The Diabetic Foot

Definition

Diabetes is a serious disease that can develop from the lack of insulin production in the body or due to the inability of the body’s insulin to perform its normal everyday functions.  Insulin is a substance produced from the pancreas gland that helps process the food we eat and turn it into energy.

Diabetes affects approximately 16 million Americans and is classified into 2 different types: Type 1 and Type 2.  Type 1 is usually associated with juvenile diabetes and is often linked through heredity.  Type 2, commonly referred to as adult onset diabetes, is  characterized by elevated blood sugars, often by people who are overweight or have not attended to their diet properly.

There are often many complications associated with diabetes.  Diabetes disrupts the vascular system, affecting many areas of the body such as the eyes, kidneys, legs, and feet.   People with diabetes should pay special attention to their feet.

Cause

Neuropathy
Of the sixteen million Americans with diabetes, 25% will develop foot problems related to the disease.  Diabetic foot conditions develop from a combination of causes including poor circulation and neuropathy.  Diabetic Neuropathy can cause insensitivity or a loss of ability to feel pain, heat, and cold.  Diabetics suffering from neuropathy can develop minor cuts, scrapes, blisters, or pressure sores that they may not be aware of due to the insensitivity.  If these minor injuries are left untreated, complications may result and lead to ulceration and possibly even amputation.  Neuropathy can also cause deformities such as Bunions, Hammer Toes, and Charcot Feet.
It is very important for diabetics to take the necessary precautions to prevent all foot related injuries.  Due to the consequences of neuropathy, daily observation of the feet is critical.  When a diabetic patient takes the necessary preventative footcare measures, it reduces the risks of serious foot conditions.

Poor Circulation
Diabetes often leads to peripheral vascular disease which inhibits a person’s blood circulation.  With this condition, there is a narrowing of the arteries that frequently leads to significantly decreased circulation in the lower part of the legs and the feet.  Poor circulation contributes to diabetic foot problems by reducing the amount of oxygen and nutrition supplied to the skin and other tissue, therefore causing injuries to heal poorly.  Poor circulation can also lead to swelling and dryness of the foot.  Preventing foot complications is more critical for the diabetic patient since poor circulation impairs the healing process, and can lead to ulcers, infection, and other serious foot conditions.

Treatment & Prevention

Footwear and orthotics play an important role in diabetic footcare.  Orthotics designed with Plastazote“ foam, the #1 material for protecting the insensitive diabetic foot, are usually recommended.  Plastazote is a material designed to accommodate pressure “hot spots” by conforming to heat and pressure.  By customizing to the foot, Plastazote provides the comfort and protection needed in diabetic footcare.  Footwear constructed with Plastazote is also recommended frequently for the diabetic patient. Diabetic Footwear should also provide the following protective benefits:

  • High, wide toe box (high and wide space in the toe area)
  • Removable insoles for fitting flexibility and the option to insert orthotics if necessary.
  • Rocker Soles ­ These soles are designed to reduce pressure in the areas of the foot most susceptible to pain, most notably the ball-of-the-foot.
  • Firm Heel Counters for support and stability.

If you are a diabetic, you should be particularly alert to any problems you may be having with your feet.  It is very important for diabetics with neuropathy to take necessary precautions to prevent injury and keep their feet healthy. If you have diabetes and are experiencing a foot problem, immediately consult with your foot doctor.

Footcare & Diabetes

Proper footcare is especially critical for diabetics because they are prone to foot problems such as:

  • Loss of feeling in their feet
  • Changes in the shape of their feet
  • Foot ulcers or sores that do not heal

Simple daily footcare can prevent serious problems.  According to the National Institute of Health, the following are simple everyday steps that will help prevent serious complications from diabetes:

  1.  Take Care of Your Diabetes
    Make healthy life style choices to keep your blood sugar close to normal. Work with your health care team to create a diabetes plan that fits your life style characteristics.
  2. Check Your Feet Every Day
    You may have foot problems that you may not be aware of.  Check your feet for cuts, sores, red spots, swelling, or infected toenails.  Checking your feet should become part of your daily routine. If you have trouble bending over to see your feet, use a plastic mirror to help.  You can also ask a family member to help you.

