About Diabetic Foot
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Diabetic Foot

Foot problems are common in people with diabetes. If you have diabetes, having too much glucose in your blood for a long time can cause some serious complications, including foot problems. Some people with diabetes develop numbness in the feet or poor blood flow that can make it difficult to notice blisters, sores and cuts. Undetected and untreated wounds can quickly become infected, leading to complications and sometimes amputation to prevent the spread of infection. Diabetic foot accounts for the highest number of non-traumatic lower limb amputations. Foot infection is the most common reason for hospitalization of the people with diabetes. Foot ulcers and non-healing wounds are the primary causes of amputations in people with diabetes. With proper foot care, however, it is estimated that as many as half of these amputations could be prevented.

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causes

What causes diabetic feet?

Diabetic foot ulcers may have multiple causes, the prominent ones being;

• A. Peripheral neuropathy (Nerve damage): Uncontrolled diabetes can damage your nerves. If you have damaged nerves in your legs and feet, you might not feel heat, cold, or pain there. This lack of feeling is called "sensory diabetic neuropathy." If you do not feel a cut or sore on your foot because of neuropathy, the cut could get worse and become infected. The muscles of your foot may not work properly because nerves to the muscles are damaged. This could cause your foot to not align properly and create too much pressure on one part of your foot.
• B. Peripheral vascular disease (Poor leg blood supply): High blood sugar expedites atherosclerosis giving peripheral vascular disease (reduction of blood supply to the foot). Without good blood flow,there is compromised delivery of essential nutrients and oxygen to the foot. Hence it takes longer for a sore or cut to heal. If you have an infection that will not heal because of poor blood flow, you are at risk for developing ulcers or gangrene (the death of tissue due to a lack of blood).
• B. Peripheral vascular disease (Poor leg blood supply): High blood sugar expedites atherosclerosis giving peripheral vascular disease (reduction of blood supply to the foot). Without good blood flow,there is compromised delivery of essential nutrients and oxygen to the foot. Hence it takes longer for a sore or cut to heal. If you have an infection that will not heal because of poor blood flow, you are at risk for developing ulcers or gangrene (the death of tissue due to a lack of blood).
• C. Trauma
  • I. Acute: any injury to the foot such as burns or cut occur often due to the absence of perception of a painful or injurious stimulus. Poor wound healing makes ulcerations more likely occur.
  • II. Chronic: due to foot deformities (changes of foot shape that lead to ill-fitting shoes and which in turn leads into ulcer formation).

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Symptoms and Signs

What Are symptoms and signs of Diabetic foot?

As a result of reduced blood flow to the foot, you may have symptoms such as rest pain(pain in the affected foot while lying and relief of pain with foot hanging by the side of the bed), gangrene (blackening of affected toes or foot) or foot infection and ulceration which are difficult to heal.

Signs of Diabetic Foot

You may also present signs such as

• • Changes in skin color
• • Changes in skin temperature
• • Swelling in the foot or ankle
• • Pain in the legs
• • Open sores on the feet that are slow to heal or are draining
• • Ingrown toenails or toenails infected with fungus
• • Corns or calluses
• • Dry cracks in the skin, especially around the heel
• • Foot odor that is unusual or won't go away

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Feel free to consult Dr. Brijendra Singh at Brij Laser and Laparoscopy Centre if you notice any of these symptoms.

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Anyone with the diabetes can develop the foot conditions listed below.
Dry skin Diabetes can cause changes in the skin of your foot. At times your foot may become very dry. The skin may peel and crack. This problem is caused by nerve damage that affects your body’s ability to control the oil and moisture in your foot. Dry skin with crack can allow germs to enter. After bathing, dry your feet and seal in the remaining moisture with a thin coat of plain petroleum jelly, an unscented hand cream, or other such products. Do not put oils or creams between your toes. The extra moisture can lead to infection. Also, don't soak your feet—that can dry your skin.

