Diabetic Foot Problems
Diabetic foot infections are a serious diabetes complication that can lead to amputation. What is diabetes foot? Diabetics even in the early stages of the illness can begin to develop a lack of sensation or a tingling in the foot, and this can be a sign of diabetes in those who have not been diagnosed. You also may get some diabetic foot pain. However, for persons who have had diabetes for a while there is often some loss of sensation and blood flow to the foot and the toes. A diabetes foot infection and/or a diabetic foot ulcer may develop and go undetected, and gangrene can set in, which will likely lead to a loss of at least some of the infected area through amputation.
How Do Diabetes Foot Infections Develop?
Both neurological and vascular systems can play a role in the development of diabetic foot problems. In diabetes, the circulatory system is greatly impacted by the extra blood sugar, and circulation is generally poorer -- and no more noticeably so than in the toes and feet, as adequate circulation to these areas becomes less available. The vessels harden and become narrower. With poorer circulation, the body's ability to fight the diabetic foot infection is compromised. Cuts and diabetic foot ulcers get out of control, and without enough help from your white blood cells, the downhill slide is likely. But you could hurry up and get an appointment with a diabetes foot doctor, and get your ulcer or foot infection under control, right?
But here is the rub (pun intended). What if you did not notice a bad wound for several days or even weeks? Would the medical intervention be rapid enough? The other major culprit in diabetic foot problems is inadequate feedback from the nerves that should be governing the toes, feet, ankles and legs. Peripheral neuropathy is the big time word for this alteration of nervous sensations in the foot. There is often still some sensation but it can become blunted and muffled. There is often nearly complete loss of your discrimination between sharp and dull sensations, not unlike the effects of anesthesia.
Diabetics with foot problems have been known to go for quite a lengthy time not even noticing that they have a foot ulcer, cut, fungus or an infection. If the routine of foot inspection is built into their day -- for example as part of the bathing or showering routine -- then it is less likely that a major infection will go unnoticed. But for the diabetic who does not regularly inspect their foot, diabetes foot infections are likely to develop and might progress to the point of no return.
Foot deformity can occur in diabetes foot as a result of the decreased sensation in neuropathy. In the typical person there is normal sensation in the foot, and it can automatically respond to pressure; you shift way from any pressure on the foot without even thinking. However, A diabetic with progressive neuropathy does not have this normal protective reaction, and necrosis and ischemic changes can turn into foot ulcerations known as plantar ulcerations. Tiny bones in your foot can be broken as well; this is known as micro-fractures.
Diabetic Foot and Leg Pain and Other Diabetes Foot Problems
Another one of the diabetes foot problems is edema. Edema is swelling of the foot, ankle and leg and can be accompanied by a general fluid intake of the body. Edema of the extremities can be be caused by congestive heart failure, but this is easily detected by blood tests your doctor can do. The role of diabetes in edema is less clear, but it likely has something to do with the circulatory problems seen throughout the diabetic complications.
Another set of problems in diabetes involve pain in the legs or calves, which can occur with diabetes. It can be brought on by walking uphill or strenuous walking, but responds to rest.
Treatment Issues in Diabetic Foot Ulcers
Neuropathy does not seem to be reversible, but for the Type 2 diabetic tight control of blood sugars can slow the onset of these problems and may even avert them. It is a matter of chronic wear and tear from too much blood sugar for too long. Similarly there is not a lot that can be done to improve the circulatory system, beyond those standard measures used to minimize other vascular conditions such as use of statins, and a high fiber, low salt diet.
If you aren't already, you should be familiar with the Diabetes Control Complications Trial (DCCT) which showed that for a protocol that included tight enough control of blood sugar to be near normal levels, many complications were averted. With regard to peripheral neuropathy, there was a 60% reduction.
Diabetic shoes are always a good idea, and most insurance, including Medicare, will pat for them; they are always a good idea and crucial when the diabetic foot problems are more severe.
Wound control and debriedment is beyond the scope of the current article, and needs to be coordinated closely with your foot doctor -- do not try to handle these wounds on your own!