foot Care

  • Diabetes
  • Diabetic Wound Care
  • High Blood Pressure
  • Peripheral Arterial Disease
  • Peripheral Neuropathy
What Is Diabetes?

Diabetes is the inability to manufacture or properly use insulin, and it impairs the body’s ability to convert sugars, starches, and other foods into energy. The long-term effects of elevated blood sugar (hyperglycemia) can lead to serious damage to the eyes, heart, kidney, nerves, and feet. Diabetes affects the lives of nearly 26 million people in the United States and nearly seven million don’t even know they have the disease yet.

While there is no cure for diabetes, there is hope. With proper diet, exercise, medical care, and careful management at home, a person with diabetes can avoid the most serious complications and enjoy a full and active life. Today’s podiatrist plays a key role in helping patients manage diabetes successfully and avoid foot-related complications.

Symptoms

Diabetes warning signs include the following:

  • Skin color changes
  • Swelling of the foot or ankle
  • Numbness in the feet or toes
  • Pain in the legs
  • Open sores on the feet that are slow to heal
  • Ingrown and fungal toenails
  • Bleeding corns and calluses
  • Dry cracks in the skin, especially around the heel

 

Visit Today’s Podiatrist

Because diabetes is a disease affecting many parts of the body, successful management requires a team approach. Today’s podiatrist is an integral part of the treatment team and has documented success in preventing amputations:

  • More than 65,000 lower limbs are amputated annually due to complications from diabetes.
  • After an amputation, the chance of another amputation within three to five years is as high as 50 percent.
  • Including a podiatrist in your diabetes care can reduce the risk of lower limb amputation up to 85 percent and lowers the risk of hospitalization by 24 percent.

The keys to amputation prevention are early recognition and regular foot screenings performed by a podiatrist, the foot and ankle expert.

Take Action

If you have diabetes, follow these foot care tips:

  • Inspect feet daily. Check your feet and toes every day for cuts, bruises, sores, or changes to the toenails, such as thickening or discoloration.
  • Wear thick, soft socks. Avoid socks with seams, which could rub and cause blisters or other skin injuries.
  • Exercise. Walking can keep weight down and improve circulation. Be sure to wear appropriate athletic shoes when exercising.
  • Have new shoes properly measured and fitted. Foot size and shape may change over time. Shoes that fit properly are important to those with diabetes.
  • Don’t go barefoot. Don’t go without shoes, even in your own home. The risk of cuts and infection is too great for those with diabetes.
  • Never try to remove calluses, corns, or warts by yourself. Over-the-counter products can burn the skin and cause irreparable damage to the foot for people with diabetes.
  • See today’s podiatrist. Regular checkups by a podiatrist—at least annually—are the best way to ensure that your feet remain healthy.

 

Additional information is available from the American Diabetes Association.

What is a Diabetic Foot Ulcer?

A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, 6 percent will be hospitalized due to infection or other ulcer-related complication.

Diabetes is the leading cause of non-traumatic lower extremity amputations in the United States, and approximately 14-24 percent of patients with diabetes who develop a foot ulcer will require an amputation. Foot ulceration precedes 85 percent of diabetes-related amputations. Research has shown, however, that development of a foot ulcer is preventable.

Causes

Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics, and older men are more likely to develop ulcers. People who use insulin are at higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.

Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain, and one may not even be aware of the problem. Your podiatrist can test feet for neuropathy with a simple, painless tool called a monofilament.

Vascular disease can complicate a foot ulcer, reducing the body’s ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body’s ability to fight off a potential infection and also slow healing.

Symptoms

Because many people who develop foot ulcers have lost the ability to feel pain, pain is not a common symptom. Many times, the first thing you may notice is some drainage on your socks. Redness and swelling may also be associated with the ulceration and, if it has progressed significantly, odor may be present.

When to Visit a Podiatrist

Once an ulcer is noticed, seek podiatric medical care immediately. Foot ulcers in patients with diabetes should be treated to reduce the risk of infection and amputation, improve function and quality of life, and reduce health-care costs.

Diagnosis and Treatment

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:

  • Prevention of infection
  • Taking the pressure off the area, called “off-loading”
  • Removing dead skin and tissue, called “debridement”
  • Applying medication or dressings to the ulcer
  • Managing blood glucose and other health problems

Not all ulcers are infected; however, if your podiatrist diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

To keep an ulcer from becoming infected, it is important to:

  • keep blood glucose levels under tight control;
  • keep the ulcer clean and bandaged;
  • cleanse the wound daily, using a wound dressing or bandage; and
  • avoid walking barefoot.

For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.”  You may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches.  These devices will reduce the pressure and irritation to the area with the ulcer and help to speed the healing process.

The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full-strength betadine, hydrogen peroxide, whirlpools, and soaking are not recommended, as these practices could lead to further complications.

Appropriate wound management includes the use of dressings and topically-applied medications. Products range from normal saline to growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.

For a wound to heal, there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels with noninvasive tests.

Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Working closely with a medical doctor or endocrinologist to control blood glucose will enhance healing and reduce the risk of complications.

