Stege's Podiatric Topics

DIABETES

Diabetes and the Feet

All of us are likely to have problems with our feet, but diabetics may develop serious problems more quickly and have more complications, especially when circulation or nerves are impaired. A random survey of diabetic patients in the outpatient clinics of a Veterans Affairs hospital found 50 percent had circulation and nerve damage plus some type of foot deformity. When circulation is poor, the tissue in the foot is less able to fight infection. When nerves are impaired, an injury can occur without pain and, as a result, may go unnoticed.

The key for the diabetic is to view all foot problems as potentially dangerous and to prevent them or seek podiatric medical care as soon as they occur.

Problems of Juvenile Diabetics

Cuts, scrapes, blisters, and puncture wounds are a part of childhood. To prevent such injuries, diabetic children should always wear some kind of footwear. If foreign bodies such as splinters become lodged in the foot, or if an infection or puncture wound occurs, the child should be treated promptly by a professional.

Ingrown toenails can cause infections which tend to be especially severe in diabetic children. To treat the problem, the podiatric physician may drain the infected area, relieve the pressure, prescribe an antibiotic, and recommend special home care to help the infection heal. If the child suffers repeated infections, surgery may be necessary to prevent the nail from becoming ingrown again.

Athlete's foot is a fungal infection common in young people. If it or other skin rashes are not promptly treated, secondary bacterial infections that require vigorous treatment with antibiotics may develop.

Structural changes in the feet of normal children also occur in the feet of children with diabetes and these problems can be far more serious because the disease causes changes in the nervous system. These changes in turn may prevent the child from experiencing or expressing pain or discomfort and will require evaluation on a continuing basis to prevent serious bone and joint changes as the child grows.

Problems of Adult Diabetics

Concerns of adult and maturity-onset diabetics are somewhat different from those of children. Foot problems neglected in youth cause more problems, and can be compounded by circulatory disorders and changes in sensation (diabetic neuropathy). Adult-onset diabetes, also referred to as Type II diabetes, occurs later in life, with relatively fewer complications, and often can be controlled by diet and oral medication.

Poor circulation often happens as we get older, but complications can occur earlier in life. Chronically tired or painful feet may mean circulation is poor. Symptoms such as numb, tingling, cold, or blue feet, and swelling that will not go down, indicate poor circulation. Cramping may occur at night, during rest, or while walking a short distance. Smoking, caffeine, and stress usually increase the severity of these symptoms. An examination by a podiatric physician will reveal any circulatory deficiencies.

Diabetic neuropathy can cause insensitivity or a loss in the ability to feel pain, heat, and cold. If precautions are not taken, a hot bath can be a potential for a burn. Position sense is also often lost with neuropathy, so the feet strike objects in their path. Diabetic neuropathy can also affect the muscles of the feet, causing deformities such as hammertoes.

When insensitivity is present, serious problems, such as ulcers and gangrene, can occur without pain. The infection may go unnoticed and appropriate care delayed until too late. By the time the trouble is discovered, amputation may be necessary to save the person's life. Daily observation of the feet is necessary by the diabetic or a responsible family member or other party.

Ulcers -- sore open areas on the foot -- can be caused by lack of blood circulating to the foot, lack of soft-tissue protection, excessive callus tissue, infection, and pressure points caused by deformities. Some causes of injury and ulcers are: wearing ill-fitting shoes; performing ìself surgery;î applying electric heating pads or hot-water bottles; and using ingrown-toenail and some corn remedies. If the circulatory response is adequate, most diabetic ulcers can be healed if diagnosed and treated early.

Skin changes in the foot can be caused by diabetes. Dehydration is common since the diabetic usually has less natural lubrication than the nondiabetic. Fissures and cracks in the skin develop and itching can become severe. Scratching can cause breaks in the skin that may become infected. Dryness can be helped by using a good skin cream daily on every part of the foot except between the toes.

Important Care

Have your feet examined by a podiatric physician at least twice a year.
Wash your feet daily and dry them well. Always wear clean socks or hosiery.
Inspect your feet daily. Check for redness, blisters, cuts or scratches, cracks between toes, discoloration, or any other change. Monitor minor abrasions, keep them clean, and treat with antiseptics recommended by your doctor. If you notice infection, change, or abnormality, notify your podiatric physician promptly. Because diabetes may cause loss of feeling in your feet, regular inspection is essential. You could have an infection and not know it.
Avoid actions that restrict circulation to your feet, such as smoking, drinking coffee and tea, sitting with your legs crossed, and exposing your feet and legs to cold or heat, such as prolonged sunlight.
Avoid burns, including extensive sunburn. Do not put your feet in hot water or add hot water to a bath without testing the water temperature. Avoid hot water bottles and heating pads.
Use of over-the-counter corn cures should be avoided. These preparations contain acid and can destroy tissue. Once tissue is lost, you can develop breaks in the skin which can cause infection.
Prevent unnecessary cuts and irritations. Do not walk barefoot; don't wear run-down shoes or worn hosiery. Do not treat your own foot problems with sharp instruments or dig into the corners of your toenails.
When toenails are trimmed, be sure they are straight across, and not below the top of the toe.
Wear shoes that fit. The widest part of the shoe should match the widest part of your foot. The shoe should follow the natural outline of your foot and be snug, but not tight. In general, shoes should have a firm heel counter that will keep the foot in place in the shoe. The heel should give a wide base of support. There should be about three-fourths of an inch of space between the big toe and the shoe. The toe box should be round and high to allow space for toe deformities. The upper portion of the shoe should be soft and flexible. The lining should be smooth and free of ridges, wrinkles, or seams. New shoes should be worn for short periods of time until they are proven and comfortable. Wear special shoes or have your shoes adapted to your feet if you have a deformity.

You should also keep in mind when seeing your podiatric physician for treatment that he or she will recognize any change in your diabetes and will promptly recommend that you go back to see the doctor who is treating you for that condition. Often, this will result in your receiving necessary treatment earlier than would have otherwise been possible.