Diabetic Complications and Amputation Prevention
People with diabetes are prone to many foot problems, often because of two complications of diabetes: nerve damage (neuropathy) and poor blood circulation. Neuropathy causes loss of feeling in your feet, taking away your ability to feel pain and discomfort, so you may not detect an injury or irritation. Poor circulation in your feet reduces your ability to heal, making it hard for even a tiny cut to resist infection.
When you have diabetes, you need to be aware of how foot problems can arise from disturbances in the skin, nails, nerves, bones, muscles, and blood vessels. Furthermore, in diabetes, small foot problems can turn into serious complications. You can do much to prevent amputation by taking two important steps: Follow the proactive measures discussed below-and see your foot and ankle surgeon regularly.
Diabetes-Related Foot and Leg Problems
Having diabetes puts you at risk for developing a wide range of foot problems:
- Infections and ulcers (sores) that don't heal. Because of poor circulation in the feet, cuts or blisters can easily turn into ulcers that become infected and won’t heal. This is a common and serious complication of diabetes and can lead to a loss of your foot, your leg, or your life. An ulcer is a sore in the skin that may go all the way to the bone.
- Corns and calluses. When neuropathy is present, you can’t tell if your shoes are causing pressure and producing corns or calluses. Corns and calluses must be properly treated or they can develop into ulcers.
- Dry, cracked skin. Poor circulation can make your skin dry. This may seem harmless, but dry skin can result in cracks that may become sores.
- Nail disorders. Ingrown toenails (which curve into the skin on the sides of the nail) and fungal infections can go unnoticed because of loss of feeling. If they’re not professionally treated, they can lead to ulcers.
- Hammer Toes and bunions. Motor neuropathy (nerve damage affecting muscles) can cause muscle weakness and loss of tone in the feet, resulting in hammertoes and bunions. If left untreated, these deformities can cause ulcers.
- Brittle bones. Neuropathy and circulation changes may lead to brittle bones (osteoporosis). This makes you susceptible to breaking a bone, even without a major blow or injury occurring.
- Charcot foot. This is a complex foot deformity. It develops as a result of loss of sensation and an undetected broken bone that leads to destruction of the soft tissue of the foot. Because of neuropathy, the pain of the fracture goes unnoticed and the patient continues to walk on the broken bone, making it worse. This disabling complication is so severe that amputation may become necessary.
- Blocked artery in the calf. In diabetes, the blood vessels below the knee often become narrow and restrict blood flow. A severely blocked artery is a serious condition that may require intervention from a vascular surgeon. If vascular surgery fails and the wound does not heal, amputation may be necessary.
What Your Podiatrist Can Do
A major goal of the podiatrist is to prevent amputation. There are many new surgical techniques available to save feet and legs, including joint reconstruction and wound healing technologies. Getting regular foot checkups and seeking immediate help when you notice something can keep small problems from worsening. Your foot and ankle surgeon works together with other health care providers to prevent and treat complications from diabetes.
Your Proactive Measures
You play a vital role in reducing complications. Follow these guidelines and contact your podiatrist if you notice any problems:
Inspect your feet daily. Skin or nail problems-Look for cuts, scrapes, redness, drainage, swelling, bad odor, rash, discoloration, loss of hair on toes, injuries, or nail changes (deformed, striped, yellowed or discolored, thickened, or not growing). Signs of fracture—If your foot is swollen, red, hot, or has changed in size, shape, or direction, see your foot and ankle surgeon immediately. (If your eyesight is poor, have someone else do it for you.)
- Observe for changes in circulation. Pay attention to the color of your toes. If they turn red, pink, or purplish when your legs hang down while sitting, poor circulation may be a problem.
- Don’t ignore leg pain. Pain in the leg that occurs at night or with a little activity could mean you have a blocked artery. Seek care immediately.
- Nail cutting. Your toenails should be trimmed professionally.
- No bathroom surgery. Never trim calluses or corns yourself, and don’t use over-the-counter medicated pads.
- Keep floors free of sharp objects. Make sure there are no needles, insulin syringes, or other sharp objects on the floor.
- Don’t go barefoot. Wear shoes, indoors and outdoors.
- Check shoes and socks. Shake out your shoes before putting them on. Make sure your socks aren’t bunched up.
- Have your sense of feeling tested. Your podiatrist will perform various tests to see if you’ve lost any feeling.
For an appointment call Doctors at Kenneth R Lawrence, DPM, PC 248-476-1616
Diabetic Foot Care Guidelines
Diabetic patients have a loss of sensation or poor circulation. Some patients are not even aware of these issues. For this reason it is important the patient follows some simple foot care prevention. Below are suggestions for preventive diabetic foot care.
