Diabetic Foot |
If you don't notice or treat the sores, they can become deeply infected, and lead to amputation.
Diabetic peripheral neuropathy can also cause sharp pain in your feet. You may become excruciatingly sensitive to the lightest touch, like the sheets on your bed.
From American Diabetes Association :
Foot Ulcers and amputations are a major cause of morbidity, disability, as well as emotional and physical costs for people with diabetes.
An American Diabetes Association Consensus statement covers the management of diabetic foot wounds.
Risk Identification :
Risk Identification is fundamental for effective preventive management of the foot in people with diabetes.The Following foot related risk conditions are associated with an increased risk of amputation :
- Peripheral neuropathy with loss of protective sensation.
- Altered bio mechanics.
- Evidence of increased Pressure (erythema, hemorrhage under a callus)
- Bony Deformity
- Peripheral Vascular disease
- A history of ulcers or amputation
- Severe nail pathology
Foot Problems commonly develop in people with diabetes and can quickly become serious.
- With damage to the nervous system, a person with diabetes may not be able to feel his or her feet properly.
- Damage to blood vessels and impairment of the immune system from diabetes make it difficult to heal these wounds.Bacterial infection of the skin, connective tissues, muscles, and bones can then occur. These infections can develop into gangrene.Because of the poor blood flow, antibiotics cannot get to the site of the infection easily. Often, the only treatment for this is amputation of the foot or leg. If the infection spreads to the bloodstream, this process can be life-threatening.
- People with diabetes must be fully aware of how to prevent foot problems before they occur, to recognize problems early, and to seek the right treatment when problems do occur. Although treatment for diabetic foot problems has improved, prevention - including good control of blood sugar level - remains the best way to prevent diabetic complications.
Diabetic Foot Care Causes :
Several risk factors increase a person with diabetes chances of developing foot problems and diabetic infections in the legs and feet.
- Footwear : Poorly fitting shoes are a common cause of diabetic foot problems.
- If the patient has red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new properly fitting footwear must be obtained as soon as possible.
- If the patient has common foot abnormalities such as flat feet, bunions, or hammertoes, prescription shoes or shoe inserts may be necessary.
- Nerve Damage : People with long-standing or poorly controlled diabetes are at risk for having damage to the nerves in their feet.The medical term for this is peripheral neuropathy.
- Because of the nerve damage, the patient may be unable to feel their feet normally. Also, they may be unable to sense the position of their feet and toes while walking and balancing. With normal nerves, a person can usually sense if their shoes are rubbing on the feet or if one part of the foot is becoming strained while walking.
- A person with diabetes may not properly sense minor injuries (such as cuts, scrapes, blisters), signs of abnormal wear and tear (that turn into calluses and corns), and foot strain. Normally, people can feel if there is a stone in their shoe, then remove it immediately. A person who has diabetes may not be able to perceive a stone. Its constant rubbing can easily create a sore.
- Poor Circulation : Especially when poorly controlled, diabetes can lead to accelerated hardening of the arteries or atherosclerosis. When blood flow to injured tissues is poor, healing does not occur properly.
- Trauma to the Foot : Any trauma to the foot can increase the risk for a more serious problem to develop.
- Infections :
- Athlete's Foot , a fungal infection of the skin or toenails, can lead to more serious bacterial infections and should be treated promptly.
- Ingrown Toenails, should be handled right away by a foot specialist. Toenail fungus should also be treated.
- Smoking : Smoking any form of tobacco causes damage to the small blood vessels in the feet and legs. This damage can disrupt the healing process and is a major risk factor for infections and amputations. The importance of smoking cessation cannot be overemphasized.
- Persistent pain can be a symptom of sprain, strain, bruise, overuse, improperly fitting shoes, or underlying infection.
- Redness can be a sign of infection, especially when surrounding a wound, or of abnormal rubbing of shoes or socks.
- Swelling of the feet or legs can be a sign of underlying inflammation or infection, improperly fitting shoes, or poor venous circulation. Other signs of poor circulation include the following :
- Pain in the legs or buttocks that increases with walking but improves with rest (claudication)
- Hair no longer growing on the lower legs and feet .
- Hard shiny skin on the legs.
