Diabetic feet

People with diabetes are prone to many foot problems because of two complications of diabetes: nerve damage (neuropathy) and poor blood circulation (ischaemia). Nerve damage due to high blood sugar causes loss of feeling in a persons feet, removing the ability to feel pain and discomfort, which means that a person may not detect an injury or irritation. Poor circulation in ones feet reduces the ability to heal, causing even a minor cut to become infected and develop an ulcer. An ulcer is an open sore in the skin that may go all the way to the bone.Diabetic feet are a common and serious complication of diabetes and can lead to the loss of a limbs or even death.

Ulcers associated with diabetic feet may develop from:

• Corns and calluses. When neuropathy is present as it is with diabetic feet, you will not be able to tell if your shoes are causing pressure and producing corns or calluses. Corns and calluses must be properly treated or they can develop into ulcers.
• Dry, cracked skin. Poor circulation, as is present with diabetic feet, can make your skin dry. This may seem harmless, but dry skin can result in cracks that may become sores.
• Nail disorders. Ingrown toenails (which curve into the skin on the sides of the nail) and fungal infections can go unnoticed because of loss of feeling that is typically experienced with diabetic feet. If these nail disorders are not professionally treated, they can lead to ulcers.
• Hammertoes and bunions. Motor neuropathy (nerve damage affecting muscles) can cause muscle weakness and loss of tone in diabetic feet, resulting in hammertoes and bunions. If left untreated, these deformities can cause ulcers.
• Brittle bones. Neuropathy and circulation changes, as is present with diabetic feet, may lead to brittle bones (osteoporosis). This makes you susceptible to breaking a bone, without a major blow or injury occurring.
• Charcot foot. This is a complex foot deformity. It develops as a result of loss of sensation and an undetected broken bone that leads to destruction of the soft tissue of the foot. In the case of diabetic feet, the neuropathy means that the pain of the fracture goes unnoticed and the patient continues to walk on the broken bone, making it worse. This disabling complication is so severe that amputation may become necessary.
• Blocked artery. In diabetes, the blood vessels below the knee often become narrow and restrict blood flow. A severely blocked artery is a serious condition that may require intervention from a vascular surgeon. If vascular surgery fails and the wound does not heal, amputation may be necessary.

Prevention

At Footcare Place Toronto, a major treatment goal for diabetic feet will be to prevent amputation. Getting regular foot checkups and seeking immediate help when you notice something can keep small problems from worsening. Our Chiropodists work together with other health care providers to prevent and treat complications from diabetic feet.

You play a vital role in reducing complications from diabetic feet. Our Chiropodists will provide suggestions as to how you can be proactive in caring for diabetic feet. Follow these guidelines and contact your Chiropodist if you notice any problems:

• Inspect your feet daily for skin or nail problems. Look for the following signs and symptoms of diabetic feet. If your eyesight is poor, have someone else do it for you:
• Cuts, scrapes, redness, drainage, swelling, bad odour, rash, discolouration, loss of hair on toes, injuries, or nail changes (deformed, striped, yellowed or discoloured, thickened, or not growing).
• Signs of fracture.
• If your foot is swollen, red, hot, or has changed in size, shape, or direction, see your Chiropodist immediately.

• Changes in circulation typically experienced with diabetic feet. Pay attention to the colour of your toes. If they turn red, pink, or purplish when your legs hang down while sitting, poor circulation may be a problem.
• Don’t ignore leg pain associated with diabetic feet. Pain in the leg that occurs at night or with a little activity could mean that you have a blocked artery. Seek professional care immediately.
• Nail care. If you have any nail problems, such as ingrown toenails, fungal nails or hard nails, or reduced feeling in your feet, as is often experienced with diabetic feet, your toenails should be trimmed professionally.
• Do not perform bathroom surgery. Never trim calluses or corns yourself, and don’t use over-the-counter medicated pads.
• Keep your floor free of sharp objects. Make sure there are no needles, insulin syringes, or other sharp objects on the floor that can be of particular concern for those with diabetic feet.
• Don’t go barefoot. Wear shoes, indoors and outdoors.
• Check shoes and socks. Shake out your shoes before putting them on. Make sure your socks aren’t bunched up.
• Have your sense of feeling in your feet tested. Your Chiropodist will perform various tests to see if you’ve lost any feeling as can often occur with diabetic feet.