Diabetes is a condition of abnormal levels of glucose in the blood.
Diabetic foot problems are a significant health condition for the patient.
The foot difficulties faced by patients with diabetes stem from two serious complications of the disease: nerve damage and poor circulation .
The Charcot arthropathy is one of the most critical problems that can cause these complications; leading in foot deformation and amputations.
People with diabetes have a higher risk of foot amputation than anyone else. Here’s what to look for when avoiding the risk of serious complications.
These two consequences caused by the diabetic foot, can cause disability in patients. There are currently treatment options for diabetic foot problems. But the most effective treatment is prevention.
In people with diabetes, careful daily foot exams are essential for overall health and prevention of foot complications.
Causes of Diabetic Foot Injuries and Complications
Diabetics are prone to foot conditions as they have abnormally high blood glucose levels for long periods of time.
Which can cause damage to the arteries and nerves, which can compromise the sensation in the feet.
When diabetics get a simple cut, scrape, or ailment on their foot and leave it untreated, it can lead to serious complications.
Diabetes mellitus causes serious foot complications.
These conditions include diabetic neuropathy and peripheral vascular disease.
Diabetic neuropathy: is the loss of normal nerve function and occurs due to damage to the nerves that causes a decrease in sensations in the feet. The damage that diabetes causes to the nerves is called neuropathy, and it is a complication that leads to loss of sensation in the feet.
People with diabetes usually cannot feel when something has irritated them, when they have sustained injuries such as wounds, scratches, or even skin punctures. A small wound like a scratch or a blister can progress to a very serious infection in a matter of hours.
Peripheral vascular disease: is a condition that affects blood flow and makes it difficult for a cut or wound to heal. Diabetes damages blood vessels, decreasing blood flow to the feet.
Poor blood circulation weakens the bones of the feet and can cause them to disintegrate, as well as the joints of the foot and even those of the ankle. That is why as a consequence of this condition, people with diabetes are at high risk of having foot injuries.
Normally when the diabetic patient fractures a bone in the foot, it is likely that they will not notice it due to the damage suffered by the nerves and can continue to walk with the injuries increasing the damage causing serious fractures or dislocations.
The edges of the broken bones within the foot can cause injury, increasing the risk of chronic ulcers due to abnormal pressure.
Both peripheral vascular disease and diabetic neuropathy are two conditions that can lead to:
- Ulcers: which are wounds that take time to heal or become easily infected.
- Infections: such as cellulitis on the skin, osteomyelitis or bone infections and abscesses.
- Gangrene : which is a dead tissue that occurs as a result of blood circulation problems.
- Charcot arthropathy: which presents fractures and dislocations that can cause serious deformities in the feet.
- Amputation: part or all of the feet, or the leg below the knee.
Diabetic foot injuries are caused by:
- Blisters that are caused by friction.
- Corns and calluses are hardened skin, caused by pressure.
- Plantar warts form from infection with a viral strain of human papilloma. Plantar warts infection should be avoided by wearing sandals in shared shower areas.
- Minor sprains can be caused by ankle injuries.
- Minor injuries such as cuts and punctures can be avoided by always wearing shoes.
- Ingrown toenails are caused by cutting the nail into a rounded shape rather than in a straight line, or by wearing shoes that are too tight.
- Fungal infections such as athlete’s foot or nail fungus can be avoided by properly drying your feet, wearing clean, breathable socks, and wearing sandals in shared showers.
Symptoms of a diabetic foot
Loss of protective or pain sensations and tingling sensations are the most common symptoms of diabetic neuropathy.
Patients develop blisters, ulceration, or wounds, however they may not feel any pain.
Reduced circulation can cause different coloration (red, blue, gray or white skin), red streaks, swelling, tingling or deformity, painless injury or minimal pain, changes in skin temperature (hot or cold).
Patients with infections may experience fevers, chills, tremors, flushing, problems controlling blood sugar levels, or shock (with unstable blood pressure, nervous system problems such as confusion and delirium).
Ulcers that fail to heal lead to lower limb amputation in diabetic patients in about 84 percent of cases.
The mortality rate for diabetic patients after a major amputation ranges from 11 to 41 percent in the first year, 20 to 50 percent in the third year, and 39 to 68 percent in the fifth year.
Infections can spread rapidly and be life threatening to the patient.
Typical places ulcers can appear include:
- Along the bottom of the foot (at the base of the toes, in the middle of the foot, or at the heel).
- On the sides of the foot (along the little toe when rubbing a shoe, the back side of the heel of the bed).
- Ankle bones (rubbing on a boot or lying in bed for a long time).
- Top of the foot (toes when rubbed with a shoe).
Infections can start in one place and spread rapidly along the veins and tendons, such as infections that start at the bottom of the metatarsal heads and spread rapidly along the tendons to the ankle.
Diabetic foot diagnosis
Nerve function may be abnormal, so the patient may not feel pain.
This frequently causes a delay in diagnosis, and the patient may be diagnosed late with a life-threatening or limb-threatening infection as a result.
The diagnosis is based on the common symptoms and signs of diabetic foot. The absence of the protective sensation is confirmed with simple equipment.
Ulcers are classified by size, depth, and vascularity. Your doctor may recommend additional imaging studies, such as X-rays, bone scans, MRIs, or CT scans.
These can show soft tissue problems, swelling, changes consistent with bone infection, fractures or dislocations.