- Localized warmth can be a sign of infection or inflammation, perhaps from wounds that won't heal or that heal slowly.
- Any break in the skin is serious and can result from abnormal wear and tear, injury, or infection. Calluses and corns may be a sign of chronic trauma to the foot. Toenail fungus, athlete's foot, and ingrown toenails may lead to more serious bacterial infections.
- Drainage of pus from a wound is usually a sign of infection. Persistent bloody drainage is also a sign of a potentially serious foot problem.
- A limp or difficulty walking can be sign of joint problems, serious infection, or improperly fitting shoes.
- Fever or chills in association with a wound on the foot can be a sign of a limb-threatening or life- threatening infection.
- Red streaking away from a wound or redness spreading out from a wound is a sign of a progressively worsening infection.
- New or lasting numbness in the feet or legs can be a sign of nerve damage from diabetes, which increases a persons risk for leg and foot problems.
Medical evaluation should include a thorough history and physical examination and may also include laboratory tests, x-ray studies of circulation in the legs, and consultation with specialists.
- History and Physical Examination : 1st the doctor will ask the patient questions about their symptoms and will examine them. This should include the patient's vital signs(temperature, pulse, blood pressure, and respiratory rate).
- Laboratory Tests : The doctor may decide to order a complete blood cell count, or CBC, which will assist in determining the presence and severity of infection.The doctor may also check the patient's blood sugar serious infection.
- X-rays : The Doctor may order X-rays studies of the feet or legs to assess for signs of damage to the bones or arthritis, damage from infection, foreign bodies in the soft tissues.
- Ultrasound : The doctor may order Doppler Ultrasound to see the blood flow through the arteries and veins in the lower extremities.The test is not painful and involves the technician moving a non-invasive probe over the blood vessels of the lower extremities.
- Consultation : The doctor may ask a vascular surgeon, orthopedic surgeon, or both to examine the patient.These specialistsare skilled in dealing with diabetic lower extremity infections, bone problems, or circulatory problems.
Several experimental approaches are being evaluated for the treatment of diabetic foot complications. New options include synthetic wound dressings, skin grown in a laboratory, substances that stimulate healing and support the growth of infection-fighting cells, electrical stimulation, and exposure to elevated oxygen levels.
Self Care At Home :
- Foot Examination : Examine your feet daily and also after any trauma, no matter how minor, to your feet. Report any abnormalities to your physician.Use a water-based moisturizer every day to prevent dry skin and Cracking.Wear cotton or wool socks.Avoid Elastic socks and hosiery because they may impair circulation.
- Eliminate Obstacles : Move or remove any items you are likely to trip over or bump your feet on. Keep clutter on the floor picked up. Light the pathways used at night indoors and outdoors.
- Toe nail Trimming : Always cut your nails with a safety clipper, never a scissors. Cut them straight across and leave plenty of room out from the nailed or quick.If you have difficulty with your vision or using your hands, let your doctor do it for you or train a family member how to do it safely.
- Footwear : Wear Sturdy, Comfortable shoes whenever feasible to protect your feet.
- Exercise : Regular exercise will improve bone and joint health in your feet and legs, improve circulation to your legs, and will also help to stabilize your blood sugar levels. Consult your physician prior to beginning any exercise program.
- Smoking : If you smoke any from tobacco, quitting can be one of the best things you can do to prevent problems with your feet. Smoking accelerates damage to blood vessels, especially small blood vessels leading to poor circulation.
- Diabetes Control : Following a reasonable diet, taking your medications, checking your blood sugar regularly, exercising regularly, and maintaining good communication with your physician are essential in keeping your diabetes under control.
Prevention of diabetic foot problems involves a combination of factors.
- Good diabetes control
- Regular leg and foot self-examinations
- Knowledge on how to recognize problems
- Choosing proper footwear
- Regular exercise, if able
- Avoiding injury by keeping footpaths clear
For people with diabetes, foot complications are an ever-present risk. However, it is possible to design a plan for keeping the feet as healthy as possible. It is important to learn as much as possible about diabetic foot care and to take an active role in medical decisions and care. While routine medical exams are important, everyday foot care plays the biggest role in preventing foot complications before they start.
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