Diabetic Foot Conditions

Why do diabetics have foot problems?

Insulin is a hormone that is vital to the maintenance of healthy metabolic activity. It enables cells to absorb sugar from the blood (blood glucose) and then convert that sugar into energy. Diabetes impedes the body's ability to produce insulin and to utilize whatever insulin is produced.

When diabetes reduces the body's ability to either produce insulin or use it to create energy, excess sugar continues to circulate in the bloodstream. High blood sugar causes multiple types of health problems. Two of those problems primarily affect the feet.

The primary foot conditions caused by diabetes are diabetic neuropathy and peripheral vascular disease. More than 50% of diabetics have one or both of these potentially serious conditions.

Diabetic neuropathy and peripheral arterial disease often combine to cause severe health problems that, if not promptly treated, can lead to gangrene, amputation, or even death.

Many diabetic patients aren't aware of the serious health risk posed by minor foot conditions. Early treatment of such conditions can prevent further complications.

What is diabetic peripheral neuropathy?

Diabetic neuropathy is called peripheral because it occurs in the extremities, away from your body's core organic structures. Uncontrolled diabetes can cause nerve damage, especially to nerve cells in the feet. This impairs the nervous system's ability to report pain to the brain. The decreased sensitivity can make it difficult or even impossible to become aware of foot injuries. Being unaware of injuries makes them more likely to be ignored and subsequently become infected.

What does neuropathy feel like?

The initial symptoms of diabetic peripheral neuropathy are numbness and tingling. 

In addition to damaging nerve cells, high blood sugar levels cause nerve cells to import water. This causes the nerve cells to swell, which in turn causes compression of the nerve tissue itself. Medical science has not yet discovered how to prevent the onset of diabetic neuropathy, but methods are available to slow or even halt its progression. This is accomplished by releasing the compression that affects both nerves and blood vessels.

When surgical decompression is performed early in the course of diabetic neuropathy, blood flow can be restored. This will alleviate the numbness and tingling and help the nerves to recover.

What is peripheral vascular disease (PVD)? 

Diabetes can negatively impact blood flow. Poor blood flow in the arms and legs (and hands and feet) is known as "peripheral vascular disease."

Poor circulation makes it harder for sores or cuts to heal. An infection or cut that won't heal due to poor blood flow puts you at risk of developing ulcers or gangrene. In extreme cases, amputation of part or all of the foot may be necessary.

Neuropathy and PVD can cause the following foot problems for diabetics: 

Foot ulcers (open sores on the feet) 

Foot ulcers are the most common diabetic foot complication. They occur in 15% of patients. Because of the loss of sensation caused by neuropathy and PVD, minor injuries can go unnoticed and untreated. 

Blisters and sores on the feet can provide an opening for bacteria and consequent infection. When these go untreated for significant periods of time, gangrene (tissue death) can occur. Severe cases can necessitate amputation of all or part of the foot.

Treatment of diabetic foot ulcers includes noninvasive remedies, designed to eliminate the pressure and friction that cause the ulcer. Doctors also use stem cell therapy to harness the body’s own healing power to heal foot ulcers.

As a last resort, surgical intervention is available for the resolution of otherwise intractable diabetic foot ulcers.

Diabetic foot osteomyelitis 

Osteomyelitis is a bone infection that often begins as a foot ulcer and then invades the bone structure of the feet. Because neuropathy and PVD make foot ulcers harder to feel, the infection can progress unnoticed.

Osteomyelitis is often responsive to a course of antibiotic treatment. When antibiotics are ineffective, surgical removal of the affected portions of the foot may be required.

Charcot foot syndrome

Sometimes diabetic neuropathy and peripheral vascular disease can jointly cause softening of the bones in the foot. This makes the bones more vulnerable to fracture. The resulting bone disintegration can severely deform the foot’s configuration. Although rare, this condition is one of the most serious that can confront diabetics.

The most effective treatment for Charcot foot syndrome is to prevent it before it occurs. Diabetics should carefully inspect their feet for cuts or injuries each and every day.

