Diabetes Information

Diabetes

Diabetes (or more correctly, diabetes mellitus) is a chronic disease that affects over 6% of the United States population (higher in the older age groups). Insulin is a hormone that helps the body deal with sugar (glucose) in the diet. When diabetes is present, either the body produces too little or no insulin (Type 1), or body tissues are resistant to the effects of the insulin produced (Type 2). This results in higher levels of sugar in the blood, which can damage a wide range of body tissues and organs.

The foot is especially affected by diabetes as:

• Diabetes damages the nerves (damage can occur to the foot and not be detected) - this is called peripheral neuropathy.
   
• Diabetes affects circulation. Poor circulation can affect the ability of the body to heal when damage occurs.
   
• Those with diabetes are more prone to infection - the body's processes that normally fight infection respond slower and often have trouble getting to infections due to the poor circulation.
   
• Diabetes can also affect the joints, making them more rigid or deformed.
   
• Charcot's disease is another complication of diabetes in the foot.  Severe nerve damage can result in breakdown of the foot joints causing arch collapse and/or deformity.  This can lead to ulcers and infections. 
   
• Other diabetic complications can also affect the feet: kidney disease (affects proteins that are involved in wound healing) and eye disease (can't see the foot to check for damage).

As a consequence of the above factors a number of problems can occur:

The foot may get damaged and you do not know it (for example, your shoe rubs a sore onto a toe that gets infected - you cannot feel it because of the nerve damage – and you may not heal well due to the infection and poor circulation).  The result of this process may be an amputation.

**Diabetes is the main cause of non-traumatic amputations of toes, feet and legs in the United States.

Foot ulcers in those with diabetes:

Foot ulcers are a common complication of the "diabetic foot."  They allow a portal for infection to occur. Ulcers are caused by too much pressure on an area, causing the skin to  "break down". They can occur under corns and callus. Healing can take a while and it is imperative that pressure be removed from the area. Appropriate wound dressings are also important.

Podiatric treatment of the foot in those with diabetes:

Podiatrists have an extremely important role to play in the prevention and management of complications of the foot in those with diabetes. All those who are at risk should have their risk status assessed at least annually (more often if the risk is greater). Your podiatrist will then communicate this risk status to other members of the health care team. Your podiatrist will provide education on how to prevent problems from occurring, as well as treatment if an issue should arise.

Regular foot care from a podiatrist is a key way to prevent problems from developing in those who are at risk.  When a problem occurs, see a podiatric physician immediately. Waiting a few days to “see what happens" before seeking care, can make all the difference.  The earlier treatment is started, the better.