Foot problems are a common complication in people suffering from Diabetes Mellitus. Most of these complications can be prevented with effective foot care. If complications do surface, daily attention will ensure early detection before they become serious. It takes effort to build good foot care habits, but self-care is very important for a diabetic.
DIABETES AND FOOT COMPLICATIONS
Diabetes may lead to various foot complications, including diabetic neuropathy, fungal infection, calluses and other foot deformities, or ulcers which may range from a simple wound to a deep infection.
Nerve damage (neuropathy) — increased blood glucose levels in the body can damage the nerves of the foot, reducing a person’s ability to feel the sensation of pain and pressure. Without these sensations, it is easy to develop callused pressure spots and accidentally injure the skin, soft tissue, bones, and joints. Bone and joint damage can dramatically alter the shape of the foot.
Poor circulation — Persistent high blood sugar can damage blood vessels and reduce the rate of blood flow to the foot. This poor circulation can weaken the skin, contribute to the formation of ulcers, and impair wound healing mechanism of the human body. Some bacteria and fungi thrive on high levels of sugar in blood and bacterial and fungal infections can complicate the ulcers.
More serious conditions include deep skin and bone infections. Gangrene (death and decay of tissue) is a very serious complication that may include infection; widespread gangrene may lead to foot amputation. Approximately 5% of men and women with diabetes eventually require amputation of a toe or foot. This consequence can be prevented in most patients by managing blood sugar levels along with daily foot care.
Patients who have had a previous foot ulcer are more likely to suffer from future foot complications. Nerve damage, poor circulation, and very high blood sugar levels increase the chances of foot complications.
It is important to wear shoes that fit well. Shoes that are too tight can cause pressure ulcers. Going barefoot, even at home, should be avoided as this increases the risk of foot related injury.
People with type 1 diabetes for at least five years should have their feet examined at least once a year. People with type 2 diabetes should have their feet examined once per year.
During a foot exam, doctor checks for poor circulation, nerve damage and deformities. Patients should mention all the problems they have noticed in their feet. A thorough test may reveal decreased or absent reflexes or decreased ability to sense pressure, vibration and changes in temperature.
Monofilament test, Sensitometer check and Vascular Doppler check can help determine the extent of nerve damage in the foot. A monofilament is a very thin, flexible thread that is used to determine if a patient can sense pressure in various areas of the foot. Sensitometer is used to determine if the patient can sense vibration in the foot and toe joints and also heat and cold sensations. Vascular Doppler check is used to assess the blood pressure and flow to the feet and toes, to determine nerve damage.
Possible foot problems
Poor circulation — some simple clues can point towards circulatory problems. Cold feet, thin or blue skin, and lack of hair signal that the feet are not getting enough blood.
Nerve damage — Nerve damage may lead to weird sensations in the feet and legs, including pain, burning, numbness, tingling, and fatigue. Patients should describe these symptoms if they occur, including the timing, if the feet, ankles, or calves are affected.
This can be very dangerous because the person may be unaware that they have improperly fitting shoes, a rock or other irritant in a shoe, or other problems that could cause damage.
Skin changes — Excessive skin dryness and cracking may indicate that blood circulation to the skin is compromised. Other skin changes may include new ulcers, calluses, and broken skin between the toes
Deformities — structure and appearance of the feet and foot joints can indicate diabetic complications. Nerve damage can lead to joint and other foot deformities. The toes may have a peculiar “claw toe” appearance, and the foot arch and other bones may appear collapsed. This destruction of the bones and joints is called Charcot arthropathy.