Vascular studies can help determine how well the blood is circulating, which is important for wound healing.
Wounds should be cleaned and dressings and immobilization devices, such as cast boots, should be placed. This non-surgical treatment of Charcot’s foot includes protective immobilization.
Special therapeutic shoes should be worn, rather than constraining the deformed feet and toes to wear normal shoes that are often uncomfortable.
Gangrene that occurs on the toes, if the infection is under control, should have continuous observation, until self-amputation naturally occurs.
Daily care is very important and common daily treatment recommendations are:
Changes in the skin
Diabetes causes changes in the skin. Sometimes the skin becomes very dry, it can peel and crack.
This is caused because the nerves that are involved in the secretion of body oils and moisture from the foot no longer work.
After bathing, your feet should be thoroughly dried and the remaining moisture sealed with a thin layer of natural petroleum jelly, an unscented hand cream, or other similar moisturizing products.
Oils or creams should not be placed between the toes, as the added moisture can lead to fungus or other infections.
Corns most often occur on the feet of people with diabetes. This is due to the high pressure that the foot must withstand.
Corns, if not trimmed, become very thick, ruptured, and develop into open ulcers.
You should never try to cut the corns yourself or remove them with chemical agents, this can lead to burns, ulcers and infections.
Using a pumice stone daily will help keep your feet callus-free. The best way to use a pumice stone is after bathing with your skin still wet.
A moisturizing lotion should also be applied immediately after exfoliating with the pumice stone.
Ulcers most often occur on the sole of the foot or on the bottom of the big toe.
When ulcers appear on the sides of the foot, they are usually caused by tight-fitting shoes.
Failure to care for ulcers can lead to complications such as infections, which in turn can lead to conditions such as gangrene and eventually the loss of a limb.
The doctor may order X-rays of the foot to make sure the bone is not infected.
The doctor can clean any dead and infected tissue. In addition, cultures of samples from the wound should be done to find out what type of infection you have and what type of antibiotic will work best.
Walking on an ulcer can make it bigger and can increase the infection in your foot. Your doctor may recommend a special shoe, brace, or cast to protect your feet.
If the ulcer is not healing and circulation is poor, your doctor may need to refer you to a vascular surgeon. High blood glucose levels make it difficult to fight infection.
After the foot ulcer heals, the foot should be treated with great care. Scar tissue that forms in the wound can easily break apart.
Gangrene can appear later as a result of loss of circulation.
In many patients vascular diseases are present at the time of diabetes diagnosis.
Infections are usually caused by bacteria entering through a break in the skin, such as ulcers, areas of pressure on the toe, ingrown toenails, or areas of skin between the bases of the toes.
Infections are fought with the administration of antibiotics.
Poor blood flow can make the foot unable to fight infection and heal.
Pentoxifylline is the drug used to improve blood flow in patients with diabetic foot problems.
People with diabetes are much more prone to tissue necrotization and foot or leg amputations.
Many people with diabetes have peripheral arterial disease and nerve disease, which reduce sensation.
Together, these problems facilitate the development of ulcers and infections that can lead to amputation.
Serious infections, such as abscesses, urgently require surgical removal of decaying tissue or amputation.
Surgical treatment for Charcot’s foot includes operative stabilization (fusion), as well as correction of the deformity that has occurred.
Vascular diseases can be treated by vascular surgeons with the use of arterial bypass procedures.
Gangrene treatment can be carried out with a partial foot amputation or a below-knee amputation.
But it is possible to control some of the things that cause poor blood flow like not smoking, smoking makes the arteries harden faster. In addition, blood pressure and cholesterol must be kept under control.
Smoking can affect the flow of the smaller blood vessels in the feet and cause wounds to heal very slowly.
Many of the people with diabetes who need amputations are smokers.
When your feet are cold, you may be tempted to warm them up.
But if your feet lose feeling, they can’t feel heat and it’s very easy to burn them with hot water or heating pads.
The best way to help cold feet is to wear thick socks.
Some people may feel pain in the calf area when they walk very fast, on slopes (uphill), or on hard surfaces.
This is a known intermittent claudication condition. It is advisable to rest for a few moments, which should end the pain.
Work with your doctor to start a walking schedule that is consistent with your diabetic foot condition.
Some people can be helped with medications to improve circulation.
Exercise is recommended to deal with poor circulation problems, as it stimulates blood flow in the extremities.
The exercise should be done in comfortable and sturdy shoes, but you should not walk when you have open sores.
Monitoring should be carried out in those patients who suffer from diabetic foot.
Recovery can be stalled and watch out for the slightest warning signs.
Long recovery periods are quite common.
It may take several weeks or a few months to recover from the damage caused by the ulcer, depending on the size and location of the infection, circulation problems, and the general health of the patient.
It is very likely that serious infections can result in amputation.
The prognosis may sound dire, but it is possible to avoid diabetic foot complications, amputations, and reduce the risk when a patient has diabetes, if proper care is given to the feet.
- Examine feet daily and after removing shoes. Regular foot exams can detect minor foot ailments, such as blisters and corns. If it is not possible for the patient to self-examine, a family member or caregiver can be trained in daily foot examinations.
- Regularly wash, clean and dry your feet properly to avoid getting fungal skin infections.
- See a podiatrist for any findings. The physician should be informed of any change in sensation, such as sudden numbness or tingling in the feet.
- Attempts should be made to avoid minor foot injuries by wearing proper shoes and socks.