If you count yourself among the 14 million people in the United States with diabetes mellitus, you know that good health requires special vigilance. You must walk a tightrope each day, keeping a watchful eye on diet, exercise, and your blood sugar and protein levels. Quite a balancing act! And like any tightrope walker, you must pay special attention to your feet.
Foot problems often begin subtly, with something as simple as a blister, bunion, or callous. Yet even relatively minor annoyances can lead to serious consequences if ignored. But if you are willing to walk that extra mile for healthy feet, you can go a long way toward preventing problems before they begin.
If you have diabetes, you should have an annual comprehensive examination of your feet. As part of the examination, your health-care professional should examine the blood flow to your legs and feet, the range of motion in your feet and ankles, and the functioning of the nerves in your legs and feet.
Stop Ulcers Before They Start
Treatment of foot ulcers starts with prevention, and prevention starts with awareness. In the case of foot care, awareness means knowing how to prevent problems before they develop and how to cope with those that do. It also means recognizing just how vulnerable your feet really are.
One condition you should be aware of is neuropathy, or nerve damage. The most common type is peripheral neuropathy, damage to the nerves in your arms and legs. Peripheral neuropathy can affect your motor, autonomic, or sensory nerves. Motor nerves carry signals to your muscles, telling them how to move. Autonomic nerves regulate things like your heartbeat, blood pressure, bladder, and sex organs. Your sensory nerves help you to sense things.
Neuropathy has a variety of symptoms, such as shooting pain, burning, and tingling sensations. Although bothersome, none of these conditions is particularly dangerous. But neuropathy also causes numbness, which can be dangerous.
The numbness caused by neuropathy can range from a slight decrease in your sense of touch to a total loss of feeling. Danger arises because numbness can block feelings of pain, which serve to alert you that something may be wrong. Minor irritations may escape your notice and quickly develop into disasters.
Since the body’s first warning system – pain – may not be signaling you when something begins to go wrong with your feet, it’s up to you to develop alternative warning systems. Daily visual inspection is your first line of defense. Examine your feet carefully, every day. Use a mirror to check out areas that are impossible to view directly. And if impaired vision prevents you from performing a detailed examination, get someone to do it for you.
Daily inspections can reveal redness, a cut, or the first sign of a blood blister, providing you with the advanced warning you need to prevent further damage. And if you suspect that an ulcer, or sore, is beginning to develop, you must take immediate action. Stay off the affected foot and seek medical attention. Remember, any foot ailment, no matter how slight, can be a threat to your health, and merits quick attention.
Reasons To Get Serious
Foot ulcers are serious business. They are often the breeding ground for infections that you may not be able to feel developing. If left untreated, infections can spread down to the bone, or rise between the muscle layers of your foot and up your leg. As the infection spreads, the gravity of the situation grows. Aggressive intervention and possibly prolonged medical attention often are required.
Before infections due to ulcers an heal, four steps must be taken: The infection must be halted, circulation must be restored, nutrition must be carefully managed, and all external pressures must be eliminated from the affected area. This requires expert medical care; it also requires a commitment on your part. Medicine alone can’t do the trick.
Healing can’t take place in the presence of infection. To control and eliminate infections, doctors usually use two procedures: draining abscesses and removing all dead tissue. Superficial ulcers can be treated in a doctor’s office, but deeper ulcers, which affect bone or muscle tissue, may require more aggressive interventions and hospitalization.
When an infected areas has been drained, you must take action to prevent reinfection. Your doctor will probably suggest that you change dressings two to three times a day, to keep the treated area clean.
As part of the process of disease control, your doctor will make cultures from the infected area to pin down the exact cause or causes of infection. This is not always a straight-forward task; more than one microorganism often is involved. Depending on the results of the culture and the tissues involved, you may need to take antibiotics. Infections in skin tissues may only require one or two weeks of antibiotic treatment; bone infections may require six weeks or more.
Once an infection has been controlled, the next step in healing an ulcer involves maintaining a healthy blood supply and good circulation. Ulcers will usually heal as long as you follow all of your doctor’s guidelines. It’s important to stop smoking, control hypertension, and try to bring down unhealthy cholesterol levels. Fortunately, most people with ulcers due to neuropathy do not have significant peripheral vascular disease.
Severe and untreated vascular disease, however, can lead to amputation. But doctors who specialize in vascular disease can offer several treatment options, depending on the severity of the vascular disease present. Bypass surgery may help, and recent progress in angioplasty, or the opening of a blood vessel with a small balloon, provides hope for avoiding amputations that would have been necessary not long ago.
Nutrition And Blood Glucose Control
Keeping good control of your blood glucose level and making sure you are meeting your nutritional needs are also important to healing foot ulcers.
Nutrition, and the amount of protein in your blood system, plays an important role in the healing process. Proteins carry important nutrients and other elements, such as zinc and amino acids, that are essential to heal ulcers. You should also be aware that chronic malnutrition or kidney disease can cause protein levels to drop.
If you have a large ulcer or one that has taken an unusually long time to heal, your doctor may want to measure the level of protein in your blood, which is also called checking your serum albumin level. He or she will check to see if too little protein is the cause of the problem. Correcting low albumin may be a matter of managing your diet with the help of your doctor and dietitian. If your albumin level doesn’t respond to changes in diet, your doctor will probably look for another cause, such as kidney disease.
Unusual pressure on the foot is the most common cause of ulcers associated with neuropathy. Pressure is so important in the development of ulcers that even if your controlled your infection, if you ensured your blood supply was good, and if you kept your blood glucose and protein levels in appropriate ranges, your ulcer would not heal if you did nothing about abnormal pressure on it.
The first step to easing pressure on foot ulcers is really the most sensible: Take the weight off the foot that has the ulcer. Doctors often recommend using crutches, a walker, a wheelchair, or even resting in bed. Unfortunately, it can be hard to convince someone whose ulcers are not yet painful to follow these instructions, even though ignoring them is fool-hardy and dangerous.
Your doctor may also recommend other ways to reduce pressure on an ulcer, such as quality walking or running shoes that are commercially available or prescription footwear.
Another simple procedure may be debridement, or the paring away of excess tissue that puts pressure on the ulcer. More serious ulcers, however, may require more serious steps for reducing pressure. A procedure called total contact casting may help redistribute pressure, but it carries a risk of more ulceration.
No matter what treatment your doctor advises, it is still important to be sure that the infection is controlled, circulation to the limb is adequate, and your blood glucose and protein levels are under control.
Down the Road
Once your ulcer has been healed, it’s important to keep checking your feet every day, because those who have had foot ulcers are the most likely to develop them again. Your doctor may suggest frequent professional foot examinations, and you may need to consider wearing protective footwear or using a cane.
The care you give your feet now, before you get ulcers or after you’ve treated them, will pay off. It’s an old saying but it’s true: Take care of your feet and they’ll take care of you!