Diabetes and Feet | Harold Cook, DPM

Diabetes

Types 1 and 2 are both diseases of impaired glucose (sugar) metabolism. Uncontrolled, diabetes can cause long-term damage to every organ in your body, including eyes, and foot. Diabetes may cause nerve damage, also called diabetic neuropathy. Neuropathy is experienced as burning or tingling sensations or numbness in the feet.  Diabetes can also cause damage to the circulatory system (peripheral arterial disease, PAD).

If diabetes is uncontrolled it can impair the body’s immune system and make the diabetic patient more susceptible to bacterial and fungal infections. Diabetes can also damage the body structure of the foot leading to difficult to treat foot deformities. When these damaging processes combine it can lead to the formation of diabetic foot ulcerations also known as diabetic foot wounds.

It is estimated that approximately 25% of diabetic patients will develop a diabetic foot ulceration. Chronic wounds and infection combined with impaired circulation in the diabetic foot all too often can result in lower extremity amputations. However the American Podiatric Medical Association has estimated the 80% of lower extremity amputations are preventable.  Prevention of these amputations greatly improves the quality of life of the patients in question and can save costs to our overburdened healthcare system.

Prevention of diabetic foot ulcerations and amputations is best accomplished through a team effort. The treatment team for prevention of these issues includes the diabetic patient, a medical doctor, and a podiatrist. Sometimes it is necessary to add a vascular surgeon to the treatment team. The medical doctor is necessary to ensure that diabetic patients are on the correct medications to control their diabetes as well as manage any other medical issues.

 

The Podiatrist’s role in the prevention of diabetic ulcerations and amputations is to perform diabetic foot screenings, checks for neuropathy and peripheral arterial disease, as well watch for the warning signs of diabetic foot ulcerations. The podiatrist should also takes steps to educate their patient about the warning signs for diabetic foot ulcerations as well as educate their patient on how to take care of their feet between visits. When the podiatrist notices any of these warning signs it is the job of the podiatrist to initiate both surgical and non-surgical treatments to prevent ulceration or to heal ulceration that have already formed.

Common non-surgical podiatry treatments for diabetic foot health include:

  • The trimming of ingrowing nails
  • The treatment of fungal foot infections of the skin and nails
  • The prescribing of diabetic shoes and custom arch supports
  • The trimming of pre-ulcerative lesions such as calluses and corns

Antibiotic medications can also be prescribed for the treatment of bacterial infections. Physical therapy and assistive devices such as braces are additional examples of non-surgical treatments. Medications are often prescribed for the treatment or prevention of neuropathy and its symptoms.

Occasionally a surgical procedure may be required to prevent or treat diabetic foot ulcerations. These surgical treatments may include:

  • The removal of damaged tissue of wounds
  • Correction of hammertoe or bunion deformities when they are causing or are at risk of causing diabetic foot ulcerations
  • Occasionally complex reconstructive surgery can be required to correct problems caused by diabetes in the foot
  • Sometimes a vascular surgeon is needed to help improve or restore bloodflow to the foot in order for a diabetic foot ulceration to heal

The diabetic patient themselves cannot be overlooked as an important member of diabetic foot care team.

Small changes in the daily routine of the diabetic patient can have a big impact on their overall foot health.

  • The diabetic patient should check their feet daily, make sure that they are using the shoes that they are directed to wear by their doctor.
  • The diabetic patient can significantly reduce their risk of ulcerations and amputations by refraining from smoking and other tobacco products.

This team approach and strategy has a major impact on the outcome and survivability of diabetes in the United states today.

It is estimated that $245 billion is spent on the treatment of diabetes and complications caused by diabetes in the United States. Research by The APMA has shown that the inclusion of podiatrist in the care of the diabetics can save the US healthcare system $3.5 Billion per year.  So by making the team effort to treat and prevent diabetic foot complications, many amputations are prevented, the quality of life of diabetic patients is improved and the costs on our overburdened healthcare system can be greatly reduced.

Trust Physicians Footcare Team of Podiatrists to treat your foot problem and help get you back to what you love to do.

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