Take care of your diabetes.
- Work with your healthcare team to keep your blood sugar within a good range.
Check your feet every day.
- Look at your bare feet every day for cuts, blisters, red spots and swelling.
- Use a mirror to check the bottoms of your feet or ask a family member for help if you have trouble seeing.
Wash your feet every day.
- Wash your feet in warm, not hot, water every day.
- Dry your feet well. Be sure to dry between the toes.
Keep the skin soft and smooth.
- Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between your toes.
Have corns and callouses treated by a podiatrist.
- Do not use a pumice stone to smooth corns and callouses. Do not rub the skin too vigorously.
- Don’t use over-the-counter products or sharp objects on corns and callouses.
Have your toenails trimmed by a podiatrist.
Wear protective footwear at all times.
- Never go barefoot.
- Wear comfortable shoes that fit well and protect your feet. Diabetic shoes and inserts are highly recommended.
- Feel inside your shoes before putting them on each time to make sure the lining is smooth and there are no objects inside.
- Wear socks at night if your feet get cold.
- Wear protective footwear at the beach, swimming pool or on hot pavement.
Keep the blood flowing to your feet.
- Wiggle your toes and move your ankles up and down for 5 minutes, 2-3 times per day.
- Don’t smoke.
- Don’t cross your legs for long periods of time.
Finally, have a podiatrist at Kenneth R. Lawrence, DPM, PC check your bare feet and find out whether you are likely to have serious foot problems. Remember that you may not feel the pain of an injury.
Call Kenneth R. Lawrence, DPM, PC right away if you find a cut, sore, blister, or bruise on your foot that doesn’t begin to heal after one day at 248-476-1616.
Diabetic Peripheral Neuropathy
What is Diabetic Peripheral Neuropathy?
Diabetic neuropathy is nerve damage caused by diabetes. The type of neuropathy occurring in the arms, hands, legs and feet is known as diabetic peripheral neuropathy. Diabetic peripheral neuropathy is different from peripheral arterial disease (poor circulation), which affects the blood vessels rather than the nerves.
Three different groups of nerves can be affected by diabetic neuropathy:
- Sensory nerves, which enable people to feel pain, temperature, and other sensations
- Motor nerves, which control the muscles and give them their strength and tone
- Autonomic nerves, which allow the body to perform certain involuntary functions, such as sweating.
Diabetic peripheral neuropathy doesn’t emerge overnight—instead, it usually develops slowly and worsens over time. Some patients have this condition long before they are diagnosed with diabetes. Having diabetes for several years may increase the likelihood of having diabetic neuropathy.
The loss of sensation and other problems associated with nerve damage make a patient prone to developing skin ulcers (open sores) that can become infected and may not heal. This serious complication of diabetes can lead to loss of a foot, a leg, or even a life.
Signs and Symptoms
Depending on the type(s) of nerves involved, one or more signs and symptoms may be present in diabetic peripheral neuropathy.
For sensory neuropathy:
- Numbness or tingling in the feet
- Pain or discomfort in the feet or legs-including prickly, sharp pain or burning feet
For motor neuropathy:
- Muscle weakness and loss of muscle tone in the feet and lower legs
- Loss of balance
- Changes in foot shape that can lead to areas of increased pressure
For autonomic neuropathy:
What Causes Diabetic Peripheral Neuropathy?
The nerve damage that characterizes diabetic peripheral neuropathy is more common in patients with poorly managed diabetes. However, even diabetic patients who have excellent blood sugar (glucose) control can develop diabetic neuropathy. There are several theories as to why this occurs, including the possibilities that high blood glucose or constricted blood vessels produce damage to the nerves.
As diabetic peripheral neuropathy progresses, various nerves are affected-and these damaged nerves can cause problems that encourage development of ulcers. For example:
- Deformities (such as bunions or hammertoes) resulting from motor neuropathy may cause shoes to rub against toes, creating a sore. The numbness caused by sensory neuropathy can make the patient unaware that this is happening.
- Because of numbness, a patient may not realize that he or she has stepped on a small object and cut the skin.
- Cracked skin caused by autonomic neuropathy, combined with sensory neuropathy’s numbness and problems associated with motor neuropathy can lead to developing a sore.
To diagnose diabetic peripheral neuropathy, the podiatrist will obtain the patient’s history of symptoms and will perform simple in-office tests on the feet and legs. This evaluation may include assessment of the patient’s reflexes, ability to feel light touch, and ability to feel vibration. In some cases, additional neurologic tests may be ordered.
