Preventing Diabetic Foot Complications

A recent study performed by the American Podiatric Medicine Association, (APMA) determined that diabetes affects more than 26 million Americans. That is an astounding number! Whether due to genetics, diet, or other health issues, the number of diabetics is increasing. Diabetes causes a variety of serious health issues, especially in the feet. Diabetic wounds on the feet are serious and can eventually lead to amputation. Problems in the diabetic foot are typically caused by one or two things, peripheral vascular compromise (poor circulation) and/or neuropathy (loss of feeling). Proper foot care is essential for diabetics and may mean the difference between remaining active and or being hospitalized, or between keeping or losing a limb. The APMA recently issued a statement predicting that if every person who might be at risk for developing diabetic foot ulcers would visit a podiatrist BEFORE the occurrence of a foot ulcer, the US would save over $3.5 billion/year in health costs. Diabetic patients may read this and ask themselves, “why visit a podiatrist without a tangible problem?”, “What will the podiatrist do to help me?”, “How do I tell if I am at risk of developing ulcers?” or “What can I do at home to prevent formation of ulcers?”The following may help answer some of those questions.

“Why visit a podiatrist without a foot problem?” Because foot complications are the most common reason for hospitalization of diabetic patients, it is recommended that diabetics see a podiatrist on a yearly basis. In cases where foot complications are already present, it may be necessary to see a podiatrist more regularly. Diabetics, especially those with diabetic neuropathy, structural foot deformities, and peripheral vascular compromise, are at risk of developing foot ulcerations. A simple visit to a podiatrist will give the doctor the opportunity to perform a complete foot examination, thus identifying potential risks and properly treating any identified complications. A podiatrist can also educate the diabetic patient, giving important instructions regarding proper foot and nail care, as well as proper foot wear. Proper care in these areas will decrease and possibly even eliminate the risk of foot ulcerations, hospitalization, and even amputation.

“How do I know if I am at risk?” If you are a diabetic, you are at an increased risk and a visit to your podiatrist will prove beneficial. In addition to merely being diabetic, early signs of vascular compromise or ischemia,(poor circulation) include pain in the foot at rest or at night, no pulses in the foot, thin or shiny skin, decreased or absent hair growth on the feet, thickened toenails, increased redness to skin color when legs are dependent/down and increased whiteness to skin when legs are elevated/raised. A podiatrist can perform additional non-invasive vascular tests to help diagnose vascular concerns including, ankle brachial index (abi), absolute toe systolic pressure, and transcutaneuos oxygen measurements. These tests are simple and non-invasive. If clinical and non-invasive tests indicate vascular ischemia, the podiatrist can consult a vascular doctor for further vascular studies and testing. Poor circulation leads to many complications and decreases healing in the feet. Simple cuts or scrapes can become ulcers that will not heal. The feet become more dry and brittle. A simple crack from dryness can turn into a wound that will not heal. Knowing the risks and knowing the how to properly care for the feet will help the patient prevent potential complications with serious consequences.

A podiatrist will often diagnose in a diabetic, a nerve disease called peripheral neuropathy, in which the nerves to the feet have a decrease in function. This can also result in dry and fissured skin, predisposing the skin to infection. Neuropathy causes loss of feeling, resulting in injuries and sores that go unnoticed. Decreased sensation leaves the diabetic foot vulnerable to puncture wounds and thermal injury. These wounds may also go untreated and can result in ulcerations and infection. Seemingly simple things like corns and calluses,and bunions and hammertoes, if left untreated, can cause ulcers and infections. Simple tests can be performed by the podiatrist to help diagnosis the presence of peripheral neuropathy including monofilament tests, two-point discrimination and sharp vs dull. If clinical and non-invasive tests indicate nerve disease the podiatrist can consult a neurologist for further nerve studies and testing.

A podiatrist can help identify and treat these common occurrences related to diabetes and work with you to prevent serious complications. Your podiatrist will teach you about proper foot care, including how to perform helpful foot inspections and foot cleaning, as well as the proper way to treat minor foot injuries. The podiatrist will ask you to inspect your feet daily and will teach you what signs indicate problems. He/she will teach you how to properly trim nails. Because diabetes also brings a compromise in immune response, decreasing the ability to fight infection, a diabetic it should have a trained podiatric specialist address any nail concerns or problems.

A podiatrist will recommend that you always wear socks or shoes, thus preventing scrapes or puncture wounds from objects on the floor. Your podiatrist will also evaluate shoe gear and socks and assess proper support and fit. Patients with foot deformities or special support needs may benefit from custom inserts and or shoes.

If you or someone you know suffers from diabetes, schedule an appointment with your podiatrist today. Regular checkups will prevent major complications and can improve quality of life. Whether you are a diabetic with existing foot complications or someone that has not yet experienced foot problems, a visit with your podiatrist will improve your overall health and may save you from ulcers, infection and possible amputation in the future.