Diabetes & Foot Care

About Diabetes

Diabetes is a chronic disease that affects up to 6% of the population (higher in the older age groups). Insulin is a hormone that helps the body utilize sugar (glucose) in the blood. When diabetes is present, the body either produces little or no insulin (Type I) or the body tissues are resistant to the effects of insulin (Type II diabetes) which results in higher levels of glucose in the blood. Elevated blood sugar can damage a wide range of body tissues and organs.
 

How Does Diabetes Affect The Foot?

The foot is especially affected by diabetes because it damages the nerves, which is called peripheral neuropathy. Diabetes also affects the circulation. Poor circulation can affect the ability of the body to heal when damage occurs. Those with diabetes are more prone to infection. The body responds slowly to infection and often has trouble resolving infections due to poor circulation. Other complications that can also affect the foot including kidney disease, which affects proteins needed in healing. Eye disease or retinopathy which may prevent you from seeing your foot clearly. The foot is at risk for injury and you would not be aware if had happened. For example, your shoe rubs a sore on a toe that gets infected. You cannot feel it because of neuropathy. You cannot heal well due to infection and poor circulation. A foot ulcer occurs. Infection spreads and sometimes the result of this process is an amputation.
 

Charcot Joint

Charcot joint is another complication of diabetes in the foot due to peripheral neuropathy. The neuropathy causes numbness. Imagine spraining your ankle and not knowing it. You would continue to walk on it and continue to damage it further. This is what happens in the Charcot foot.
 

Diabetic Foot Ulcers

Diabetic foot ulcers are a common complication of the "diabetic foot." They allow a portal for infection to occur. Ulcers are caused by too much pressure to an area and the skin just "breaks down." They can occur under corns and callouses. Healing can take weeks to months and it is imperative that pressure is removed from the area and good wound dressings are used.
 

Prevention

• Wash feet daily. If skin is dry use an emollient but not between the toes.
• Inspect the feet daily. Use a mirror if you cannot see the bottoms.
• Look after your health. Lose weight, stop smoking and exercise regularly.
• Look after your feet. Cut toenails straight and never cut in to the corners. Use an emory board on sharp corners. Avoid going barefoot, even at home.
• Fitting of footwear is very important. Poorly fitting shoes are a common cause of problems in the feet in those with diabetes. Get measured each time you get a new pair. They should fit both length and width.
• See a podiatrist at least annually.
   

Podiatrists have an extremely important role to play in the prevention and management of complications of the foot in those with diabetes. Diabetics who are at risk for a problem should have that risk status assessed annually (more if risk is greater). When something does go wrong, see a podiatrist immediately. Waiting "a few days to see what happens" before seeing someone may mean the difference between a good and poor outcome. The sooner treatment is started the better.

Your podiatrist treats diabetic feet and their complications every day. Such things as diabetic shoes, orthotics, wound care and surgery are a few of the many treatments available.