First and foremost, treatment of diabetic peripheral neuropathy centers on control of the patient’s blood sugar level. In addition, various options are used to treat the symptoms.
Medications are available to help relieve specific symptoms, such as tingling or burning. Sometimes a combination of different medications is used.
In some cases, the patient may also undergo physical therapy to help reduce balance problems or other symptoms.
The patient plays a vital role in minimizing the risk of developing diabetic peripheral neuropathy and in preventing its possible consequences. Some important preventive measures include:
- Keep blood sugar levels under control.
- Wear well-fitting diabetic shoes to avoid getting sores.
- Inspect your feet every day. If you notice any cuts, redness, blisters, or swelling, see your podiatrist right away. This can prevent problems from becoming worse.
- Visit your podiatrist on a regular basis for an examination to help prevent the foot complications of diabetes.
- Have periodic visits with your primary care physician or endocrinologist. The podiatrist works together with these and other providers to prevent and treat complications from diabetes.
For an appointment call Doctors at Kenneth R Lawrence, DPM, PC 248-476-1616.
Why do you need Diabetic Shoes?
A common side effect of diabetes is “peripheral neuropathy,” which causes loss of sensation in the extremities. Ill-fitting shoes which rub or pinch the feet excessively can lead to ulceration and foot injury, simply because the diabetic does not feel the injury until it is too late.
Properly fitted diabetic shoes are very important in preventing such injuries. Companies specializing in pedorthics — the design of footwear and specialty insoles to help alleviate and/or prevent foot pain and injury — manufacture special shoes and insoles for diabetics.
Diabetic shoes are often wider and deeper than regular shoes to make room for special diabetic insoles. Insoles for diabetics are generally customized for the patient’s feet to ensure proper fit and minimize rubbing and uneven weight distribution, preventing injury. It is also important for a diabetic to have shoes with good air circulation, meaning a lot of diabetic footwear features fabric or sandal-style uppers.
It is very important for a diabetic to have their shoes custom fitted by a trained podiatrist, since they may not be able to feel an improper fit, due to peripheral neuropathy.
By ensuring proper fit and good air circulation, properly designed diabetic shoes and insoles prevent pressure ulcers, encourage good blood circulation, and allow the skin to breathe.
Some things to look for in good shoe designs for diabetics are:
- Diabetic shoes need to have a breathable construction — fabric shoes are good for this.
- Deep and wide designs that allow room for customized diabetic insoles.
- Designs with no interior seams (or covered seams) to prevent
- Diabetic shoes need a roomy “toe box” to prevent pinching or squeezing of the toes.
- Elastic or easily adjustable fit, to prevent the diabetic shoe from sliding around on the feet.
Shoes and customized insoles which are specially designed to meet the needs of diabetics’ feet will often be partially or fully covered by Medicare or private insurance, offsetting the cost.
For an appointment call Doctors at Kenneth R Lawrence, DPM, PC 248-476-1616.
Comfort and Protection
Many complications of diabetes involve the feet. While diabetic socks cannot prevent all of these problems, they can help with a lot of them. Proper supportive socks can help prevent blood collecting in the feet and lower legs, which can lead to injury and infection in the diabetic. Diabetic socks which help cushion the feet and protect them from rubbing on the inside of shoes can help prevent pressure ulcers and blisters. Many diabetic socks are designed with minimal or no seams, to prevent friction injuries as well. Socks which both absorb moisture and keep the feet warm can help prevent fungal infections and encourage good circulation.
One of the most common features to look for in diabetic socks are ones which provide firm support to the lower leg. Poor circulation contributes to many diabetic foot and leg problems, including slow healing of injuries, bruising, and damages arteries and nerves. Well-designed diabetic support socks help prevent blood pooling in the feet and lower legs, which alleviates many of these problems.
Because of dry skin and nerve problems cause by diabetes, skin injuries are common. Shoes and socks which rub against the feet can cause blisters and ulcers which are very slow to heal, or develop serious infections. Diabetic socks should be thick and well padded, to help cushion the foot from pressure and prevent friction injuries from shoes. The best options in diabetic hosiery also avoid any seams which may rub against the toes or calves. Because of common loss of sensation in the feet with diabetes, damage caused by friction from socks or shoes may not be noticed until an actual injury is caused. Prevention is the best option.
Diabetics are also prone to infections in damaged skin and fungal infections of the feet and toes. When looking for quality diabetic socks, try to find brands which absorb moisture to help prevent such problems. Good quality warm socks will also help improve circulation, which greatly helps healing time if problems do occur despite your best efforts.
For an appointment call Doctors at Kenneth R Lawrence, DPM, PC 248-476-1616.