Diabetic Foot

Causes:
Several risk factors increase a person with diabetes chances of developing foot problems and diabetic infections in the legs and feet.
  • Footwear: Poorly fitting shoes are a common cause of diabetic foot problems.
  • Nerve damage: People with long-standing or poorly controlled diabetes are at risk for having damage to the nerves in their feet. The medical term for this is peripheral neuropathy.
  • Poor circulation: Especially when poorly controlled, diabetes can lead to accelerated hardening of the arteries or atherosclerosis. When blood flow to injured tissues is poor, healing does not occur properly.  
  • Trauma to the foot: Any trauma to the foot can increase the risk for a more serious problem to develop.
  • Infection: Athlete's foot, a fungal infection of the skin or toenails, can lead to more serious bacterial infections and should be treated promptly. 
  • Ingrown toenails should be handled right away by a foot specialist. Toenail fungus should also be treated

Symptoms:

  • Persistent pain can be a symptom ofsprain, strain, bruise, overuse, improperly fitting shoes, or underlying infection.
  • Redness can be a sign of infection, especially when surrounding a wound, or of abnormal rubbing of shoes or socks.
  • Swelling of the feet or legs can be a sign of underlying inflammation or infection, improperly fitting shoes, or poor venous circulation. Other signs of poor circulation include the following: 

    • Pain in the legs or buttocks that increases with walking but improves with rest (claudication
    • Hair no longer growing on the lower legs and feet 
    • Hard shiny skin on the legs
  • Localized warmth can be a sign of infection or inflammation, perhaps from wounds that won't heal or that heal slowly.
  • Any break in the skin is serious and can result from abnormal wear and tear, injury, or infection. Calluses and corns may be a sign of chronic trauma to the foot. Toenail fungus, athlete's foot, and ingrown toenails may lead to more serious bacterial infections.
  • Drainage of pus from a wound is usually a sign of infection. Persistent bloody drainage is also a sign of a potentially serious foot problem.
  • A limp or difficulty walking can be sign of joint problems, serious infection, or improperly fitting shoes.
  • Fever or chills in association with a wound on the foot can be a sign of a limb-threatening or life-threatening infection.
  • Red streaking away from a wound or redness spreading out from a wound is a sign of a progressively worsening infection.
  • New or lasting numbness in the feet or legs can be a sign of nerve damage from diabetes, which increases a persons risk for leg and foot problems.

Treatment:

Self-Care at Home - A person with diabetes should do the following:

 

  • Foot examination: Examine your feet daily and also after any trauma, no matter how minor, to your feet. Report any abnormalities to your physician. Use a water-based moisturizer every day (but not between your toes) to prevent dry skin and cracking. Wear cotton or wool socks. Avoid elastic socks and hosiery because they may impair circulation.
  • Eliminate obstacles: Move or remove any items you are likely to trip over or bump your feet on. Keep clutter on the floor picked up. Light the pathways used at night - indoors and outdoors.
  • Toenail trimming: Always cut your nails with a safety clipper, never a scissors. Cut them straight across and leave plenty of room out from the nailbed or quick. If you have difficulty with your vision or using your hands, let your doctor do it for you or train a family member how to do it safely.
  • Footwear: Wear sturdy, comfortable shoes whenever feasible to protect your feet. To be sure your shoes fit properly, see a podiatrist (foot doctor) for fitting recommendations or shop at shoe stores specializing in fitting people with diabetes. Your endocrinologist (diabetes specialist) can provide you with areferral to a podiatrist or orthopedist who may also be an excellent resource for finding local shoe stores. If you have flat feet, bunions, or hammertoes, you may need prescription shoes or shoe inserts.
  • Exercise: Regular exercise will improve bone and joint health in your feet and legs, improve circulation to your legs, and will also help to stabilize your blood sugar levels. Consult your physician prior to beginning any exercise program.
  • Smoking: If you smoke any form of tobacco, quitting can be one of the best things you can do to prevent problems with your feet. Smoking accelerates damage to blood vessels, especially small blood vessels leading to poor circulation, which is a major risk factor for foot infections and ultimately amputations.
  • Diabetes control: Following a reasonable diet, taking your medications, checking your blood sugar regularly, exercising regularly, and maintaining good communication with your physician are essential in keeping your diabetes under control. Consistent long-term blood sugar control to near normal levels can greatly lower the risk of damage to your nerves, kidneys, eyes, and blood vessels.





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