Diabetes and Foot Ulcers

There are over 23 million American with diabetes, and another 57 million with pre-diabetes. Many argue that diabetes is becoming an epidemic. As technology continues to advance the efficiency of our world, it also takes away the need for physical exertion. In order to get the exercise necessary to stay healthy, we have to “go work out.” Most of us are dropping the ball on this; and thus, America is gaining weight. This combined with fast food and fat filled diets are causing diabetes to be on a continual rise. Unfortunately, many underestimate the severity of the disease. Diabetes is a very serious condition that has many complications which includes blindness, cardiovascular disease, kidney failure, and foot ulcerations. These complications are acquired over time and greatly increase mortality rates. A person diagnosed with diabetes before the age of 40 will lose 15-20 years of their life!
Out of all of the complications linked to diabetes, the complication that causes the most hospitalizations is foot ulceration. Many of these ulcers may lead to amputations and this greatly increases the mortality rate. A person has a better chance of survival with colon or breast cancer than they do having a diabetic amputation. There are several reasons why diabetes has such strong effects on the feet; all of these complications combine into a formula for disaster if one does take proper measures to protect their feet and their health.
Causes foot ulcers 1o1
1) Macrovascular/Microvascular complications. Diabetes is the inability of the body to control blood glucose levels. The rise in blood glucose, or hyperglycemia, is when there is excess sugar in your blood stream. This can facilitate clot formation and increase your chance of heart attack and stroke, but more commonly leads to micro vascular complication that decreases your blood flow in small vessels and in your extremities. A decrease in blood supply in an area, such as the foot, makes it difficult for your body to keep those tissues healthy.
2) Foot deformities. The excess sugar in circulation can deposit in tissues and joints and lead to foot deformation. Diabetics may see changes in their foot structure or feel pain with motion. In very serious cases, the foot develops Charcot’s foot. In this instance, the bones in the foot are actually being destroyed. The deformity is often described as the foot becoming a” bag of bones.” These deformations change how forces are applied across the foot. Normally, when walking, weight is nearly evenly distributed across your foot, deformations cause increases in pressure at certain areas. This facilitates tissue break down
3) Peripheral Neuropathy. Neuropathy is the loss of nerve function. The nerves most commonly affected are sensory nerves. Over time, diabetics experience nerve damage due to the increased levels of sugar. Initially, this damage presents as tingling and burning but eventually leads to loss of feeling. Thus, diabetics lose the ability to feel pain, the body’s natural warning sign. It is very dangerous for diabetics to be unable to perceive a problem in the foot. For an example: If one steps on a piece of glass, they would be unaware and walk around on the glass all day.
Preventing Ulcers 101?
1) Controlling your blood sugar levels with diet and exercise is the best way to prevent all diabetic complications. When diet and exercise is not enough, there are medications that can assist your body in maintaining appropriate amounts of sugar in your blood.
2) Inspect your feet regularly. Look in-between your toes under and all around. Watch your feet for any changes in appearance, temperature, and feeling. Before or when changes are noted, contact a podiatric physician. A podiatric physician can help prevent and accommodate changes in your feet due to diabetes.
3) Avoid walking around barefoot, in sandals, or any other open shoes. This leaves your feet vulnerable to getting cuts, bruises, bumps, and infections.
Diabetes is a multisystem disease that can cause many complications. Foot ulcers are highly prevalent, but also highly preventable. It is important to consult your physician to help you control your blood sugar levels. Podiatric Physicians are foot specialist that have extensive training in diabetic feet and wound care. They will provide you with the best care to prevent foot ulcers and amputations, the leading cause of diabetic hospitalizations.

Diabetic Neuorpathy

Burning, tingling, and numbness in your toes and feet may be the first signs of diabetes. Peripheral neuropathy is a dysfunction of nerves and is commonly seen in the hands and feet. There are two types of nerves that may be affected: small nerve fibers, and large nerve fibers. Small nerve fiber damage will cause abnormal sensation and large nerve fiber damage leads to decreasing sensory perception and coordination. Damage to these nerves can be caused for several reasons, but the most common is diabetes. The progression of the neuropathy is highly dependent on the glucose levels in the blood, though the exact mechanism of damage is still unknown.

In uncontrolled or undetected diabetes, there are abnormally high levels of glucose or “sugar” in the blood. The abnormal levels of glucose causes multiple problems in your body including, eye, kidney, and cardiovascular damage. Often, the first problem noticed is the atypical sensations in the feet caused by peripheral neuropathy or nerve dysfunction. The symptoms are progressive and start at your toes and move up like a sock. Diabetic patients often complain of tingling, burning, numbness sensations, similar to the sensations a person feels when their foot “falls asleep.” Over time, the damage will lead to complete loss in sensation. This is the leading cause for diabetic foot ulcerations. A person with lost foot sensation still has motor (muscle) function and can continue to walk, but they are unable to detect sores or pain. Unknown sores on the feet combined with other diabetic complications leads to ulcers (open sores) and sometimes amputations.

To assess your peripheral nerve function, a podiatric physician can do several basic screening tests. While the patient’s eyes are closed, the podiatric physician uses several tools to test the small and large fiber nerves in the foot. Such tools consist of a Semmes Weinstein Monofilament (similar to fishing line), tuning fork, and a Q-tip. It is such a simple screen and takes only five minutes to perform, so, there is no excuse for diabetics or pre-diabetics not to get tested. Early detection of neuropathy can greatly decrease its progression and protect the feet from ulcers, infections, and even amputations.

Diabetes is one of the leading causes of death in the United States and the complications associated with the disease can greatly impede on a person’s quality of life. It is important to prevent and detect diabetes early to avoid and slow down the debilitating damage of the high glucose levels in the blood. Diabetes has a great effect on a person’s feet and often shows some of the first signs of diabetic complications. Thus, one with diabetes or diabetic risk factors should pay close attention to their feet and contact their podiatric physician.