Ronald W. Smith, M.D.

Diabetes of the Foot

diabetesI.      The Facts:
•    15% of diabetics will develop a foot ulcer
•    25% of diabetic hospitalizations are for foot problems
•    Diabetes is a leading cause of foot and leg amputations
•    50,000 amputations of feet and legs occur in diabetics per year
•    There are several foot problems that occur frequently in patients with diabetes.
•    Ulcers – Ulcers are basically just severe sores. Loss of sensation in the foot prevents diabetics from realizing when pressure or friction caused by a shoe is developing into a sore.  In addition, because diabetics lose the ability to regulate moisture in their skin, the skin more readily develops cracks, leading to ulcers.
•    Toe deformities – Hammertoe, a severe deformity of the toe, may result from diabetes. It is partly the result of nerve damage that affects muscle balance. The deformity can also lead to ulcers because the toes are more likely to rub on shoes.
•    Charcot process – The Charcot process is a condition of the foot whereby the foot becomes swollen, often red, and warm to the touch. Deep in the foot, the joints eventually collapse and the bones break apart, leaving deformed arches or ankles.
•    Gangrene 
Diabetics have a greater risk of gangrene than non-diabetics. Gangrene is caused by advanced infection or by narrowed blood vessels that prevent the flow of blood to the foot and toes. Smoking worsens this problem.

II.      Cause:   Diabetics suffer from damage to nerves and sometimes partial loss of circulation.  The resulting loss of sensation, dry, thickened skin, and abnormal shape of the foot all put diabetics at higher risk for the above foot conditions.

III.      Treatment and Prevention:  Steps can be taken for diabetics to lower their risk of developing diabetes related foot conditions:
•    Control the blood sugar  – This can be done through diet, insulin, or other medication. High blood sugar is a major cause of nerve damage, which leads to the loss of sensation and to ulcers, deformities, and lack of moisture control in the skin, resulting in many foot complications.

Examine your feet daily  – This way you can find areas of irritation, blisters, or cuts and get them treated before they become severe ulcers or get infected.
•     Keep skin moist – Use Vaseline or an effective lotion twice a day on the feet to keep the skin moist and prevent cracking. 

Wear wide, roomy shoes – Avoid constrictive shoes and shoes with heels. Wider shoes (like running shoes) will help avoid rubbing and blistering, which could lead to ulcers.
•    Get early professional attention – If you notice any of the above warning signs, get professional attention immediately. The earlier treatment begins, the more likely it is that surgeries and amputations can be avoided.

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