Diabetes affects all areas of the feet including the skin, the nails, the blood supply, the nerves, and the joints of the feet. People with diabetes are susceptible to foot issues because the potential for improper blood sugar control affects the nerves of the feet, but also the vascular supply to the feet at times. Patients with diabetes can certainly have injury to their feet. This injury could possibly not be felt by the patient. If their blood sugar is not under proper control, often patients acquire diabetic neuropathy, while the normal sensations that one would feel to their feet with the injury or stepping on an object, a diabetic patient may not necessarily feel this problem. Subsequently, this can lead to some type of infection or ulceration. These are very typical. The heels in patients with diabetes are at risk for losing a portion of their foot and/or leg.
Neuropathy is either the lack of sensation, in this case to the bottom aspect of a patient’s foot, or it can be a heightened sensation, or a constant sensation, such that it is tingling and reminding the patient of discomfort to this area over a long period of time. Patients can have both poor sensation and tingling/burning sensation simultaneously. To arrive at a diagnosis we assess the patient with a tuning fork to see if they have adequate vibration sensation, or if they can tell the difference between a soft swab against their foot versus a sharp pin. We can also put a non-painful wire up against their toes to see if they are able to tell us which specific toe is being touched with this wire. Other ways to diagnose include a specific biopsy of the skin, this is sent to the pathologist, and they’re able to evaluate the number of nerves within that skin segment. Current treatment options for neuropathy, which are medicine approved by the FDA, are Neurontin, Lyrica and Cymbalta. The other options are naturopathic include Metanx, which is a specific Vitamin B formulated supplemental medicine, in addition there is another supplement called Neuremedy, which is another vitamin supplement specifically formulated. Other treatment options include release of nerves surgically and possible injections, but certainly we encourage all our patients to keep their blood sugar under control as possible, as this is the optimum way to try and prevent this from happening.
Calluses are thickened hyperkerotic areas of skin. Calluses are quicker to happen in people who have diabetes. Some of the mechanics of the feet encourage repetitiveness of this area for being irritated, and subsequently the skin tries to protect the patient and thickens up very quickly at this area. Also, as we get older, sometimes our skin becomes more and more used to this problem and continues to generate repetitive thickening of the skin on a much quicker basis. Symptoms include sometimes a yellowing of the skin, thick or hard skin, sometimes this area may crack, and sometimes it may even open or ulceration. We treat calluses by simply periodic debridement or a shaving of these areas for relieve for the patient. Also, sometimes the areas are padded, and finally sometimes inserts are placed in the shoes to try and prevent or limit the frequency as to which these areas may return.
Foot ulcerations are basically calluses gone badly. With foot ulcerations there is too much pressure and too much shearing of this area, and subsequently the skin begins to break down exposing underlying tissue, which now has become an open wound. Symptoms of this condition include a wound that is beginning to drain and it is not necessarily painful; however a hole begins to form on often the plantar aspect of the patient’s foot. We treat this condition by getting rid of the bad tissue. This will allow and encourage proper chemical reaction and tissue to come to the area to help heal the wound. Another treatment option is offloading or getting pressure off these areas in a variety of ways, followed by use of topical medications, and new skin-related graph type material.
Poor circulation is the inability for the body to bring proper blood supplies, specifically in this case to the feet and lower legs. The causes for this condition can be genetic, as well as from smoking, and of course diabetes. Symptoms include redness or swelling that remains in the feet or legs after they’ve been in a dependent or a downward position for an extended period of time. Other symptoms are that the feet become blanched or are white for a prolonged period of time. After elevating the feet, the skin can also be thick, shiny, changes in the toenails, and lack of hair on the feet. In addition to these symptoms the pulses may simply be non-palpable on both the feet, and possibly the legs. Treatment for poor circulation in the feet includes arterial duplex studies, possibly special x-rays, and possibly evaluation by a vascular surgeon.
A person with diabetes should always be wearing closed toed shoes which are protective of their feet. It can be a slide type shoe, but should be secure to their foot with either a strap, lace, or a buckle. We can help you identify what type of footwear is needed for your feet.
Surgery is not normally a treatment option for someone with diabetes, but there are times when this is necessary to prevent a continual recurrent problem, and a problem which is not resolved with proper shoe gear.
Diabetics can avoid amputation by regular visits with their family doctor and endocrinologist, keeping their blood sugar under proper control, daily observation of their feet and regular visits to their podiatrist. Should you have any problems sooner than you scheduled appointment, you should certainly contact your regular doctor or podiatrist as soon as possible. If you are an amputee, it’s important to keep your blood sugar under control, daily inspection of feet, quit smoking – if you haven’t already – and regular frequent visits to their family doctor and their podiatrist.
If You Are Experiencing Symptoms For Diabetic Foot Care, Or Would Like More Information About This Condition, Please Contact Our Office Today.
Instride Upstate Footcare
269 North Grove
Medical Park Drive
Spartanburg, SC 29303