Overview of diabetic foot
People with diabetes are prone to foot problems that develop due to prolonged periods of high blood sugar levels. Diabetic neuropathy and peripheral vascular disease are the two main foot problems that occur, and both can have serious complications.
Diabetes is a disease that causes faulty or insufficient insulin production or low insulin sensitivity. Insulin is an essential hormone that is responsible for helping cells absorb sugar from the blood to use for energy.
When this process does not work correctly, sugar remains circulating in the blood, causing health problems.
Prolonged periods of high sugar levels in the blood can damage many areas of the body, including the feet.
What are the causes of diabetic foot?
Diabetes can cause two problems that affect your feet:
Diabetic neuropathy. Uncontrolled diabetes can damage your nerves. If the nerves in your legs and feet are damaged, you may not feel heat, cold, or pain there. This lack of sensitivity is called “diabetic sensory neuropathy.” If you don’t feel an incision or pain in your feet due to neuropathy, the cut may deteriorate further and become infected. The foot muscles may not work properly because the nerves of the muscles are damaged. This can cause your foot to go out of alignment and create more pressure on one part of your foot.
Peripheral vascular disease. Diabetes also affects blood flow. Without good blood flow, the wound or incision may take longer to heal. Poor blood flow in the arms and legs is called “peripheral vascular disease.” If you have an untreated infection due to poor blood flow, you are at risk for ulcers or gangrene (tissue death due to lack of blood).
Diabetic foot risk factors
Common risk factors for developing foot ulcers in diabetics:
- Peripheral vascular disease
- Poor glycemic control
- Smoking cigarettes
- Diabetic nephropathy
- Previous foot ulceration/amputation
So far, the two most common risk factors are neuropathy and peripheral vascular disease.
Diabetic foot prevention
Diabetes can cause serious foot problems that can result in feet or limb loss, deformity, and infections. However, a person can prevent or minimize many of these problems.
While controlling blood sugar by following the recommended diabetes treatment plans is the best way to prevent these serious problems, self-care and regular check-ups with a doctor can also help prevent problems from developing.
If you have a foot ulcer, see your doctor when you first notice it. They also want to know if you have any other medical conditions, such as peripheral neuropathy or artery disease in the lower extremities, that increase the risk of foot ulcers.
Your doctor will examine your foot, toes, and toenails for blisters, cuts, scratches, or ingrown toenails that can lead to additional ulcers. It also assesses the speed of blood flow in the foot by feeling its pulse.
The doctor can evaluate how your body weight is distributed to the bones and joints of your feet. A limp indicates structural damage and an uneven gait can cause blisters. They will also assess the shape of the feet, as abnormal alignment increases the risk of ulcers.
Magnetic resonance imaging uses a magnetic field and radio waves to create 3-dimensional computerized images of soft tissues in the body. Your doctor may recommend this test if you need more information about the damage caused by the ulcer. MRI scans can also reveal inflammation, which can be a sign of infection.
If there are signs of infection such as redness, swelling, and warmth in the affected foot, your doctor may recommend a blood test to detect it.
Treatment options for diabetic foot
Treatment for diabetic foot problems varies according to the severity of the condition. A range of surgical and nonsurgical options is available.
A doctor will first attempt to treat diabetic foot problems without using surgery. Some methods include:
- Keeping wounds clean and dressed.
- Wearing immobilization devices, such as a cast boot or total contact cast.
- Closely observing any gangrene on the toes until self-amputation occurs, which is when the toes fall off due to lack of blood flow.
When non-surgical treatment does not successfully heal diabetic foot problems, the doctor might consider surgery. Surgical options include:
- The removal of decaying or dead tissue
- Amputation, ranging from single toes or sections of the foot to amputation of the leg below or even above the knee.
- Surgical stabilization of Charcot’s Foot
- An arterial bypass for peripheral vascular disease, which assists blood flow to the area.
- Endovascular surgery with placement of stents, which uses small devices to keep blood vessels open.