Diabetic
Foot Care
© 1999 by Seth A. Rubenstein, D.P.M.
What
is Diabetes?
Diabetes is a disease process which affects how the body stores
and uses sugar (glucose). In juvenile or type I diabetes, there
is an insufficient or absent supply of Insulin, a hormone produced
in the Pancreas gland. Insulin enables glucose in the blood to pass
into muscle for use as food or energy. Insulin also controls the
entrance of glucose into fat cells for storage.
In adult onset or type II diabetes, the supply of Insulin may be
low or normal however, the body's cells are not as sensitive to
insulin, resulting in a buildup of glucose in the blood stream.
Chronically elevated blood glucose can potentially affect the body
in many adverse ways, including kidney damage, blindness and various
forms of nerve damage or neuropathy. The discussion of these affects
on the body are beyond the scope of this article.
What are the effects of Diabetes on the Lower Extremity?
In the lower extremity, Diabetes greatest affect is on the vascular
(blood flow) and nervous system. Specifically, the large arteries
of the lower leg can become calcified and or clogged. It is also
felt that the capillaries (smallest blood vessels) become thickened,
thus decreasing their ability to permit oxygen and nutrients to
pass into the surrounding tissue and skin.
Decreased blood flow can lead to death of tissue (necrosis) and
compromise the ability to fight infection. Rapidly spreding infection
in skin is called cellulitis. Localized pockets of infection under
the skin, known as abscess can also develop. While these are usually
associated with long standing wounds or ulcers, even small scrapes
or cracks in the skin can lead to severe infection when inadequate
blood flow is present.
High glucose (sugar) levels can damage nerves resulting in abnormal
or decreased sensation. This process, called neuropathy, can affect
over 50% of Diabetics. Early signs of neuropathy may present as
a burning pain on the bottom of the feet. More commonly, neuropathy
develops as progressive numbness, starting in the toes and moving
up the foot. The ability to feel pain or hot temperature is a protective
mechanism. Without this ability, abnormal pressure spots can develop
into thick callus on the foot. Pressure from these regions can cause
breakdown of the underlying skin called malperforant ulcers.
In the absence of pain, an individual can be fooled into thinking
that the ulcer is not serious and delay seeking medical attention.
In fact, such wounds should be treated as emergencies. Medical attention
should be obtained within 24 hours once an ulcer or bleeding within
the skin is noted. Prompt wound care and antibiotics help lessen
the need for hospitalization and or amputation.
What should a person with Diabetes do to protect their feet?
-
Even if you do not have neuropathy it is wise to examine your
feet at the end of every day. Look for cracks, bleeding in the
skin, red streaks or other sign of infection.
- Examine
the inside of your shoes before putting them on. Look for small
pebbles, torn leather or nail pops which could irritate your skin.
Test bath water with your hand or elbow. Your toes may not feel
scolding water as to hot.
- Keep
your feet clean. If they are dry use a moisturizing cream. Do
not apply creams between the toes as this can lead to a fungal
infection. Prescription strength creams and lotions are available
for severe cases of dry skin (diabetic anhydrosis).
- If
you see something that looks bad such as an ulcer or bleeding
in the skin, or smell a foul odor, contact your doctor or podiatrist
immediately. Do not rely on the absence of pain to determine if
treatment is needed.
- If
you have neuropathy, see your foot doctor once a year for a check
up.
What
should a person with Diabetes avoid doing?
- Do not walk
barefoot, even around the house. This can expose the skin to cuts
and foreign bodies. Walking barefoot on hot sand can result in
serious burns.
- Do not trim
you own calluses, corns or abnormally thick nails, unless advised
to by your podiatrist.
- Do not wear
tight shoes that can rub and cause blisters or callus.
- Do not wear
tight socks, stockings or garters that can cut off circulation.
- Do not use
hot water bottles or heating pads on your feet that may cause
burns.
- Do not soak
your feet except under the direction of a doctor. Soaking can
dry out the skin and may cause the skin to crack.
Additional
sources of information on diabetes:
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