PARDEE FOOT CLINIC
Diabetic Foot Care
According to the CDC, almost 24 million Americans have diabetes. This includes an estimated 6 million Americans that have diabetes, but have not been diagnosed. Almost 40% of individuals with diabetes are age 65 and older.
Most individuals have type 2 diabetes. In type 2 diabetes the body produces insulin, but it does not produce enough of this hormone or the cells don't respond to it appropriately. The result is an elevated blood sugar and sometimes an elevated insulin level as well. The blood sugar is high because the sugar is not being taken into the cells and utilized for energy properly. Most of the diabetics over the age of sixty have type 2 diabetes.
Serious complications associated with diabetes include stroke, heart disease, blindness, kidney disease, high blood pressure, nervous system diseases, and amputations. In 2004 there were approximately 71,000 lower extremity amputations in diabetics. In 2005 the CDC estimated that 4.3 individuals of every 1,000 people with diabetes will have a lower extremity amputation. A slow healing or non-healing open sore (known as an ulceration) on the foot is the most common reason diabetics will end up with a foot or leg amputation. Over 2 million diabetics have ulcerations and one in four diabetics with an ulcer will have an amputation.
There are many factors which contribute to the development of ulcerations. Let's start by looking at the two main effects of diabetes on the feet: the impact of the elevated blood sugar on the circulation and the nervous system.
When we talk about circulation, we are referring to the blood circulating in the body through the blood vessels. The arteries carry blood with oxygen and nutrients from the heart to the tissues. The veins carry blood with CO2 and other waste products back to the heart and lungs to be excreted. By far, the worst circulation problem is caused when the blood, oxygen and nutrients can't get to the lower extremities. High blood sugar can contribute to hardening of the arteries, making blood flow and nutrient transfer to tissues difficult. Without vital nutrients and oxygen, the feet and toes can become cold and painful, the skin changes color and even the smallest cut or scrape or infection will be difficult to heal. Smoking also causes problems with circulation to the feet and in combination with diabetes, usually results in disaster.
Your nerves tell you what types of sensations you are feeling, whether you are feeling something that is hot, cold or painful. The nerves control movement in your body and also control functions like breathing, heart rate and sweating. We typically don't think of pain as a good thing, but pain tells your body something is wrong. For example, if you were to step on a sharp object, the pain signal would be sent to the brain and in response to this pain, you would pick up your foot up, off the sharp object.
In diabetics, the nerves can lose their ability to sense pain. There are many theories for why this happens:
The blood supply is decreased to the nerves, causing dysfunction.
The increase in blood sugar causes malfunction.
The sugar metabolism within the nerve causes swelling and results in compression of the nerves.
There are loses of specific enzymes that are needed to enable nerve function.
There are more free radicals causing oxidative damage within the nerve as a result of the increased sugar.
Regardless, the result is the same. There is a loss of sensation in the feet and sometimes in the hands. This is called diabetic peripheral neuropathy.
Diabetics develop ulcerations because of the lack of feeling in their feet due to diabetic peripheral neuropathy. The ulcerations don't heal because of the constant pressure and rubbing on the ulcer or because of poor circulation. For this reason, treating diabetic ulcers is difficult. Preventing diabetic ulcers is not.
Take these steps to help prevent diabetic foot complications:
1. Check your feet everyday! This is an absolute necessity. If you can’t reach your feet, have a friend or family member check your feet. If needed, put a mirror on the floor and put your foot over it to look for cuts, scraps, bruises, openings or areas of irritation. Make sure you check between your toes. Look for moist areas, white areas or red areas. Look for anything unusual. If you see something unusual, make an appointment with your podiatrist.
2. Don’t walk around barefoot. Needles, tacks, broken glass, splinters of wood can be hidden in the carpet, even if you vacuum regularly. You can puncture a foot without sensation. Punctures can go unnoticed and develop into ulceration or infections.
3. Watch out for folds in your socks. Rough seams and small folds in the socks can cause areas of irritation that may lead to skin breakdown and ulceration.
4. Don’t be a victim of fashion. High fashion shoes usually lead to a high number of problems in the feet. Make sure the shoes are wide enough. Don’t buy shoes that are too wide or too long which can cause a lot of slipping. Pick shoes that are soft and flexible and allow for cushioning on the top and sides, but are rigid on the sole. Make sure they don’t fold in half. You may be eligible for your insurance to pay for diabetic extra-depth shoes with custom insoles. These shoes will take the pressure off your feet and help prevent ulcerations. Ask your doctor. General information for choosing shoes.
5. Check your bath water with your hand before you put your foot in it. The temperature your foot feels is much different from the temperature your hand feels when you have neuropathy. Make sure to check the temperature with your wrist. This will be much more accurate than testing the water with your foot.
6. Avoid medicated corn pads. Medicated corn pads contain acid and can be dangerous to diabetics. Yes, it will remove the corn, but there is a good chance it will also remove all the surrounding skin. What you will be left with is an ulceration. Check foot products you buy to make sure they are safe for diabetics.
7. Dry between your toes. Increased moisture between your toes can lead to the skin breaking down or foot fungus. This can eventually lead to an ulcer between the toes. Ulcers between the toes go unnoticed for longer periods of time and they can be difficult to treat.
8. Avoid cotton socks. Those white cotton socks you were told to wear for so many years are not the right socks for a diabetic. Cotton socks don't wick moisture properly, they lose their elasticity quickly and have a greater chance for thick seams and bunching at the toes. Try synthetic socks, acrylic, small fiber wool socks or diabetic socks. More information on socks.
9. Know your risk. Some diabetics do not have any loss of sensation or circulation in their feet. They are not at risk of developing an ulceration and have a low risk of an infection becoming a problem. Others, have severe neuropathy or circulation problems and don’t know it. It’s important to know your risk. Make sure your primary care doctor evaluates your feet and uses a monofilament wire (thin wire to assess sensation) or refers you to a podiatrist.
10. Do not trim your own toenails, calluses or corns. If you have a loss of sensation or blood supply then have your podiatrist trim your corns, calluses or toenails for you every two months.