Diabetic Feet

What is Diabetes?

Diabetes is a chronic condition that is characterised by high blood glucose (sugar) levels. When a person has a high blood sugar level they are said to be hyperglycaemic.

Glucose is essential for providing the body with energy. The body converts many of the foods that we eat into glucose. A hormone called insulin is required to transfer glucose from the bloodstream to the body’s cells.

Diabetes is a chronic condition that can impact other functions of the body including the: Feet, Toes and Skin. If you suspect or know you have diabetes it is important to speak with your doctor to seek testing and advice on how to best manage your diabetes.

How does Diabetes Affect Your Feet?

In diabetic patients, foot ulcers or wounds that do not heal occur due to two major complications:

• Neuropathy: Nerve damage causes numbness in your feet, reducing the ability to feel pain and discomfort. When you do not feel pain, even a small cut or blister can form ulcers, sores and infections by going unnoticed.
• Peripheral Vascular Disease: Good blood supply is very important for healing of tissues. Poor blood circulation, and thereby insufficient oxygen supply to your feet, is caused by diabetes-associated damage to the blood vessels. This makes healing difficult.

Other factors that can contribute to the risk of developing diabetic foot problems include:

• Impairment of the immune system
• Fungal and bacterial infections
• Poorly fitting shoes 
• Cigarette smoking.

Signs and Symptoms Of Diabetic Foot

If you are a diabetic, you should be aware of any problem that affects your feet. Early warning signs of foot problems that should be recognised include:

• Burning, tingling or acute pain in the feet
• Numbness of the feet or loss of sensation to heat, cold or touch
• Changes in the shape of the feet
• Loss of hair on the lower legs, feet and toes
• Changes in the colour of your feet
• Appearance of blisters, ingrown toenails, yellowing toenails, sores or ulcers
• Infection of corns and calluses on the feet (thickened areas of skin that can become painful)

Complications of Diabetic Foot

Diabetic wounds are one of the most severe types of chronic (non-healing) wounds that can impair your quality of life.

Complications can include:

• Wound infection: A small ulcer on the foot when left untreated can attract bacteria, resulting in skin and bone infections.
• Gangrene: Chronic wound infections may cause gangrene, a condition characterised by death of tissue.
• Amputation: Chronic wounds may not respond to treatment and if serious enough, may require amputation.
• Charcot Arthropathy

What is Charcot Arthropathy?

Charcot arthropathy is a chronic and progressive disease which can lead to the destruction of foot and ankle joints and surrounding bony structures. A deformed and misshapen foot and ankle can lead to altered weight bearing and prominences, and lead to acute and chronic ulceration of the foot.

Diabetes is a leading cause of charcot arthropathy. The diagnosis is often made clinically with a warm and red foot with redness that decreases with foot elevation. Xrays and CT scans often show disintegration of bones and obliteration of joint spaces with dislocated joints.

Early diagnosis and treatment is vital in preventing deformity and ulcers. Treatment can consist of:

• Casting / Specialised Moon Boot
• Surgery to correct the bony alignment or to remove bony prominences
  

How is Diabetic Foot Diagnosed?

The diagnosis of diabetic foot problems is based on:

Medical History

Your doctor will ask questions about:

• Current symptoms and their severity
• If an injury was sustained
• Obtain a medical history especially concerning your diabetic treatment including any heart, kidney or eye damage
• Confirm medications, past and present
• The impact of the problem on your occupation and lifestyle
  

Physical Examination

Your doctor perform comprehensive physical evaluation that will include:

• Examining the affected area for swelling, pain, bruising or other features
• Assessing your range of motion, walking pattern and other relevant features

Diagnostic Testing

Once your doctor has completed the physical examination further tests maybe required. These tests can help your doctor determine or eliminate possible causes. These can include:

• X-Ray
• Ultrasound (US)
• Computerised Tomography (CT)
• Magnetic Resonance Imaging (MRI)

Once a final diagnosis has been completed your doctor can discuss with you and recommend any treatment options. Bloods tests to look for infection as well as to assess your diabetes and overall health will be required.

Non Surgical Treatment for Diabetic Foot

Treatment of diabetic foot problems including Charcot Arthropathy will also involve your diabetes specialist, podiatrist, and vascular surgeon (if required). It is important that your diabetes is well controlled as this will reduce your risk of recurrence.

Non surgical treatment can include:

• Antibiotics
• Corrective or custom footwear to help offload any ulcers or bony prominences
• Orthotic devices
  
  

Surgical Treatment for Diabetic Foot

Corrective surgeries may sometimes be indicated for foot or ankle deformities that may progressively worsen. Surgical treatment may help to create an environment that encourages healing, and preserves the structural and physical integrity of the foot. 

Surgical treatment may include:

• Surgical debridement of ulcers: This process involves the removal of dead and infected tissue, and treatment with antibiotics.
• Reconstruction: This process involves bone cuts to reconstruct the normal architecture of the foot and ankle.
• Skin defect covering: Once the infection has alleviated, surgical procedures to cover the skin defect may be performed.
• Calf Lengthening (gastrocnemius recession): To help reduce pressure on the forefoot and offload ulcers
• Amputation: In severe cases of gangrene, the affected part of the body is surgically removed to prevent spread of infection to other parts of the body.

What if Diabetic Feet go Untreated?

If left untreated, these wounds can cause serious problems that can lead to infections and gangrene, which may require amputation.

Preventive Care for of Diabetic Feet

Since chronic foot wounds are common in diabetics, taking a few preventive steps can keep your feet healthy.

• Avoid walking barefoot, especially on hot surfaces.
• Don’t cut corns or calluses with scissors or razors.
• Wash your feet regularly with warm water and dry them thoroughly, especially between the toes.
• Wear comfortable and well-fitting shoes.
• Wear socks or stockings all the time.
• Check your feet regularly for cuts, sores, blisters or infections.
• Quit smoking
• Get your diabetes under control with medications and the help of a specialist
• Attend a podiatrist regularly who can help monitor your feet