Because of their distance from the heart and because of the force of gravity, the feet and legs are more at risk for difficulties with circulation and healing than other parts of the body. In patients with diabetes, these risks are exacerbated by the disease since diabetes can lead to: impaired circulation, nerve damage (neuropathy) and a damaged immune system. Not only are diabetic patients less able to fight off infection, but they are also frequently unaware of injuries because of neuropathy and impaired vision.
Since patients with diabetes are at high risk for developing problems with their feet, it is extremely important for them to establish a healthy routine of foot care. An effective regimen should include:
- Thoroughly inspecting the feet every day
- Washing the feet in temperate water daily
- Keeping the feet dry, especially between the toes
- Changing socks daily
- Taking careful care of nails, corns and calluses
- Applying moisturizer to dry skin, but not between the toes
- Not walking barefoot
- Wearing properly fitted shoes
- Carefully monitoring blood glucose levels
Diabetic patients should also make sure to take care of their general health in order to avoid potentially serious problems with their feet. In addition to having regular medical checkups, they should have regular appointments with a podiatrist to make sure of proper foot care and the detection of any injuries or abnormalities.
A healthy lifestyle is especially important for patients with diabetes. This includes maintaining an appropriate weight, engaging in gentle exercise such as swimming or biking, avoiding smoking and not drinking alcohol, and keeping cholesterol levels under control. Following these directives considerably lowers the probability of the development of diabetic foot problems and lowers the risk of the serious consequences of neglect.
Peripheral Neuropathy and Ulcers
Peripheral neuropathy refers to damage of the peripheral nerves, which branch out from the brain and spine to the rest of the body. It typically begins with pain, numbness, tingling, burning or weakness in the feet or legs, and may progress to more serious conditions such as ulcers, pain and loss of sensation. Numbness is especially dangerous, as patients sometimes do not detect an injury until the damage is so pervasive that the limb requires amputation.
Peripheral neuropathy may develop because of a nerve disease or as a side effect of an illness or medication. Diabetes is one of the most common causes of this condition. Some of the procedures used to treat peripheral neuropathy are nerve decompression and partial joint denervation to relieve foot, ankle, knee and leg pain.
Another common problem for those with diabetes is ulcers and other wounds that form on the bottom of the foot. These can easily become infected or lead to other serious complications. Ulcers may develop as a result of poor circulation, lack of feeling in the feet, irritation or trauma.
Once a wound has been detected, it should be treated immediately in order to prevent complications from developing. Diabetic wound treatment focuses on relieving pressure from the area and removing dead skin cells and tissue through a process called debridement. The wound is then medicated and dressed to prevent infection and promote healing. For more severe wounds, patients may be required to wear special footwear or a brace to relieve pressure and irritation to the wound. To prevent wounds from developing, patients should avoid walking barefoot and keep blood glucose levels under control.
Charcot arthropathy is a neurological disorder affecting motor and sensory function throughout the body. Patients with this condition experience damage to the nerve or the myelin sheath, the protective covering over nerves in the brain. This results in a weakening of signals sent from the brain to the extremities so patients often have problems with their feet. Patients with diabetes are at an increased risk of developing Charcot arthropathy and may experience more severe symptoms.
Symptoms of Charcot arthropathy may include:
- Loss of muscle
- High foot arches
- Frequent tripping
While there is no cure currently available for Charcot arthropathy, certain treatments can help patients cope with the symptoms of this condition and improve their quality of life. Physical therapy, occupational therapy, braces and surgery for severe cases may be used to promote muscle strength and function, while medications may be prescribed to relieve pain as needed. Most patients benefit from a combination of treatments in order to treat their individual condition.