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Diabetic Foot Conditions

What are diabetic foot conditions?

Diabetic foot conditions can develop in people with diabetes from having too much blood sugar, called glucose, in their system. This can lead to serious complications, including in the feet, where nerves can be damaged and the flow of blood reduced. Damaged nerves may keep someone with diabetes from feeling a simple injury, while reduced blood flow could keep the injury from healing or resisting infection—both of which could lead to the loss of a foot or leg to amputation.

Nerve damage that is caused by uncontrolled diabetes is called neuropathy, which typically affects the feet and legs. Neuropathy occurs over time as damaged nerves stop sending signals, or sends them too slowly or at the wrong times. This can cause tingling, burning, or weakness in the legs and feet, but it can also stop you from feeling pain, heat, or cold. This loss of feeling means you could have a pebble in your shoe that causes a sore, but you don't feel it, leading to infection or worse. Neuropathy can also lead to foot deformities or changes in the muscles, bones, and shape of your feet.

Poor blood flow (or circulation) to the arms and legs is called peripheral artery disease (PAD). If you have diabetes, PAD can make it hard for a sore or infection to heal, which can lead to the development of skin ulcers or gangrene, the death of skin and tissue due to lack of blood. Most often, PAD affects the legs, causing intermittent claudication, which is basically leg pain when walking. PAD can also cause changes in the shape of your feet and toes, leading to other problems.

Common problems that can affect feet and lead to complications include:

  • athlete's foot, which is a fungus that can enter through cracks in the skin that causes itching, redness and cracking; it can also lead to infection
  • blister, which develops from shoes rubbing against the skin; the bubble that forms helps protect skin from infection
  • bunion, which forms when the big toe angles in toward the second toe, causing the area where the big toes attaches to the foot to become red, callused, and sometimes hard
  • callus, which is a build-up of hard skin, usually on the bottom of the foot; calluses occur more often and build up faster on the feet of people with diabetes; if not trimmed, calluses can get very thick, break down, and turn into ulcers
  • Charcot fractures, which are fractures in the feet that people are a not aware due to a lack of pain
  • corn, which is a build-up of hard skin near a bony area of the toe or between toes; this can be caused by pressure from shoes that rub against or cause friction between the toes
  • dry skin, which can crack and allow germs to enter
  • foot ulcer, which is a break in the skin or a deep sore that occurs most often on the ball of the foot or on the bottom of the big toe; left untreated, if can become infected
  • hammertoe, which is a toe that is bent because of a weakened muscle, causing the toe to curl under the foot; it can cause problems with walking and lead to blisters, calluses, and sores
  • ingrown toenail, which occurs when the edges of the nail grow into the skin; this may lead to a cut into the skin, causing redness, swelling, pain, drainage, and infection
  • plantar warts, which look like calluses on the ball of the foot or on the heel; they are usually painful and are caused by a virus that infects the outer layer of skin on the soles of the feet

Because minor injuries can become major infections, foot problems are a major reason behind hospitalizations for diabetics. Regular inspection, proper care, and consulting with your doctor are the best ways to avoid having diabetic foot problems.

What are the symptoms of diabetic foot conditions?

Signs and symptoms of diabetic foot problems develop over time, so you may not become aware of them until some damage has been done. Some general signs and symptoms may include:

  • persistent pain, which can be the result of strain, sprain, bruise, overuse, underlying infection, or from shoes that don't fit properly
  • swelling of the feet or legs, which can be a sign of underlying inflammation or infection, poor circulation, or improperly fitting shoes
  • redness, which could be a sign of infection or of the rubbing of shoes or socks
  • red streaking or spreading away from a wound, which could be a sign of a worsening infection
  • new or lasting numbness in the feet or legs, which can be a sign of nerve damage caused by diabetes
  • a break in the skin that could result from abnormal wear and tear, injury or infection
    • corns and calluses may be a sign of chronic trauma to the foot
    • athlete's foot, toenail fungus, and ingrown toenails can lead to serious bacterial infections
  • pus draining from a wound on the foot is usually a sign of infection; persistent bloody drainage is often a sign of a potentially serious problem
  • fevers or chills associated with a wound on the foot can be a serious sign of a limb- or life-threatening infection

Some symptoms develop from the peripheral neuropathy, others can be the result of peripheral artery disease (PAD). Peripheral neuropathy is the most common type of diabetic neuropathy, and it affects the body's extremities, including the legs. Often, the feet and legs are affected first, then the hands and arms. Signs of peripheral neuropathy can include:

