Diabetes is a medical condition that can affect the feet. If you have diabetes it is absolutely essential that you see a podiatrist, as many of its potential foot problems are preventable. If blood sugar is well-controlled, the risk of complications is greatly reduced. Diabetes is a multi-system disease – many different organs and parts of the body are involved. Diabetics are best managed by a multi-disciplinary team. This will usually include the general practitioner, internist or diabetic specialist, podiatrist, dietician and specialty nurse. Vascular and orthopedic surgeons may become involved in later stages.
Some of the problems that diabetics may have in the lower extremity include:
• Decreased blood flow to the feet and/or toes. This makes the foot more prone to infections that may not heal.
• Reduced sensory perception to the feet. This may eventually result in loss of all sensation – something as simple as stepping on a pebble in the shoe could lead to life-threatening tissue damage and when combined with decreased blood flow may result in gangrene or loss of limb.
• Progressive structural deformities. These can lead to pressure points, painful calluses and pain with walking.
• Skin changes including dryness, poor skin tone, athlete’s foot, calcium deposits in tendons and excessively hot or cold feet.
• Ulcerations – these are sores that don’t heal easily. Often they exist under thick calluses, usually on the bottom of the foot (where they can’t be seen easily). Ulcerations in diabetics may be difficult to heal. They must be treated by a professional.
• Loss of balance and stability in walking. This is due to nerve damage resulting from long-term diabetes, often because it was not treated adequately or recognized for many years.
• Charcot Foot presents as a red, hot, swollen foot – sometimes with collapse of the arch. There may be much pain or very little pain. This problem is serious and must be evaluated by the diabetic specialist immediately. The podiatrist can also diagnose this problem and refer to the appropriate specialist.
What a podiatrist will do for a diabetic?
Initial assessment will involve evaluation of blood flow to the feet and sensory perception in the feet. These 2 factors will help to predict how likely it is that complications may arise. High risk diabetics should see a podiatrist every 4 to 6 weeks. Lower risk diabetics may only need to see a podiatrist every 6 to 12 months.
Structural deformities will be evaluated and a treatment plan offered to help reduce the problems associated with structural deformities, which include corns, calluses, ulcerations and pain. Often a soft accommodative insole is helpful. Padding of bony prominences is essential. Advice about footwear is given.
Wound care is provided for diabetics who have existing ulcerations. Sometimes this includes surgical procedures to reduce bony deformities. This type of care is highly specialized and is best provided by a podiatrist who is specially trained in this area.
Podiatrists can save a diabetic’s life, literally. The smallest problem such as an ingrown toenail in a high-risk diabetic can progress to serious life-threatening complications. Early recognition and treatment in addition to preventive foot care is priceless.
Please do not use this information to self-diagnose or design your own treatment plan. It is a guideline only.