The cause of a foot problem in a patient with diabetes is usually multifactorial due to decreased sensation to the foot, poor circulation, and a decreased resistance to infection. Foot deformities with trauma also plays a major role in causing ulcerations and infections.
Your ability to detect sensations or vibration may be diminished, allowing injuries to remain untreated for lengthy periods of time. Neuropathy can also become very painful, and affect nerves that supply the muscles in your feet and legs to weaken them causing development of hammertoes, bunions, or other foot deformities.
People with diabetes often have poor circulation. Some symptoms are cramping in the legs and buttocks while walking. There may also be color and temperature changes noted to the foot. The skin sometimes becomes shiny, thinned, and easily damaged. The nails may become greatly thickened with afungus infection. The hair growth on the toes may lessen. Poor circulation restricts the proper flow of blood to the feet which is needed to supply oxygen and nutrients for normal maintenance and repair of tissue. Sometimes special vascular studies need done, or your podiatrist may refer you to a vascular surgeon. Peripheral vascular bypass operations may prevent lower extremity amputations.
People with diabetes are more prone to infections, due to deficiencies in the ability of white blood cells to defend against invading bacteria. Infections may be undetected due to neuropathy. Sometimes unexplained high blood sugar with or without a fever may be a sign of an infection. Some infections require hospitalization to receive the proper antibiotics or debridement of an ulcer.
People with diabetes often acquire foot deformities such as hammertoes,bunions, or metatarsal disorders. These may first be seen with thickened skin like a corn or callous. Sometimes surgery is the best line of defense to prevent an ulcer or infection from developing. Your podiatrist can advise you on this. Special deformites can occur when there is great circulation, but poor sensation. A charcot joint results from trauma to a foot with decreased feeling. It is sometimes first noted by a great deal of redness and swelling. If this occurs it is important to stay off your foot and call for an immediate appointment with your podiatrist or other physician.
Your cooperation is an important step in your foot care. You must guard against injury and provide the daily care necessary to maintain the health of your feet. Here are a few basic guidelines to follow:
Inspect your feet daily for blisters, bleeding, and lesions between the toes. If you cannot see your feet well, ask a relative, neighbor, or place a mirror on the floor to see the bottom of your feet and heels.
Do not soak your feet, wash them daily with warm, soapy water, and dry them well, especially between the toes.
Avoid temperature extremes, do not use hot water bottles, or heating pads on your feet. Test temperature of water with your hand or other body part with good sensation.
Do not use acids or chemical corn removals, do not perform bathroom surgery on callouses, corns, or ingrown nails.
Trim your toenails carefully and file them gently. If you cannot trim them yourself without difficulty see your podiatrist for this.
Do not smoke.
Educate yourself as much as you can about diabetes and how it can affect your feet.
See your podiatric surgeon on a regular basis for a foot examination. Contact them immediately if your foot becomes swollen, painful, or if redness occurs.