Nonsurgical care for diabetic Charcot foot includes eliminating any weight-bearing and wearing a protective splint, walking brace, or orthotic. Severe cases of Charcot foot require installation of hardware (plates and screws) to restore an appropriate structure to the foot.

Cellulitis

Cellulitis is a bacterial infection of the skin and soft tissues. Diabetes may not be a direct cause of cellulitis. However, it can increase your risk of developing the condition. This is because a weakened immune system from diabetes increases your general risk of infection. 

Cellulitis of the foot in diabetic patients can quickly escalate if not caught early. With diabetic neuropathy, foot injuries can go unnoticed due to a lack of pain sensation. Unnoticed injuries can easily become infected, and a weakened diabetic immune system allows that infection to spread quickly.

How to care for diabetic feet

Diabetic neuropathy and PVD interrupt the nerve signals to the brain. This means that diabetics often obliviously suffer foot damage. Constant vigilance and good foot care are the answer.

Check your feet every day for anything unusual. Look for cuts, redness, swelling, sores, blisters, or any other alteration in the foot.

Make sure to check every part of the foot, including between the toes. Use a mirror or ask for help if you have trouble bending over to see your feet.

Keep a close eye for warm spots, warts, and athlete's foot. (A "hot spot" can be an early sign that a blister or ulcer is forming. Cover any existing blisters, sores, or cuts with a bandage to keep it clean.

How to take care of your feet

• Wash your feet every day in warm (not hot) water. Dry your feet completely and apply lotion to the top and bottom to prevent dry skin. Dry, cracked skin is vulnerable to infection. 
• Use talc between the toes to keep them dry and avoid fungal infection.

• 

  Never go barefoot. Always wear shoes, even indoors, make sure that there are no objects inside your shoes and that the shoe’s lining is smooth. Always wear socks with your shoes.
• Make sure your shoes fit perfectly. Get fitted for new shoes towards the end of the day, when your feet have expanded.
• Special shoes can help if you're suffering from a bunion, hammertoe, or other foot deformities.
• Trim your toenails straight across, and gently smooth any sharp edges. This will help prevent ingrown toenails. If you struggle reaching your toes, talk to your podiatrist about having your toenails professionally trimmed.
• Get expert help from your diabetes care team in dealing with corns and calluses, and don’t use over-the-counter products to remove them. You may be able to gently smooth corns and calluses with a pumice stone.
• Have a regular diabetic foot exams with your podiatrist.
• Keep the blood flowing. Elevate your feet when you’re sitting and flex your feet and wiggle your toes for a few minutes several times throughout the day.
• Give your feet some exercise by walking, riding a bike, or swimming.
• Don’t smoke (this is good advice in any context).
• Work with your healthcare team to keep your diabetes under control.

When to see a doctor about your diabetic foot problems 

If you have type 1 or type 2 diabetes you should already be seeing a doctor regularly. However, if you notice any of the following changes or new symptoms you should seek medical attention:

• Changes in skin color of the foot
• Swelling in the foot or ankle
• Temperature change in the foot
• New pain or tingling in the feet or lower legs
• Athlete's foot or another fungal infection
• Signs of infection
• A new cut or blister

Why choose University Foot and Ankle Institute for diabetic foot care? 

If you’re experiencing problems with diabetic feet or any other foot issues, we’re here to help. Our nationally recognized foot and ankle specialists have decades of combined experience treating diabetic foot conditions including Charcot foot, diabetic neuropathy, ulcers, and infections. The physicians at University Foot and Ankle Institute offer state-of-the-art diabetic care, helping to reduce complications and improving long-term foot health.

At University Foot and Ankle Institute, we take our patients’ safety seriously. Our facility’s Covid-19 patient safety procedures exceed all CDC recommendations.

For more information or to schedule a consultation, please call (877) 736-6001 or make an appointment online now.

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area as our foot doctors are available at locations in or near Santa Monica (on Wilshire Blvd.), Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia California, to name a few.