Diabetes affects approximately 18 million people in the United States. Of this number, 15-20% of those affected will develop foot ulcerations. It is a known fact that foot ulcerations are the most frequent cause of hospitalization in patients with diabetes, accounting for up to 25% of all diabetic admissions. Diabetes is the sixth-leading cause of death by disease in the United States. Diabetes is truly a silent killer causing blindness, kidney disease, nerve disease and amputation, heart disease and stroke, and often death. Diabetes disproportionately affects African Americans, Hispanics, and Native Americans more commonly than their white counterparts. Unfortunately, approximately 67,000 lower extremity amputations per year are performed in people with diabetes at a cost of $30,000 per admission. It is therefore, vital that all diabetic patients commit to taking care of their feet properly. Diabetics are at an increased risk for developing foot ulcerations and infections, which if left untreated, can lead to gangrene and loss of limb. Common ailments, such as corns, callouses, bunions, ingrown toenails, and other basic foot deformities can lead to very serious conditions, resulting in hospitalization and ultimately loss of life or limb. It is therefore, imperative that diabetic patients take these conditions very seriously. Proper shoe gear is essential in maintaining healthy feet! Visit your podiatrist regularly.
Diabetic Neuropathy and Diabetic Nerve Damage
Two of the things that make the diabetic foot more vulnerable are Nerve Damage (Peripheral Neuropathy) and a decrease in circulation (Peripheral Arterial Disease or Angiopathy).
Diabetics suffer from an abnormal rise of the body's blood sugar (glucose) level and lack the sufficient levels of insulin to metabolize the blood sugar or have an inability of the body's cells to utilize the available insulin in the blood (Insulin Resistance). Consequently, the blood sugar enters the nerve tissue, damaging the nerve causing the nerve to swell and ultimately affecting its nutrition. Once the nerve is damaged, the protective nerve sensors become dulled and non-responsive. The ability to distinguish between hot and cold, dull and sharp, as well as the ability to feel pain and pressure, becomes increasingly more difficult, causing potentially dangerous and undetected injuries for a diabetic. Often, diabetics with neuropathy can have a cut or infection and not realize it because of the lack of feeling in their foot. The risk of developing ulcers and infections is significantly increased. In most cases the damage to the nerve is permanent, however with good glucose control, exercise, and one-a-day multiple vitamins, further damage can be avoided and in some cases, partial feeling may return to the foot. Diabetics should adhere to a special diet and monitor their glucose daily. Alcohol consumption should be kept to a minimum as ethanol, a component of alcoholic beverages, is toxic to the nerve and may also cause neuropathy. There are a number of symptoms that neuropathies can cause. In addition to numbness, one can experience tingling, pins and needles sensation, pain, and burning. There is a phenomenon called "burning foot syndrome." These symptoms are often managed with oral and/or topical medications.
Loss of Circulation
Poor circulation inhibits the body's ability to deliver adequate blood flow to vital body parts. Blood carries the required oxygen and nutrients necessary to aid in the body's healing processes as well as keeping those body parts active and healthy. The lower extremities arteries become increasingly narrower as they approach the feet and then toes. It is therefore easy to see why these vessels are more vulnerable to arterial disease and can clot more easily. This scenario can obviously lead to gangrene of the toes and foot. Poor circulation to the feet and legs prolongs the healing of cuts and sores, greatly increasing the risks for diabetics and individuals with peripheral arterial disease to develop gangrene and subsequent loss of limb.
Helpful Diabetic Foot Care Tips
- Examine your feet daily. Check for swelling, redness, blistering, cuts, bleeding, excessive moisture between the toes, and ingrown toenails
- Inspect your shoes before wearing. Select proper shoe wear. Check for foreign objects that can pierce the skin, uneven seams or cracks that may cause skin irritation, proper sizing - shoes should never fit tightly (especially in toe box), redness and swelling upon wearing new shoes-discontinue wear
- Never walk barefooted (even around the house)-cuts and blisters can easily develop into infections or ulcerations
- Never soak your feet in hot water-this can leads to burns, blisters, and ulcers. Lukewarm water is safest
- Never use a heating pad - a patient with neuropathy can be seriously burned
- Do not smoke - smoking reduces circulation to the feet. Nicotine causes constriction of the arteries
- Never use "corn/callous removal pads" - they contain salicylic acid and can cause chemical burns to the skin
- Never use sharp instruments to trim corns, callouses, and toenails - cuts can lead to serious infection
- Wear white cotton soaks when wearing slippers around the house - germs in slippers can lead to bacterial or fungal infections
- Avoid backless shoes, slippers - this will lead to heel callous and fissuring (cracking of the skin) which can lead to bacterial invasion of skin and infection
- Do not sleep in tight-fitting socks - this can cut off circulation to the feet
- Never lotion between your toes - this can lead to fungal infections due to excessive moisture
- Avoid wearing sandals or "sling backs"
- Keep your feet clean and dry - can use a blow dryer to dry your feet after bathing
- Always wear socks or stocking with shoes (preferably socks)
***Call your podiatrist if you notice any unusual signs or symptoms with your feet***