Diabetic Foot

Diabetes is a disease which causes changes in many organ systems. Those with diabetes, especially those with poor control of their disease, have a high risk of eye disease, kidney disease and amputation. It is estimated that 15% of diabetics will undergo an amputation of the foot or leg. Two million Canadians have diabetes. Seven hundred thousand people in Canada don’t know that they have diabetes.

Foot ulceration, infection and amputation are the result of the effects of diabetes on the vascular system, the nervous system and the immune system. Nerves can be injured by high blood sugar resulting in pain, burning sensations and eventually numbness. The nerves that relay pain and temperature are injured first. The damage starts in areas furthest from the brain and spinal cord: the feet. This is called peripheral neuropathy. It inhibits the ability to feel pain from injuries to the feet. Simple injuries such as blisters or small cuts can lead to limb threatening infections. Diabetes can also decrease blood flow to the feet. This inhibits the body’s ability to heal small wounds and can also limit the amount of antibiotics available to fight bacteria in an area of infection. It also causes skin changes including dryness and tightness. The ability of the immune system to fight infection is also affected by diabetes.

Signs of diabetes include, but  are not limited to, constant thirst, hunger, frequent urination, visual changes and sometimes burning or numbness in the feet.

What You Can Do

• Control your diabetes. Your risk is decreased by good control of the disease.
• Wash your feet daily. Dry carefully between the toes.
• Apply a moisturizer to feet lightly after bathing. It is important for you to keep your skin soft and supple.
• Do not cut toenails too short. The corners of the nails should always be visible. If you have difficulty reaching or seeing your feet have someone else cut your toenails.
• Stop smoking. Smoking reduces blood circulation and increases your risk of amputation.
• Wear comfortable, well-fitting shoes.
• Examine feet every day for cuts, blisters, dry blood, redness or swelling. Call your podiatrist immediately if you notice a problem. Hours can make the difference between saving your foot and losing it.
• Inspect the inside of shoes for foreign objects.

What You Should NOT Do

• Never use hot water bottles or heating pads. These can cause serious burns.
• Don’t walk barefoot, even indoors.
• Don’t trim corns or calluses with any type of blade. An emery board can be used safely if necessary.
• Don’t use corn removal pads, liquids or wart treatments. These products contain acids that can cause an ulcer or hole in the skin.
• Don’t wear open-toed shoes, particularly sandals with thongs between toes.

What Your Doctor Can Do

• Educate you regarding diabetes and foot complications.
• Care for areas that are at risk for ulceration.
• Consult nerve and vascular specialists where appropriate.
• Make protective insoles to decrease pressure on problem areas.
• Perform surgery to reduce the risk of ulcer and infection.
• Perform wound care for ulcers.

Foot Complications of Diabetes mellitus

• Diabetic ulcers – the loss of skin and subcutaneous tissue over areas of pressure
• Neuropathy – loss of sensation due to damage to peripheral nerves
• Charcot joint disease – Severe destructive joint changes to the neuropathic foot
• Diabetic osteolysis – the resorbtion of bone, especially of the forefoot bones
• Osteomyelitis – infection of bone, usually from an overlying skin ulcer
• Amputation of foot or leg due to severe infection