The Diabetic Foot and Treatment

In a generally healthy person, the concentration of insulin in the circulation is balanced and serves to preserve a constant amount of glucose in the blood – about 90 mg/100 cc of blood. A lack of insulin causes the breakdown of fats and proteins in the muscles causing weight loss despite increased food intake. The automatic increase in blood pressure resulting from this causes the blood to absorb water from the body tissues and dry them out. The water in the blood is taken up by the kidneys and the blood becomes more viscous (higher concentration of red blood cells) thus interfering with blood flow and disrupting the circulatory system. The inadequate circulation has visual repercussions that may lead to blindness, loss of sensation in the hands and feet sometimes resulting in necrosis, slow healing of wounds, and frequent infections.

Diabetic lower limb

The term 'diabetic foot' describes the foot of the diabetic. The blood circulation in such a foot is frequently disturbed, the skin dries out and may become scaly. This is a foot at risk. The risk is of development in the diabetic of a sore or ulcer on the foot, which fails to heal. One of the factors that enhance this risk in diabetics is the frequent loss of nervous sensation in the feet. In such cases, any injury to the foot will not be felt by the patient. He will not feel pain, heat or cold which would cause a healthy person to withdraw from the offending stimulus. A diabetic who steps on a nail may not feel pain, and he may be exposed to further injury. In addition, the blood vessels in the limbs of diabetics are affected and the flow of blood bringing oxygen to the wound is slowed down – oxygen is vital for rapid wound healing. Moreover , the white blood cells reaching the wound are also depleted, contributing to slower wound healing. As a result, blisters and ulcers appear, and infection, inflammation and edema may develop, all leading to further interference with blood flow, and so on. Thus , in many cases even slight wounds may become infected and may develop into severe foot ulcers and necrosis. Many diabetics reach a condition where several toes, or even the whole lower leg, from the knee down, may necessitate amputation.

Prevention of wounds and acceleration of healing: the best treatment for the diabetic foot is preventing occurrence of the offending wound. Diabetics should be encouraged to examine the condition of their feet, and should consult a foot physician at least twice a year. They should pay special heed to foot hygiene, wear appropriate socks and shoes, combined with effective soft insoles, designed especially for diabetics. It is essential that they tread on smooth. Soft surfaces adapted to their personal needs. A large number of amputations could be avoided by consistent use of these appliances.

Statistics

Diabetes is a rising health problem today throughout the world. In the united states today, there are 16 million diabetics, and about 8 million more undiagnosed cases. Every day, about 1700 cases of both types of diabetes are diagnosed. Diabetes is the 7th most frequent cause of death in the USA, and the chief cause of blindness.

The life expectancy of diabetics is about 15 years shorter than that of the healthy population. Correct control and treatment contribute to the quality of life of the patients.

Diabetes and other high risk diseases may affect the nervous system and lead to loss of sensation in the feet. Narrowing of the blood vessels result in an inadequate blood flow to peripheral parts of the body, these slowing down wound healing.

Stress, blows, ingrown toenails, blisters or objects falling on the foot may cause trauma, injury or infection , and may even necessitate hosptalization.

The information presented here is vital to foot health. It is crucial for us and for you to be aware of the importance of adequate foot treatment and of the adverse results of not heeding the recommendations in this presentation. I've prepared information to answer some of your questions and provide you with the necessary knowledge for appropriate care of your feet.

Daily foot care

1. Wash your feet with warm water and soap (do not soak them for prolonged periods).

2. Do not use hot water – test the temperature by hand or with the elbow' to avoid burns.

3. Dry them thoroughly – especially between the toes.

4. Apply ointment or cream.

5. Examine your feet (if you cannot see them yourself, ask for assistance of use a mirror).

If you encounter a problem or change in the condition of your feet, do not try to treat it alone – visit a nurse at a clinic.

When should you visit a foot clinic urgently?

You should contact a physician or a clinic immediately if you see any infection around the nails. On the foot or the calf. Many patients think they can deal with such 'small' problems on their own. This mistake could resuly in the loss of the foot and endanger life!



To your health,

Daniel A. Weisz - Podiatrist

A very informative article.

I am a T1D for 52 years. Have had complications, recently a kidney transplant and more, but nothing to my feet. My story: had a sore on the bottom of my index toe but went unnoticed for two moths. As stated on your article the toe would not heal. Went to a vascular surgeon. Based on ultrasound, very little blood flow to either foot. I brought up the possibility of amputation someday. Doctor said only as a last resort. More likely toe, if he is unable to get more blood to foot, will likely shrivel up “like a raisin” and fall off. Wasn’t kidding. Toe has finally started to heal. Not as painful and red but still after five moths a long way from healing. Am questioning this doctors competence after comment about toe shriveling up and falling off. Is this a possible or likely scenario?

I’m sure complications are a result of poor control for decades but over the past five years A1C and time in range are excellent. If suddenly, one is able to really control diabetes, will circulation improve or stay the same or will it continue to get worse?
Thanks.

What type of doctor are you seeing?

My relative (80s), not diabetic, has poor circulation due to heart and kidney conditions, with sores on feet often. He now is treated by wound specialist, which has restored better circulation and helps wound healing.

I am also 50+ year T1D, and so far feet are fine, some damage to eyes. Had many years of high BGs before using newer insulins and then a pump to get A1C down.

Maybe you could ask about seeing wound specialist if not improving soon.

I saw a vascular surgeon. Never heard of a “wound specialist” but will look into it. If toe doesn’t heal, I know I must do something quickly. Thanks