    Important Reminder ­

    Be sure to call your doctor immediately if a cut, sore, blister, or bruise on your foot does not heal after one day.

  3. Wash Your Feet Every Day
    Wash your feet in warm, NOT HOT, water.  Do not soak your feet because your skin will get dry. Before bathing or showering, test the water to make sure it is not too hot.  You should use a thermometer or your elbow. Dry your feet well.  Be sure to dry between your toes. Use talcum powder to keep the skin dry between the toes.
  4. Keep the Skin Soft and Smooth
    Rub a thin coat of skin lotion or crème on the tops and bottoms of the feet. Do not put lotion between your toes, because this might cause infection.
  5. Trim your Toenails Each Week or When Needed
    Trim your toenails with clippers after you wash and dry your feet.  Trim the toenails straight across and smooth them with an emery board or nail file. DO NOT cut into the corners of the nail or rip off hangnails. If you’re nails are thick or yellowed, DO NOT cut your own nails, have a foot doctor trim them.
  6. Wear Shoes and Socks At All Times
    Wear shoes and socks at all times.  Do not walk barefoot, not even indoors. It is extremely easy to step on something and hurt your feet. Always wear seamless socks, stockings, and nylons with your shoes to help avoid the possibility of blisters and sores developing. Be sure to choose seamless socks that are made of materials that wick moisture away from your feet and absorb shock and shear.  Socks made of these materials help keep your feet dry. Always check the insides of your shoes before putting them on.  Make sure the lining is smooth and there are no foreign objects in the shoe, such as pebbles. Wear shoes that fit well and protect your feet.
  7. Protect Your Feet From Hot and Cold
    Always wear shoes at the beach or on hot pavement. Put sunscreen on the tops of your feet for protection from the sun. Keep your feet away from radiators or open fires. DO NOT use hot water bottle or heating pads on your feet. If your feet are cold, wear seamless socks at night.  Lined boots are good to keep your feet warm in the winter.  Choose socks carefully.  DO NOT wear socks with seams or bumpy areas.  Choose padded socks to protect your feet and make walking  more comfortable. In cold weather, check your feet often to keep your feet warm avoid frostbite.
  8. Keep the Blood Flowing to Your Feet
    Put your feet up when you are sitting. Wiggle your toes for 5 minutes, 2 or 3 times a day.  Move your ankles up and down and in and out to improve blood flow in your feet and legs.
     

    • DO NOT cross your legs for long periods of time.
    • DO NOT wear tight socks, elastic, or rubber bands, or garters around your legs.
    • DO NOT wear restrictive footwear or foot products.  Foot products that can cut off circulation to the feet, such as products with elastic, should not be worn by diabetics.
    • DO NOT smoke.  Smoking reduces blood flow to your feet.

    If you have high blood pressure or high cholesterol, work with your health care team to lower it.

  9. Be More Active
    Ask your doctor to plan an exercise program that is right for you. Walking, dancing, swimming, and bicycling are good forms of exercise that are easy on the feet. Avoid all activities that are hard on the feet, such as running and jumping.
    Always include a short warm-up or cool-down period. Wear protective walking or athletic shoes that fit well and offer good support.
  10. Communicate With Your Doctor
    Ask your doctor to check the sense of feeling and pulses in your feet at least once a year. Ask your doctor to tell you immediately if you have serious foot problems.
    Ask your doctor for proper footcare tips. Ask your doctor for the name of your local podiatrist.

underline;”>Learn more about our advanced Charcot foot solutions.

What is Diabetic (Charcot) Foot?

Diabetic foot problems are common in diabetic patients and affect millions of people around the world.

Diabetic foot problems arise from two serious complications of the disease:

  • Nerve damage
  • Poor circulation

One of the more critical foot problems these complications can cause is Charcot arthropathy (or Charcot foot). Charcot foot is classified as a neuropathic disease (nerve damage) condition in the foot.

