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For many people, a blister or ingrown toenail would be a minor nuisance, painful for a few days, but then it would heal and disappear. But for people with diabetes, common foot problems can become serious problems. In severe cases, they can result in amputation.
This is because diabetes can damage your nerves and blood vessels. Nerve damage can cause you to lose feeling in your feet. You might not even feel a blister or cut until it turns into a diabetic foot ulcer. In fact, people with diabetes have a 15 percent chance of developing this type of open wound in their lifetime. And if there’s damage to your blood vessels, your feet don’t get enough blood and oxygen, making it more difficult for a wound to heal.
Nearly one in 10 D.C. residents has been diagnosed with diabetes. But having diabetes doesn’t have to mean you’ll develop foot problems, too. With prevention, best practices and early treatment, we often can resolve the problem before it becomes more serious.
If you or a loved one has diabetes, learn how foot problems can develop, how you can prevent them, and how we treat them.
How diabetic foot problems develop
High or unstable blood sugar levels, the hallmark of diabetes, can cause the arteriesto change, which can choke off or damage nerves. This is known as diabetic neuropathy, and it initially feels like a tingling or pins-and-needles sensation, then burning, and finally numbness and lack of feeling in the foot.
Diabetic foot ulcers are usually the result of minor trauma, such as a blister or callus. They often appear under bony pressure areas, such as the heel or bottom of the foot. Normally, a person who develops one of these on their foot would feel pain and walk differently or wear different shoes to avoid putting additional pressure or friction on it. But if you have diabetic neuropathy, you won’t feel that pain. You’ll keep wearing the same shoes and walking on it just as you always do, leading it to turn into a more serious wound.
Unfortunately, we often don’t see people with diabetic foot ulcers until the wound is advanced and an infection has begun to set in. They may not have felt the pain of the wound, but the infection is now making them sick, causing fever, chills and swelling or redness in the leg.
You may be able to avoid getting to this point by practicing some simple foot care techniques and seeing your doctor as soon as a problem develops.
How to keep your feet healthy when you have diabetes
We all have a tendency to ignore minor symptoms. No one wants to feel like they’re running to the doctor for something silly. But problems with your feet are never silly, especially if you have diabetes.
In a perfect scenario, diabetes patients will see a podiatrist once a year. During these exams, we’ll assess your blood flow and check for nerve damage. We’ll also evaluate your risk and develop a protection plan to prevent you from getting foot ulcers in the first place. Even if you’re not having problems, don’t skip that annual visit. I’d rather see you regularly and when you have a small wound than see you in the emergency room with a serious problem.
Request an appointment if you have diabetes and need an annual foot evaluation.
Along with an annual visit, follow these simple foot care tips:
- Inspect your feet every day. Check for cuts, sores, blisters, ingrown nails, redness or swelling. Use a mirror if you can’t see the bottom of your feet. Call your doctor if you find anything.
- Buy sensible shoes. Find shoes that fit your foot type and allow even distribution of foot pressure. Choose leather or canvas, which allows your feet to “breathe” better than plastic or other materials. Avoid pointed toes or high heels.
- Wear shoes and socks at all times, even in the house. This can help prevent injuries.
- Keep your skin moisturized. The soles of our feet contain more sweat glands per square centimeter than any other part of our body and excrete as much as half a pint of moisture each day. However, diabetics tend to sweat less in their feet, so they may experience more dry, cracking skin. This can be managed by applying moisturizer to your feet once or twice a day.
- Trim your toenails regularly. If you can’t reach your feet, ask a family member, friend or podiatrist to trim them for you.
How we treat diabetic foot problems
How we treat a diabetic foot depends on the severity of the wound. We also may recommend procedures to prevent further problems.
Treating minor foot ulcers
A minor foot ulcer, or one that is detected early, often can be taken care of with three simple steps:
- Debridement: This means we clean the wound and remove unhealthy tissue to allow healthy tissue to grow.
- Topical wound care: We’ll prescribe medication to keep the wound clean and stimulate healing.
- Offloading: This means we do something to take the pressure off the wound location, such as recommend crutches, a wheelchair, special shoes or a cast. It’s perhaps the most important step because once we take the pressure off, most wounds heal fairly quickly.
Limb salvage and amputation
Unfortunately, advanced diabetic foot ulcers can lead to below-knee amputation. We never want to see patients experience the loss of a body part. Through our limb salvage program, podiatric surgeons team up with plastic surgeons, vascular surgeons and experts in dermatology and infectious disease to save as much of the foot and leg as possible.
Our goal is always to prevent any type of amputation, but when necessary, we try to keep it as minimal as possible. By amputating only the toes or partial foot, you may be able to use a special shoe or insert to accommodate the loss. This is preferable to needing a prosthetic leg, which requires more work to stay active.
Along with treating diabetic foot conditions, there are other things we can do to prevent further problems. If you’ve had foot or vascular surgery to correct a problem, we’ll monitor you over the months and years after.
If we determine at some point down the road that there’s a new area of pressure developing, we may be able to correct it before it becomes a problem. Surgical examples include tendon lengthening or osteotomy, in which we cut or reshape a bone to relieve pressure.
We also may be able to avoid surgery with a non-invasive procedure. If, for example, you have hammertoe, in which the toe bends downward causing repeated ulcers on the tip of the toe, we could perform a percutaneous needle tenotomy. In this procedure, we use a needle to release part of the tendon from the bone.
Diabetes care doesn’t stop at controlling blood sugar. If you or a loved one has diabetes, get in the habit of practicing proper foot care, scheduling regular check-ups and seeking early treatment for problems to prevent serious diabetic foot complications, including amputation.