DIABETES: FOOT CONDITIONS AND CARE
Diabetes mellitus is a chronic disease that affects about 16 million people in the USA. 5.4 Million Are unaware that they even have the disease. Diabetes is the inability to manufacture or properly use insulin, and impairs the body’s ability to convert sugars, starches, and other foods into energy. This causes hyperglycemia (elevated blood sugar) which is damaging to the eyes, heart, feet, kidneys, nerves and blood vessels.
Symptoms of hyperglycemia may include frequent urination, excessive thirst, extreme hunger, unexplained weight loss, tingling or numbness of the feet or hands, blurred vision, fatigue, slow to heal wounds, and susceptibility to certain infections. Control of diabetes is necessary to help prevent complications. About 86,000 lower limbs are amputated annually due to complications from diabetes. Diabetes is the leading cause of end stage kidney disease, accounting for about 40% of new cases. Diabetes if the leading cause of new cases of blindness among adults, age 20-74. With proper diet, exercise, medical care, and careful management, a person with diabetes can avoid many of the consequences, and enjoy a long, full life.
Podiatric Physicians can help prevent amputations. Regular foot screenings at least annually is necessary for early recognition and prevention.
Definitions:
1. Peripheral Neuropathy- Disease involving the sensory, motor, and autonomic nerves.
2. Peripheral Vascular Disease- disease involving the arteries of the limbs.
3. Immunopathy- defect in white blood cells predisposing a patient to infection.
Peripheral neuropathy involves sensory, motor, and autonomic fibers of nerves and is the major predisposing cause of diabetic foot ulcerations.
Sensory neuropathy results in the characteristic “stocking-glove” distribution of sensory dysfunction which can range form an imperceptible loss of Light touch, vibration, or pain sensation to complete anesthesia of the feet and lower legs. When the body doesn’t feel pain, we do not know a problem exists e.g., walking on a thumb tack in the shoe ECT.
Motor neuropathy frequently co-exists with sensory neuropathy. It results in weakness, atrophy, or paresis (lack of movement) of lower extremity muscles. It also results in atrophy of the muscles of the foot causing hammertoe formation and almost a skeleton look to the arch of the foot.
Autonomic neuropathy is present in diabetics and is characterized by reduced or absence of sweat and alterations in micro vascular blood flow. This leads to excessively dry and thicker callused skin which cracks easily. This can lead to skin fissuring accompanied by bleeding, especially around the heels. All of this predisposes the foot to ulceration and infection.
Peripheral vascular disease is the major cause of limb loss in the diabetic patient. It manifests earlier and progresses faster in diabetic patients than it odes in non-diabetic patients. Atherosclerotic occlusive disease tends to involve the femoral-popliteal and tibio-peroneal segments of the blood vessels (the blood vessels behind the knee) and is very characteristic of diabetic vascular disease. If the blood can’t get to the tissue, the cells die and gangrene results.
Immunopathy is a defect in the bodies white blood cell function and are a major problem in the diabetic patient. Immunopathy causes an increase in susceptibility to infection. This causes impaired wound healing. The slow response of the white blood cells to the site of an infection and the decreased ability of the white blood cells to kill bacteria are reasons why diabetics do not fight off infections well. Infections adversely affect diabetic control but more commonly, poor diabetic control severely weakens the bodies’ natural ability to respond to infection.
The bottom-line, check your feet daily. If you see a crack, blister, red area, blood or drainage notify our office immediately. Remember that the ounce of prevention is worth a leg!
TWENTY-FOUR DO'S AND DON'TS FOR OUR DIABETIC PATIENTS
1. Do not Smoke. Tobacco can contribute to circulatory problems, which can be especially troublesome in patients with diabetes.
2. Do not walk barefoot or without protective shoe gear.
3. Wash your feet daily. Dry carefully, especially between the toes.
4. Avoid extremes of temperatures. Test the water temperature with your hand, elbow, or thermometer before bathing.
5. If your feel cold at night, wear socks or put a light blanket on the foot of your bed covering up to your knees. Do not apply hot water bottles or heating pads. Do not use an electric blanket. Don not soak feet in hot water.
6. Do not walk barefoot on hot surfaces such as sandy beaches or on cement around swimming pools.
7. Inspect your feet daily for blisters, cuts, scratches, swelling or any unusual appearance. The use of a mirror can aid in seeing the bottom of your feet, get someone to help you. Check between the toes too.
8. Do not use any type of chemical agents for removal of corns and calluses, corn plasters, or strong antiseptic solutions.
9. Do not use adhesive tape on your feet.
10. Check the inside of shoes daily for foreign objects, nail points, torn linings, and rough areas. Feel with your hand as well as look with your eyes.
11. If your vision is impaired, have a family member inspect your feet daily, trim nails, and buff calluses.
12. Do not soak your feet unless instructed to do so.
13. For dry feet, use a very thin coat of lubricating oil or cream. Apply this after bathing and drying your feet. Do not put the oil or cream between the toes.
14. Stockings: wear properly fitting stockings. Do not wear mended stocking or stockings with seams. Change stockings daily. Thor-Lo socks have lots of padding and cushion.
15. Do not wear garters or roll your stockings back on themselves.
16. Shoes should be comfortable at time of purchase. Do not depend on them to stretch out. Shoes should be made of leather. Purchase shoes late in the afternoon when feet are the largest. Do not wear new shoes for more than two hours at a time. Running or special walking shoes may be worn after checking with the doctor.
17. Do not wear shoes without stockings.
18. Do not wear sandals.
19. In winter time, take special precautions. Wear wool socks and protective footgear such as fleece-lined boots.
20. Nails should be cut straight across. Do not trim them back in the corners. If you have peripheral vascular disease or neuropathy, let our office perform regular diabetic foot care for you.
21. Do not cut corns and calluses.
22. See your primary care physician regularly and be sure your feet are examined at each visit.
23. Notify the office at once should you develop a blister or sore on you feet, let the scheduler know you are diabetic and must see the doctor right away.
24. Be sure to inform any doctor if you are diabetic.