• • Fungal infection of nails. The dark, moist, and warm environment of shoes or an injury to your nail can also lead to a fungal infection. Nails that are infected with a fungus may become discolored (yellowish-brown or opaque), thick, and brittle and may separate from the rest of your nail. In some cases, your nail may crumble. Fungal nail infections are hard to treat. Oral anti-fungal drugs along with medications for application over the nail may be prescribed by your doctor or might also remove the damaged nail in certain situation.
• • Athlete's foot It is caused by fungus that causes itching, redness, and cracking. Germs can enter through the cracks in your skin and cause an infection. If you develop any kind of sore or wound on your feet that don’t heel in a day or two, it is very important that you see a doctor right away. Untreated lesions or ulcers can become infected quickly. Sometimes even treated foot ulcers may not heal well in diabetic people.
• • Diabetic ulcers A foot ulcer is a break in the skin or a deep sore. They can become infected. Foot ulcers can happen from minor scrapes, cuts that heal slowly, or from the rubbing of shoes that do not fit well. It's important to treat them as soon as you notice them.
• • Plantar warts Plantar warts are caused by a virus that infects the outer layer of skin on the soles of the feet. they look like calluses or may appear to have small pinholes or tiny black spots in the center. The warts are usually painful and may grow singly or in clusters. They tend to go away without treatment otherwise there are several ways to remove them.
• • Calluses Calluses occur more often and build up faster on the feet of people with diabetes. A callus is a buildup of hard skin, usually on the sole of foot. This is because there are high-pressure areas under the foot. Calluses are caused by an uneven distribution of weight. Use of cushioned pads and insoles in your shoes may be of some help in reducing the symptoms. Using a pumice stone every day on wet skin will help keep calluses under control. Never try to cut calluses or corns yourself—this can lead to ulcers and infection. Let a health care professional cut your calluses. Also, do not try to remove calluses and corns with chemical agents. These products can burn your skin.
• • Corns A corn is a buildup of thick and hard skin near a bony area of a toe or between toes caused by too much of rubbing or pressure on the same spot. Do not use over-the-counter remedies to dissolve corns. DO NOT try to cut the corn or remove it with a sharp object.
• • Blisters Blisters can form when your shoes rub the same spot on your foot. Wearing shoes that do not fit properly or wearing shoes without socks can cause blisters, which can become infected. When treating blisters, it's important not to "pop" them. The skin covering the blister helps protect it from infection. Use an antibacterial cream and clean, soft bandages to protect the skin and prevent infection.
• • Bunions A bunion forms when your big toe bends toward your second toe. Often, the spot where your big toe joins your foot becomes red and callused. This area also may stick out and become hard. They may run in the family, but most often they're caused by wearing high-heeled shoes with pointed toes. These shoes put pressure on your big toe, pushing it toward your second toe. Felt or foam padding may help protect the bunion from irritation. If the bunion causes severe pain or deformity, you might need surgery to realign your toes.
• • Hammertoes A hammertoe is a toe that is bent because of a weakened muscle. The weakened muscle makes the tendons in your toe shorter, causing your toe to curl under your foot. Hammertoes can run in families. They can also be caused by shoes that are too short. Hammertoes can cause problems with walking and can lead to blisters, calluses, and sores. Splints and corrective shoes can treat them. In severe cases, you may need surgery to straighten your toes.
• • Ingrown toenails Ingrown toenails happen when the edges of the nail grow into the skin. The edge of the nail may cut into your skin, causing redness, swelling, pain, drainage, and infection. The most common cause of ingrown toenails is pressure from shoes which are too tight. Other causes include improperly trimmed nails, crowding of the toes, and repeated trauma to the feet from activities such as running, walking, or doing aerobics. Surgery to remove part of the toenail and growth plate can treat severe problems from ingrown toenails.

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Complications

What are the Complications of untreated Diabetic Foot?

• • Skin and bone infections A small cut or wound can lead to infections. Nerve and blood vessel damage, along with immune system problems, make them more likely. Most infections happen in wounds previously treated with antibiotics. Infections can be treated with antibiotics. Severe cases may require treatment in a hospital.
• • Abscess Sometimes infections eat into bones or tissue and create a pocket of pus called an abscess. The common treatment is to drain the abscess. It may require removal of some bone or tissue, but newer methods, like oxygen therapy, are less invasive.
• • Gangrene Diabetes affects the blood vessels that supply your fingers and toes. When blood flow is cut off, tissue can die. Treatment is usually oxygen therapy or surgery to remove the affected area.
• • Deformities Nerve damage can weaken the muscles in your feet and lead to problems like hammertoes, claw feet, prominent metatarsal heads (ends of the bones below your toes), and pes cavus, or a high arch that won’t flatten when you put weight on it.
• • Charcot foot The diabetic Charcot foot syndrome is a serious and potentially limb-threatening lower-extremity complication of diabetes. Charcot foot, is a condition affecting the bones, joints, and soft tissues of the foot and ankle, characterized by inflammation in the earliest phase.Diabetes can weaken the bones in your foot so much that they break. Nerve damage can lessen sensation and prevent you from realizing it. You keep walking on broken bones and your foot will change shape. It might look like your midfoot arch has collapsed into a rocker shape, described as a “rocker-bottom” foot. Offloading the foot and immobilization are the most important treatment recommendations in active Charcot neuropathic osteoarthropathy (CN) and can prevent further destruction. Lifetime surveillance is advised to monitor for signs of recurrent or new CN episodes as well as other diabetic foot complications.
• • Amputation People with diabetes are far more likely to have a foot or leg amputated than other people.Many people with diabetes have peripheral artery disease (PAD), which reduces blood flow to the feet. Also, many people with diabetes have neurpoathy, which makes it so you can’t feel your feet. Togather, these problems make it more likely for people with diabetes to get a foot injury and not realize it until infection sets in. When an infection can’t be healed, creates an abscess, or if low blood flow leads to gangrene, may lead to amputation. Most amputations are preventable by checking your feet daily, regular care and visits with your doctor, and proper footwear.

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