The incidence of diabetes mellitus appears to be on the rise in Anguilla and many other countries. The complications associated with poorly controlled diabetics appear to be rising as well, including problems of the feet. Diabetes can cause two main problems that can affect the feet: diabetic neuropathy and peripheral vascular disease.
What is diabetic neuropathy?
Uncontrolled diabetes can damage your nerves. If you have damaged nerves in your legs and feet, you might not feel heat, cold or pain. This lack of feeling is called “sensory diabetic neuropathy.” If you do not feel a cut or sore on your foot because of neuropathy, the cut could get worse and become infected. The muscles of the foot may not function properly because the nerves that make the muscles work are damaged. This could cause the foot to not align properly and create too much pressure in one area of the foot. It is estimated that up to 10% of people with diabetes will develop foot ulcers.
What is peripheral vascular disease?
Diabetes also affects the flow of blood. Without good blood flow, it takes longer for a sore or cut to heal. Poor blood flow in the arms and legs is called “peripheral vascular disease.” Peripheral vascular disease is a circulation disorder that affects blood vessels away from the heart. If you have an infection that will not heal because of poor blood flow, you are at risk for developing ulcers or gangrene (the death of tissue due to a lack of blood). Peripheral vascular disease is a common cause of foot ulcers.
Diabetes and your feet
Individuals with diabetes are at much greater risk of developing problems with their feet, due to the damage raised blood sugars can cause to sensation and circulation. If left untreated, these problems can cause foot ulcers and infections and, at worst, may lead to amputations. Most foot problems are preventable with good, regular foot care and good control of blood sugar levels.
How to prevent ulcers of the feet?
Ulcers of the feet are a common complication of poorly controlled diabetics. The good news is that these ulcers can be prevented, thus avoiding amputations and further complications.
Proper foot care will help prevent problems with your feet and ensure prompt medical care when problems occur. The following might prove helpful:
• Inspect your feet daily. All individuals who are diabetics should check their feet once a day for blisters, cuts, cracks, sores, redness, tenderness or swelling. If you have trouble reaching your feet, use a hand mirror to see the bottom of your feet. Place the mirror on the floor if it is too difficult to hold, or ask someone to help you.
• Wash your feet daily. Individuals are encouraged to wash their feet in lukewarm water once a day. Dry them gently, especially between the toes. Sprinkle talcum powder or cornstarch between your toes to keep the skin dry.
• Do not remove calluses or other foot lesions yourself. To avoid injury to your skin, do not use a nail file, nail clipper or scissors on calluses, corns, bunions or warts. Do not use chemical wart removers. See your doctor or foot specialist (podiatrist) for removal of any of these lesions.
• Trim your toenails carefully. Trim your nails straight across. Carefully file sharp ends with an emery board.
• Do not go barefoot. To prevent injury to your feet, do not go barefoot even in your home.
• Wear clean, dry socks. Wear socks made of fibers that pull sweat away from your skin, such as cotton and special acrylic fibers — not nylon. Avoid socks with tight elastic bands that reduce circulation, as well as thick bulky socks that often fit poorly and irritate your skin.
• Buy shoes that fit properly. Buy comfortable shoes that provide support and cushioning for the heel, arch and ball of the foot. Avoid tightfitting shoes and high heels or narrow shoes that crowd your toes.
• Avoid smoking. Smoking impairs circulation and reduces the amount of oxygen in the blood. These circulatory problems can result in more-severe wounds and poor healing.
• Schedule regular foot checkups. Your doctor or podiatrist can inspect your feet for early signs of nerve damage, poor circulation or other foot problems. Schedule foot exams at least once a year or more often if recommended by your doctor.
• Take foot injuries seriously. Contact your doctor if you have a foot sore that does not quickly begin to heal or other persistent problems with your feet. Your doctor will inspect your foot to make a diagnosis and prescribe the appropriate course of treatment.
What are the danger signs for foot problems?
Many individuals with diabetes are not aware of some problems with their feet, while others ignore warning signs. These warning signs include the following:
• your foot is red, warm or swollen
• There a break in the skin or discharge (or oozing) onto your socks or stockings
• You may feel unwell
Remember you may not experience pain even with a visible wound. If your sight is not good make sure someone else looks at your feet every day.
Treatment of foot ulcers
Treatments for foot ulcers vary depending on the severity of the wound. In general, the treatment employs methods to remove dead tissue or debris, keep the wound clean, and promote healing. When the condition results in a severe loss of tissue or a life-threatening infection, an amputation may be the only option.
Conclusion
Individuals who have diabetes are prone to have many serious complications, including problems of the feet. Proper foot care can help prevent these common foot problems and/or treat them before they cause serious complications. All individuals with diabetes are encouraged to take good care of their feet at all times, and should not ignore warning signs. If in doubt contact your healthcare provider. The best strategy for preventing complications of diabetes — including foot ulcers — is proper diabetes management with a healthy diet, regular exercise, blood sugar monitoring and adherence to a prescribed medication regimen.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty-two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