Surgical Options: A majority of non-infected foot ulcers are treated without surgery; however, if this treatment method fails, surgical management may be appropriate. Examples of surgical care to remove pressure on the affected area include shaving or excision of bone(s) and the correction of various deformities, such as hammertoes, bunions, or bony “bumps.”

Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound. Healing may occur within weeks or require several months.

Prevention

The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrist on a regular basis. Your podiatrist can determine if you are at high risk for developing a foot ulcer and implement strategies for prevention.

You are at high risk if you have or do the following:

  • Neuropathy
  • Poor circulation
  • A foot deformity (e.g., bunion, hammer toe)
  • Wear inappropriate shoes
  • Uncontrolled blood sugar
  • History of a previous foot ulceration

Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose, are important in prevention and treatment of a diabetic foot ulcer. Wearing the appropriate shoes and socks will go a long way in reducing risks. Your podiatrist can provide guidance in selecting the proper shoes.

Learning how to check your feet is crucial so that you can find a potential problem as early as possible. Inspect your feet every day—especially the sole and between the toes—for cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality. Each time you visit a health-care provider, remove your shoes and socks so your feet can be examined. Any problems that are discovered should be reported to your podiatrist as soon as possible; no matter how simple they may seem to you.

The key to successful wound healing is regular podiatric medical care to ensure the following “gold standard” of care:

  • Lowering blood sugar
  • Appropriate debridement of wounds
  • Treating any infection
  • Reducing friction and pressure
  • Restoring adequate blood flow

 

Additional information is available from the American Diabetes Association.

What Is High Blood Pressure?

High blood pressure is also known as hypertension. Blood pressure refers to the force of blood pushing against the walls of the arteries as your heart pumps out blood. Hypertension occurs when your blood pressure rises and stays above normal over a period of time.

Hypertension is often related to atherosclerosis, which is the buildup of plaque in blood vessels. This condition leads to decreased circulation and peripheral arterial disease (PAD).  People with decreased circulation in their legs and feet may develop ulcerations (open wounds on the skin) that can lead to amputations.

As a member of the health-care team, your podiatrist is vitally concerned about hypertension and vascular disease (heart and circulatory problems). Make sure you tell your podiatrist if you have high blood pressure and any medications that you may be taking for treatment.

Symptoms

Symptoms of poor circulation in the feet and legs may include:

  • Cramping in the feet and legs, particularly with exercise
  • Sores on the feet or legs that do not heal or take a long time to heal
  • Changes in color to the feet
  • Changes in temperature to the feet
  • Loss of hair on the feet and legs

Uncontrolled hypertension can also lead to heart disease, which may present as swelling in your feet and legs.

When to Visit a Podiatrist

If you experience any of the above symptoms, it is important to visit a podiatrist. And if you have been diagnosed with hypertension, it is important to tell your podiatrist, because medications that may be prescribed for a foot or ankle condition could interact with your blood pressure medications. Also, if you need to have foot or ankle surgery, it is important that your blood pressure is under control prior to any surgical procedures.

Diagnosis and Treatment

As part of your visit, your podiatrist may check your vital signs—height, weight, and blood pressure. Your podiatrist will conduct a careful examination to determine if there is lower than normal temperature in any of the extremities, absence of normal skin color, or diminished pulse in the feet. Your podiatrist will also ask you about increased or periodic swelling in the lower extremities.

If any abnormalities in your blood pressure are noted, your podiatrist will notify you and may refer you to your primary care physician for further evaluation and treatment.

What Is PAD?

PAD is short for Peripheral Arterial Disease. PAD is caused by a blockage or narrowing of the arteries in the legs when fatty deposits called plaque buildup. The buildup of plaque causes the arteries to harden and narrow, which is called atherosclerosis. This results in a reduction of blood flow to the legs and feet. This is commonly referred to as poor circulation.

PAD occurs most often in the arteries in the legs, but it can also affect other arteries that carry blood outside the heart. This includes arteries that go to the aorta, the brain, the arms, the kidneys, and the stomach. When arteries inside the heart are hardened or narrowed, it is called coronary artery disease or cardiovascular disease.

PAD affects 8 to 12 million Americans, and one in every five people over the age of 70 has the disease. People with PAD have a two-to-six times’ greater chance of death from a heart attack or stroke. PAD and diabetes are the leading causes of foot or leg amputations in the United States.

Causes/Risk Factors

Risk factors for PAD and other conditions that may complicate PAD include the following:

  • Smoking
  • High Cholesterol
  • High Blood Pressure
  • Physical inactivity
  • Obesity
  • Diabetes

 

Symptoms

The symptoms of PAD include the following:

  • Fatigue, tiredness, or pain in your legs, thighs, or buttocks that always happens when you walk but goes away when you rest.
  • Foot or toe pain at rest that often disturbs your sleep.
  • Skin wounds or ulcers on your feet or toes that are  slow to  heal  (or that do not heal for 8 to 12 weeks)

However, many individuals with PAD do not experience typical leg symptoms such as cramping, pain, or fatigue known as claudication.

