Foot problems are a leading cause of hospitalization for the eight million persons in the United States who have been identified as having diabetes mellitus. Expenditures related to diabetic foot problems total hundreds of millions of dollars annually. It is estimated that 15% of all diabetics will develop a serious foot condition at some time in their lives. Common problems include infection, ulceration, or gangrene that may lead, in severe cases, to amputation of a toe, foot or leg.
Most of these problems are preventable through proper care and regular visits to a podiatric foot and ankle surgeon. Corrigan Podiatry can provide information on foot inspection and care, proper footwear, and the early recognition and treatment of foot conditions.
Causes
Foot problems in persons with diabetes are usually the result of three primary factors: neuropathy, poor circulation, and decreased resistance to infection. Also, foot deformities and trauma play major roles in causing ulcerations and infections in the presence of neuropathy or poor circulation.
Neuropathy (Nerve Damage)
Neuropathy can reduces one’s ability to detect sensations or vibration. It allows injuries to remain unnoticed and untreated for lengthy periods of time. It may cause burning or sharp pains in the feet and interfere with sleep. Ironically, such painful neuropathy may occur in combination with a loss of sensation. Neuropathy can also affect the nerves that supply the muscles in your feet and legs. This “motor neuropathy” can cause muscle weakness or loss of tone in the thighs, legs, and feet, and the development of hammertoes, bunions, and other foot deformities.
Poor Circulation
Persons with diabetes often have circulation disorders (peripheral vascular disease) that can cause cramping in the calf or buttocks when walking. The symptoms can progress to severe cramping or pain at rest, with associated color and temperature changes (the feet may turn bright red when hanging down and constantly feel cold). Also, the skin may become shiny, thinned and easily damaged. A reduction in hair growth and a thickening of the toenails may also occur.
Poor circulation, resulting in reduced blood flow to the feet, restricts the delivery of the oxygen and nutrients required for normal maintenance and repair. Foot injuries may not heal; infection or ulceration may develop. Peripheral vascular bypass surgery may be required in order to avert lower extremity amputation.
Infection
Persons with diabetes are generally more prone to infections than non-diabetic people. Due to deficiencies in the ability of white blood cells to defend against invading bacteria, diabetics have more difficulty mounting an immune response to infection. Infections often worsen and may go undetected, especially in the presence of diabetic neuropathy or vascular disease. Often, the only sign of a developing infection is unexplained high blood sugar, even without fever. The combination of fever and high blood sugar often warns of a severe infection requiring hospitalization. Lesser degrees of infection are often treated on an outpatient basis.
Foot Deformities
Foot deformities such as hammertoes, bunions, and metatarsal disorders have special significance in the diabetic population. Neuropathy places the foot at increased risk for developing corns, calluses, blisters, and ulcerations. If these are left untreated, serious infections may result.
Special deformities can occur in persons with neuropathy and very good circulation. A Charcot joint, resulting from trauma to the insensitive foot, causes the foot to collapse and widen. This destructive condition is often first heralded by persistent swelling and redness, mild to moderate aching, and an inability to fit into your usual shoes. If this occurs, it is important to stay off the foot and call Corrigan Podiatry immediately.
Ulcers of the Foot
An ulceration or ulcer is usually a painless sore at the bottom of the foot or top of the toes which results from excessive pressure at that site. Ulcers frequently underlie a pre-existing corn or callus that was allowed to build up too thickly. Trauma from heat, cold, shoe pressure, or penetration by a sharp object are also potential causes. Neuropathy allows the lesions to develop because the normal warning pain has been lost and they go unrecognized. Continued pressure or walking on the injured skin creates even further damage, and the ulcer will worsen. The open sore will frequently become infected and may even penetrate to bone.
Treatment relies on early recognition of the ulceration by a podiatric surgeon, avoidance of weight bearing activities such as walking, avoidance of wearing “closed-in” shoes, and early intervention. Besides local wound care, dressings and antibiotics, other measures may be necessary to adequately relieve pressure on the area. When the use of crutches, a wheelchair, or rest is not feasible, plaster casts, braces, healing sandals, or orthoses (special shoe inserts) can be used to protect the foot while it heals. If circulation is inadequate to allow healing, a vascular surgeon can make an appropriate evaluation and possibly perform vascular reconstructive surgery.
Once an ulcer has healed, it is important to continue to see a podiatric foot and ankle surgeon regularly. Special footwear and inserts may be recommended to protect your feet and prevent new or recurrent lesions from developing.
Footwear Guidelines
Shoes must always fit comfortably and provide adequate width and depth for the toes. Leather shoes easily adapt to the shape of feet and allow them to “breathe.” Athletic shoes, jogging shoes and sneakers are usually excellent choices if they are well fitted and provide adequate cushioning. Corrigan Podiatry may recommend “extra depth” shoes, custom molded shoes adapted to your particular needs, or orthoses to provide cushioning and support.
Shoes should always be checked for foreign objects or torn linings before they are put on. Those with foot problems should wear two or three pairs of shoes each day so that no pair is worn for more than four to six hours. New shoes should be worn for only a few hours at a time, and wearing them requires extra care in inspecting the feet for points of irritation.
Socks should be well fitted without irritating seams or folds, and not so tight as to interfere with circulation. Well-padded socks can be very protective if there is an abundance of room in your shoes. Avoid wearing open-toed shoes or sandals until you have discussed this with a Corrigan podiatric surgeon. Above all else, do not walk with bare feet.
Call our office immediately if any area on your foot or ankle is red, hot or swollen, or if you have an open wound or blister!