Diabetes and Foot Care

By Brian P. Bach, DPM

There are about 25.8 million diabetics in the United States. There are also about 1.9 million cases of diabetes that are diagnosed yearly. People with diabetes often develop complications such as heart disease, stroke, nerve damage and vascular disease. These often lead to other signi?cant problems, which may first be seen in the feet.

When the blood sugars are elevated the nerves can become damaged. This will often cause tingling, numbness, or loss of feeling. This is called, diabetic neuropathy. There are medications and creams that have been tried for this, but the best treatment is to have good blood sugar control.

The next signi?cant problem with diabetes and feet is poor blood flow. The walls of the arteries can harden and narrow, decreasing blood flow to the feet. This is called peripheral arterial disease (PAD). Some symptoms include leg pain, cold feet and sores that do not heal. In order to diagnose this, there is a simple painless blood flow test that can be done in a physician's office.

There are also many bones in the feet that protrude or are in close contact with the skin. They can be easily irritated in shoes or simply by not wearing shoes. Sometimes the bones in the feet can actually collapse. This is called a Charcot foot. If the patient has neuropathy and PAD, these can become infected and lead to ulcerations and amputations. To prevent these we routinely use shoes, boots and braces.

If a diabetic does get an ulceration, early treatment such as antibiotics or local care often heal the problem. If, however, the wounds do not heal, there are many new procedures and products invented. Orthobiologics or so-called “synthetic” skin grafts can cover wounds. A wound VAC has been developed to close large wounds. We also use antibiotic beads, placed into infected wounds, or bones.

In the past, a lot of diabetic wounds could not be healed and lead to amputations. Now we have new modalities and are able to save many more feet and legs. The main key avoiding amputation is early treatment. Check your feet every day. If you see any redness, drainage, open cuts, etc. immediately call your podiatrist.