  • a tingling or burning sensation in the legs and feet
  • numbness or reduced ability to feel pain or temperatures in in the legs or feet
  • a sharp stabbing pain in the legs and feet at night
  • muscle weakness and difficulty walking
  • serious foot issues, such as sores and ulcers, infections, bone and joint pain, and deformities
  • extreme sensitivity to even the lightest touch

Signs of PAD may include:

  • intermittent claudication, which is a pain, cramping or discomfort in the leg muscles due to reduced blood flow that is felt during activities, such as walking or climbing stairs; the problem tends to go away after a few minutes of rest
  • pain in the legs when resting
  • numbness in the legs and feet
  • cold feeling in the legs or feet
  • weakness of the calf muscle
  • loss of hair around the affected area

With diabetic foot problems, it is very important to see your doctor if you are experiencing any of these symptoms. If you have tingling or weakness in your legs or feet or a sore or skin ulcer that will not heal, you need to talk to your doctor before the condition progresses to a more severe stage.

How are the underlying causes of diabetic foot conditions diagnosed?

If you are experiencing any diabetic foot conditions, you should contact a doctor for an evaluation and diagnostic testing. The doctors may want you to have one or more tests to determine if you have peripheral neuropathy and/or peripheral artery disease (PAD).

First your doctor will ask you to describe your symptoms, then discuss your and your family’s medical history with you. Next, the doctor will perform a physical exam on you to check your muscle strength and tone, tendon reflexes, and sensitivity to touch and temperature. He or she will also do a thorough foot exam, looking for any signs of calluses, corns, sores, cuts, bruises, infections, foot pain, or joint abnormalities.

When diagnosing peripheral neuropathy, your doctor may request one or more of the following tests:

  • nerve conduction studies, which measure how fast your arms and legs process electrical signals
  • electromyography (EMG), which measure the electrical discharges that are produced in your muscles
  • quantitative sensory testing, which assesses how nerves respond to changes in temperature and vibrations
  • filament test, which uses monofilament (a soft nylon fiver) to test the sensitivity of nerves in your feet

When testing for PAD, the doctor may request one or more of these tests:

  • blood tests to measure your cholesterol and triglyceride levels
  • ankle/bracial index (ABI), which compares the blood pressure readings in your ankles with the blood pressure readings in your arms. Blood pressure cuffs are placed on your ankles and arms, then inflated as a handheld ultrasound device evaluates blood pressure and flow.
  • pulse volume recording (PVR), which is similar to ABI, but uses multiple cuffs on the leg to measure and record blood volume changes in the leg; its purpose is to help locate any blockages in the arteries
  • vascular ultrasound, which uses a device that creates sound waves that bounce off of an artery and creates an image to measure blood flow and detect any blockages
  • angiography, which involves using an iodine dye and x-rays to show the inside of your blood vessels so that the doctor can see the flow of blood through your arteries and veins

The American Diabetes Association recommends that anyone with diabetes should have a thorough foot exam at least once a year by a doctor or podiatrist (foot doctor). If you have a history of foot problems, you should be checked more often.

How are diabetic foot conditions treated?

Treatment for diabetic foot conditions starts with a comprehensive preventive care program that you can practice by yourself every day. The goal is to keep your feet healthy and avoid developing foot ulcers.

In this section, we will review prevention and treatment methods, including:

  • managing your diabetes to keep your blood sugar levels stable
  • maintaining proper foot care, which is something you can do on your own
  • accessing medications and medical procedures to help treat and resolve any foot conditions you may develop

Prevention

Because people with diabetes are so vulnerable to foot problems, it’s important to keep your glucose levels under control. The best ways to do that is to take your medications, eat a healthy diet, check your blood sugar regularly, and exercise on a regular basis. It’s also important to maintain good communications with your doctor. By keeping your glucose levels normal, you can greatly lower the risk of damage to the nerves and blood vessels in your legs and feet.

Because you may not always feel problems with your feet, it’s very important to follow a regular routine when caring for them. This routine should include:

