Diabetic Foot
Definition
A foot with a constellation of pathologic changes affecting the lower extremity in diabetics, often leading to amputation and/or death due to complications; the common initial lesion leading to amputation is a nonhealing skin ulcer, induced by regional pressure, pathogenically linked to sensory neuropathy, ischemia, infection.
Causes
Several risk factors increase a person with diabetes chances of developing foot problems and diabetic infections in the legs and feet.
• Footwear: Poorly fitting shoes are a common cause of diabetic foot problems.
- If the patient has red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new properly fitting footwear must be obtained as soon as possible.
- If the patient has common foot abnormalities such as feet, bunions, or hammertoes, prescription shoes or shoe inserts may be necessary.
Nerve damage: People with long-standing or poorly controlled diabetes are at risk for having damage to the nerves in their feet. The medical term for this is peripheral neuropathy.
• Because of the nerve damage, the patient may be unable to feel their feet normally. Also, they may be unable to sense the position of their feet and toes while walking and balancing. With normal nerves, a person can usually sense if their shoes are rubbing on the feet or if one part of the foot is becoming strained while walking.
• Poor circulation: Especially when poorly controlled, diabetes can lead to accelerated hardening of the arteries or atherosclerosis. When blood flow to injured tissues is poor, healing does not occur properly.
• Trauma to the foot: Any trauma to the foot can increase the risk for a more serious problem to develop.
• Infections
o Athlete’s foot, a fungal infection of the skin or toenails, can lead to more serious bacterial infections and should be treated promptly.
o Ingrown toenails should be handled right away by a foot specialist. Toenail fungus should also be treated.
Treatment and Prevention
It’s estimated that 15 percent of all diabetics will require diabetic foot treatment at some time in their lives. A diabetic’s ability to detect sensations or vibration may be diminished, which can allow injuries to go unnoticed and untreated for lengthy periods of time. This can result in infection, ulceration or gangrene that may lead, in severe cases, to amputation of a toe, foot or leg.
Fortunately, most of these problems are preventable through proper care and regular visits to an orthopedic surgeon specializing in diabetic foot treatments.
Prevention of diabetic foot problems involves a combination of factors.
- Good diabetes control
- Regular leg and foot self-examinations
- Knowledge on how to recognize problems
- Choosing proper footwear
- Regular exercise, if able
- Avoiding injury by keeping footpaths clear
- Having a doctor examine the patient’s feet at least once a year using a monofilament, a device made of nylon string that tests sensation
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