A quarter of people with diabetes will develop a diabetic foot ulcer (DFU). Despite the prevalence and disabling consequences of a DFU, many people lack awareness of this serious diabetic complication. The longer a DFU remains untreated, the greater risk of hospitalization and increased health care costs. Diabetic patients with a DFU are at a significant risk for infections like MRSA and increased risk for amputation.
With nearly 246 million people across the globe battling diabetes and its complications, staying one step ahead of the disease has never been more important.More than 60 percent of non-traumatic, lower-limb amputations in the United States occur among people with diabetes. Because of this, the American Podiatric Medical Association (APMA) continues its national campaign “Elect to Save Your Feet.” This campaign, began in 2008, aims to educate the public about the importance of seeing a podiatrist regularly to prevent diabetic, lower limb amputations.
Spokesmen for the APMA continue to empahsize that the rate of amputation for those with diabetes is 10 times higher than those without the disease. Being vigilant in your personal footcare and including your podiatrist in your diabetes management team, can save both your limbs and your life.
Every 30 seconds, a lower limb is lost to diabetes somewhere in the world. Those with diabetes are more prone to develop foot infections, called foot ulcers, which can quickly result in amputation. Preventing amputation means knowing all of the main warning signs. Other common diabetes warning signs in the feet besides ulcers include:
·A tingling or loss of feeling in the feet
·A change in the shape of the feet
·Loss of hair
·Cuts and scrapes that are slow to heal
If you discover any of these symptoms, visit a podiatric physician immediately. A comprehensive foot care treatment plan can reduce amputation rates by 45 percent to 85 percent. Including a podiatrist in your diabetes management team – as well as having a proactive attitude about your footcare – can drastically improve your chances of managing diabetes successfully.
Because diabetes is a condition that affects many different parts of the body (systemic disease), the ideal case management involves a team approach. The podiatric medical physician is an integral part of the team, providing early recognition and treatment of foot pathology associated with diabetes. Early intervention can prevent amputations and complications.
Diabetes increases the chance of developing foot problems because of poor circulation and decreased sensation in the lower extremities.
damaged nerves may make it difficult to feel irritations, pain, pressure , heat and cold; decreased feelings may allow injuries to go unnoticed
poor circulation may lead to blocked blood vessels with reduced blood flow, oxygen and nutrients; infection fighting white blood cells and healing red blood cells may be insufficient to fight an infection and heal wounds
weakened bones and joints may cause your foot to collapse and provide less stability
In 2002 there were 82,000 lower extremity amputations in diabetics. 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. Unfortunately, over 25% of diabetics have not heard of an ulcer. There are many factors which contribute to the development of ulcerations.
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 canít 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 podiatric physician.
2. Donít 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. Donít 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. Donít 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 donít fold in half. These shoes will take the pressure off your feet and help prevent ulcerations. Ask your podiatric physician.
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. More information coming soon . . .
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.
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 donít know it. Itís important to know your risk.. Evaluation by your podiatric physician who will use a monofilament wire (thin wire ) can assess sensation.
10. Do not trim your own toenails, calluses or corns. If you have a loss of sensation or blood supply you will need to see your podiatric physician for medical treatment of your corns, calluses or toenails every two months.