  • foot examination every day to look for any red spots, sores, cuts, blisters or swelling, or after you’ve had any kind of trauma to your foot. If you can’t see the bottoms of your feet, use a mirror or ask for help. If you have any abnormalities, report them to your doctor right away.
  • washing your feet every day using warm water and a mild soap, then carefully patting them dry—especially between the toes. After washing, apply a thin coat of water-based moisturizer or lotion over the tops and bottoms of your feet (but not between your toes) to prevent dry skin and cracking.
  • trimming your toenails when needed with a safety clipper (not scissors), cutting them straight across and leaving room beyond the nail bed, then filing them with a nail file or emery board. If you have difficulty cutting your nails, have a family member help.
  • wearing proper footwear, which includes sturdy, comfortable shoes and cotton or wool socks. Work with a podiatrist to make sure the shoes fit properly, or shop at shoe stores that focus on people with diabetes; if you have hammertoes, bunions, or flat feet, you may require shoe inserts or prescription shoes. You may also want to ask your doctor about Medicare coverage for special shoes.
  • protecting your feet from hot and cold, which means avoiding placing your feet in hot water, walking in bare feet on pavement or the beach, and wearing appropriate insulating footwear in cold weather. Also, never use heating pads, electric blankets, or hot water bottles; they can burn your feet without you feeling it.
  • staying active with regular exercise, which will help to stabilize your blood sugar levels, improve circulation in your legs, and improve bone and joint health in your feet and legs. Always talk to you doctor before starting any exercise program.
  • keeping blood flowing to your feet by raising your feet above your heart when sitting, avoiding crossing your legs for long periods of time, wiggling your toes, and raising and lowering your ankles for five minutes, two or three times a day
  • seeing a doctor for corn and callus removal; never attempt to cut or remove them yourself
  • quitting smoking, which is a major risk factor for foot infections and potentially, amputation; smoking accelerates damages to blood vessels, which can lead to poor circulation in the legs and feet

Treatment

Foot ulcers are the leading reason why people with diabetes are hospitalized. But foot ulcers can be treated effectively—if they are caught early. The likelihood of infection rises the longer you wait. Infections that can’t be treated may result in an amputation.

If you develop a foot ulcer, the first thing you need to do is call your doctor as soon as possible to ensure you get proper treatment. Once treated, diabetic foot ulcers can take several weeks to heal, so it’s important to stay off your feet and follow your doctor’s instructions.

Depending on the type and severity, foot problems can be treated in a variety of ways, including:

  • antibiotics, which are prescribed when a doctor determines that an ulcer or wound on the patient’s legs or feet is infected or is at risk of becoming infected. Oral treatment must be taken for the full course prescribed, through improvement to the wound is usually seen in three days. Limb- or life-threatening wounds are usually treated in the hospital using antibiotics delivered intravenously.
  • surgery, which may be used for:
    • debridement of the wound, during which doctors remove unhealthy tissue to promote healing and reduce the risk of infection
    • correction of bone problems, including hammertoe, bunions, and Charcot fractures
    • improvement of circulation by removing plaque and blockages from affected arteries in the legs and feet to allow blood to flow freely
  • at a wound center, which is usually located in a larger community hospital and specializes in the treatment of diabetic wounds and ulcers of the leg and feet. These centers use teams of professionals, including doctors, nurse, and therapists, to develop a treatment plan for the patient that could combine surgery, therapy, special dressings, and antibiotic.
  • by a podiatrist or orthopedic surgeon, who specialize in bone problems of the foot, as well as toenail problems, corns and calluses, bunions, flat feet, and heel spurs. In addition to performing surgery to correct bone-related issues, these doctors also help patients find shoes and inserts that address the patient's specific needs.
  • assistance at home after treatment with a nurse or aide who specialize in helping with wound care and dressings, monitoring blood sugar, and helping the patient take their medications during the healing period

Advanced Cardiovascular Care at Jeanes Hospital

If you're experiencing symptoms of a diabetic foot condition, the academic-level vascular surgeons at the Temple Heart & Vascular Institute at Jeanes Hospital are ready to assist in the diagnosis and treatment of your condition. From patient consultation to a full range of diagnostic tests and surgical procedures, our Temple doctors are prepared to help you understand and manage all aspects of your condition.

The Temple vascular surgeons at Jeanes Hospital evaluate hundreds of patients every year, managing a wide range of serious vascular conditions. After careful evaluation, they can develop and oversee a treatment plan tailored to meet your specific needs.

If surgery is required, there's no need to travel to another institution to have it done. Since 2006, Temple vascular surgeons have been performing vascular surgery and procedures at Jeanes Hospital. Our surgeons are supported by a full-time team of anesthesiologists, surgical technicians, and critical care nurses. Dedicated nurse practitioners also collaborate with surgeons to manage patient care in Jeanes Hospital and in our outpatient settings.

Procedures performed here for the diagnosis and treatment of diabetic foot conditions include:

  • atherectomy with cutting blade/burr or laser
  • diagnostic angiography
  • endovenous laser therapy
  • extremity balloon angioplasty and stenting
  • radiofrequency ablation in peripheral venous disease
  • renal and mesenteric artery angioplasty and stenting

This is the level and quality of care you would expect to find downtown or in another city. Yet, it's available right here, in your own community.

To schedule an appointment with a vascular surgeon at the Temple Heart & Vascular Institute at Jeanes Hospital, click here or call 215-728-CARE (2273).

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