Early detection has been proven to not only improve the patient’s quality of life, but also provides the experienced foot and ankle surgeon the opportunity to correct the damaged foot by using advanced surgical techniques.

As Charcot foot progresses, nerve damage and reduced blood flow in the extremities actively weakens the bony structures in the foot and gets worse over time, making simple activities like walking challenging and dangerous.

As the condition continues to progress, bone degeneration or even fracture can occur. In most Charcot foot patients the nerve damage prevents them from feeling the fracture. Continuing to walk on the injured foot results in more severe fractures and joint dislocations. Sharp edges of broken bone within the foot can point downward toward the ground, causing lesions or ulcers to form. Due to poor circulation and constant irritation, the ulcers tend to not heal properly increasing the risk of infection.

If you notice an ulceration forming on the bottom of your foot, you should contact a foot and ankle specialist immediately.

While Charcot foot is a severe condition, the options for reconstructive surgery offer a solution. Learn more about our advanced Charcot foot solutions. 

What are the symptoms?

Although a patient with Charcot foot typically will not have much pain, they may have other symptoms:

  • Beginning Stages – Numbness, swelling and the foot may be warm to the touch.
  • Middle Stages – Increased numbness and some skin discoloration.
  • Late Stages – Collapsed arch and potentially a skin lesion or ulcer on the bottom of foot. At this point, the internal structure of the foot has deteriorated to the point where surgical intervention is likely a necessity.
  • Extreme Cases – If the condition goes uncorrected, amputation below the knee may be required.

Nonsurgical Treatment

Casting: The early stages of Charcot are usually treated with a cast or cast boot to protect the foot and ankle. The use of a cast is very effective in reducing the swelling and protecting the bones. Casting requires that the patient not put weight on the foot until the bones begin to heal. Crutches, a knee-walker device, or a wheelchair are usually necessary. Healing can sometimes take 3 months or more. The cast will usually be changed every week or two to make sure that it continues to “fit” the leg as the swelling goes down.

Custom shoes: After the initial swelling has decreased and the bones begin to fuse back together, a specialized custom walking boot or diabetic shoe may be recommended. The specialized shoe is designed to decrease the risk of ulcers. Some diabetics may not be able to wear regular, over-the-counter shoes because they do not fit the deformed foot correctly.

Surgical Treatment

Surgery may be recommended if the foot deformity puts the patient at a high risk for ulcers, or if protective shoewear is not effective. Unstable fractures and dislocations also require surgery to heal.

  • Mild deformity with tightness at the heel – In some cases, the deformity is mild and associated with tightness at the back of the heel. Ulcers in the front of the foot that do not respond to a period of casting and protective shoewear, may be treated through Achilles tendon lengthening. Surgically lengthening the tendon that runs down the back of the leg and attaches to the back of the heel decreases the pressure on the midfoot and front of the foot. This allows the ulcer to heal and reduces the chance that it will return.
  • Bony prominence on the bottom of the foot – A more severe deformity is the appearance of a very large bony bump on the bottom of the foot. If this cannot be addressed with shoe modification, it requires surgery. The type of surgery depends on the stability of the bones and joints in the foot.
  • Stable deformity – Surgery involves a simple removal of the prominent bone by shaving it off.
  • Unstable deformity – When the bones are too loose at the sight of the prominence, a simple removal of the bump will not be effective. The loose bones will simply move and a new prominence will develop. In this situation, fusion and repositioning of the bones is needed.

Fractures that occur in the softer bone of diabetics are typically more complex. Operations to fix them generally involve more hardware (plates and screws) than would normally be required in people without diabetes. The screws and plates may even be placed across normal joints to provide added stability.

The sooner Charcot foot is diagnosed and treated, the better the final outcome. Careful daily foot inspections and closely monitored blood sugar levels are the keys to recognizing Charcot foot early and avoiding future complications.

A small percentage of bunions can be attributed to heredity, arthritis or polio.
If the problem persists, please call us to schedule an appointment.