It may come as a surprise to learn that most of the foot problems and complications stemming from diabetes are preventable. When complications first develop, they are often treatable, and conservative treatments are available that may help salvage the foot.
Both people with type I (insulin-dependent) and type II (non-insulin-dependent) diabetes need to take foot care seriously. Two major complications of diabetes contribute to the development of foot problems: poor circulation (peripheral vascular disease) and nerve damage (diabetic neuropathy).
Peripheral vascular disease affects both the large and small blood vessels of the legs and feet. Signs of peripheral vascular disease include discomfort or pain in the thigh, calf, or buttocks while standing or walking. Pain from this cause goes away when sitting. This pain is often caused by obstructions in the tibial vessels, the arteries between the knee and the ankle. These obstructions decrease blood flow to the feet.
Vascular disease is responsible for only a small portion of the foot problems common to people with diabetes. The major culprit is peripheral neuropathy. Doctors are not yet sure what causes this nerve damage, but they do know that peripheral neuropathy breaks down the communication between the nerves in the feet and the brain. With peripheral neuropathy, the brain no longer perceives most of the sensory stimuli from the foot.
It is important for people with diabetes to be alert to changes in sensation in the feet. Unfortunately, neuropathy can develop so slowly changes may go unnoticed. Sometimes underlying neuropathy isn’t detected until a serious foot problem occurs. A person with neuropathy may complain of numbness in the foot. Some people may experience a burning or tingling pain and then numbness.
Undetected, neuropathy can lead to injury. For example, a man with neuropathy develops a corn on his small toe. He doesn’t notice the corn, and since he has neuropathy he has no sensation of pain from the corn so he ignores it. Over time, the inflammation from the corn becomes severe enough to cause the skin to break open. Once the skin breaks, the chances of infection increase. Once infection sets in, an ulcer forms on the toe. This can happen within one week’s time or less if the man isn’t washing his foot daily or wearing clean socks. Neuropathy short-circuits the usual nerve signals of pain. The result: injury without warning.
There is no treatment that will reverse neuropathy. However, good diabetes control may help slow the progression of nerve deterioration.
Early Detection and Care
A daily foot exam should be part of your personal hygiene routine. You or someone in your family should check your feet daily.
Perhaps the most crucial step in preventing and treating foot complications is awareness of loss of feeling in the foot and early detection of neuropathy. When you and your doctor both know that neuropathy exists, you can work to prevent foot problems.
Unfortunately, too often the individual seeks medical help too late – the complication, such as a foot ulcer, is already present.
Because foot care and foot problems are a major concern for people with diabetes, be aggressive in seeking good care for your feet. Insist that your physician examine your feet at every visit. Help remind him or her by removing your shoes and socks.
Your physician should also teach you how to examine your feet. Ask your doctor about seeing a podiatrist, a specialist in foot care. Your physician or local ADA chapter can recommend a podiatrist with experience in treating people with diabetes.
Keep in mind that mechanical stresses (stress that occurs while walking) can cause problems. Walking in an inappropriate shoe or with an unprotected foot can be enough to cause an ulcer or Charcot joint to develop. A complete foot exam will include an exam of your feet’s biomechanics (how your foot moves when you walk).
With computer-assisted gait analysis, podiatrists can evaluate the forces of walking on the foot. With this information, the specialist can then take steps to minimize stresses on the foot. This can be especially important in people with neuropathy. By minimizing stress on the foot, it may be possible to prevent further breakdown. Stress correction can be accomplished in two key ways: orthotics – padded inserts in shoes, or prescription shoes. Occasionally, surgery may be necessary.
Regular follow-up visits are important for maintaining healthy feet. We recommend that people with diabetes return for follow-up care every three to six months. With early detection and prompt treatment, you can keep foot problems to a minimum and keep your feet in tip-top shape.