When to Visit a Podiatrist

Do not ignore leg pain. It is important to discuss any leg or thigh pain that you are having with your podiatric physician since it could be a warning sign of a serious disease such as PAD. Early detection of PAD can offer an opportunity to treat risk factors that can slow the progression of the disease and decrease the chance of heart attack and stroke.

Diagnosis and Treatment

Your podiatric physician can do a simple test to determine if you have PAD. The test is called an ABI, or ankle-brachial index. It compares the blood pressure in your ankles with the blood pressure in your arm. If your ABI is abnormal, your podiatric physician may order other tests to determine the extent of your PAD.

PAD can be treated with lifestyle changes, medicines, and surgical procedures if necessary. Medical treatment options include:

  • Programs to stop smoking
  • Blood pressure control
  • Lowering cholesterol
  • Manage high blood sugar (diabetes)
  • Medications to prevent clotting
  • Healthy diet
  • Exercise program

A variety of surgical treatment options are available depending on the location and severity of the artery blockage. Your podiatric physician can refer you to the appropriate specialist for these procedures.

What is Peripheral Neuropathy?

Peripheral neuropathy is damage of the peripheral nerves. Your peripheral nervesthe nerves in your toes and fingertipsare the ones on the periphery of your body. When the nerves are damaged, they don’t function properly. People with peripheral neuropathy have decreased or abnormal sensation in their toes and fingers. Sometimes, they develop problems moving these parts of the body as well.

Causes

In the United States, the most common cause of peripheral neuropathy is diabetes. According to the American Diabetes Association, 60 to 70 percent of people with diabetes will develop neuropathy within their lifetime.

Other causes of peripheral neuropathy include:

  • Certain medications. Including some chemotherapy drugs.
  • Heredity. Some people have a family history of peripheral neuropathy.
  • Advanced age. Peripheral neuropathy is more common as people age.
  • Arthritis. Certain type of arthritis can cause peripheral neuropathy.
  • Alcoholism. According to the US National Library of Medicine, up to half of all long-term heavy alcohol users develop peripheral neuropathy.
  • Neurological disorders. Certain neurological disorders, including spina bifida and fibromyalgia, are associated with peripheral neuropathy.
  • Injury. Acute injury to the peripheral nerves may also cause peripheral neuropathy.

 

Symptoms

The most common symptoms of peripheral neuropathy include burning, numbness, tingling, or shooting or stabbing pain in the toes and/or fingertips. Any change in sensation in the fingers or toes may be a symptom of peripheral neuropathy. Be sure to report any abnormal sensations to your doctor. Those sensations may be the first sign of another problem, such as diabetes.

Home Care

If you have peripheral neuropathy, it is important to inspect your feet regularly. Because decreased sensation may develop eventually, you might not notice an injury or infection. Someone who has diabetes and peripheral neuropathy with loss of protective sensation, for instance, could step on a tack without noticing it. Regularly inspect your feet so you can note any injuries or infections and seek appropriate medical attention as needed.

If you’re unable to properly inspect your own feet, enlist a family member or friend to help you. It’s absolutely essential that any injuries are caught and treated promptly. Otherwise, an infection can develop and progress.

People with peripheral neuropathy should wear properly fitted shoes and avoid walking barefoot to prevent injury. If you have diabetes, it’s important to control your blood sugar as well, because out-of-control blood sugar leads to increased nerve damage. Take your insulin or medication as prescribed and follow the recommended diet.

When to Visit a Podiatrist

Everyone with peripheral neuropathy of the feet should see a podiatrist. Podiatrists are doctors who are specially trained to preserve the health of the feet.

Diagnosis and Treatment

A podiatrist, family physician, internist, or physician who specializes in diabetes can diagnose peripheral neuropathy. The diagnosis is made on the basis of a physical exam, health history, and your reporting of symptoms. The doctor may order a blood test to check your blood sugar level because high blood sugar levels and diabetes are an important cause of peripheral neuropathy.

There is no known cure for peripheral neuropathy. The goal of treatments are to slow the progression of the disease, to maintain foot health, and to decrease pain (if present) and improve the quality of life.

The podiatrist may prescribe oral medication to help with pain. He or she will also perform a thorough foot check to look for any injuries or infections and will teach you how to do the same. Your podiatrist will also show you how to take care of your feet at home. People who have peripheral neuropathy should have their feet examined by a podiatrist at least once per year.

If you also have diabetes, the podiatrist will work closely with you and other health-care professionals. Controlling the patient’s blood sugar levels with diet, exercise, and medication (if needed) can slow the progression of peripheral neuropathy and maintain foot health.

Prevention

The best thing you can do to prevent peripheral neuropathy is to keep your blood sugar levels under control. Peripheral neuropathy is common in people with diabetes, but the degree of neuropathy generally corresponds to the degree of blood sugar control. Someone whose blood sugar is kept under tight control will usually have much better sensation in their fingers and toes than someone with poorly controlled diabetes.