Diabetic Foot

Diabetes – An Overview

Diabetes mellitus is a chronic condition caused by too much glucose in your blood. Your blood sugar level can be too high if your body doesn't make enough of the hormone insulin. Insulin is produced by the pancreas (a gland behind the stomach) and moves glucose out of the blood and into cells, where it's broken down to produce energy.

If diabetes is not treated, it can cause long-term health problems because the high glucose levels in the blood damage the blood vessels.

Type 1 or insulin-dependent diabetes

In type 1 diabetes the body produces little or no insulin. Someone with this type of diabetes needs treatment for the rest of their life. They must check the levels of glucose in their blood regularly and watch out for complications. Type 1 diabetes is also known as juvenile diabetes or early onset diabetes because it usually develops before the age of 40, often in the teenage years.

You're more at risk of type 1 diabetes if it runs in your family.

Type 2 or non-insulin dependent diabetes

Nine out of 10 people with diabetes have type 2 diabetes, which means their body doesn't make enough insulin or cannot use insulin properly. Type 2 diabetes used to be referred to as maturity onset diabetes because it occurs mostly in people over the age of 40.

Type 2 diabetes is closely linked to obesity. You're also more at risk of developing type 2 diabetes if:

· you have high blood pressure or high cholesterol,

· type 2 diabetes runs in your family,

· you're of Asian, Afro-Caribbean or Middle-Eastern background, or

· you're a woman who has given birth to a large baby (over 9 lbs/4 kg).

The risk of developing type 2 diabetes also increases as you get older.

Diabetes - Affecting The Foot

One of the first ways in which diabetes may affect your feet is through the loss of sensation within your feet, often starting at the toes. You may experience a cotton wool like feeling or numbness in your feet, this is called neuropathy. Your chances of losing feeling in your feet increases with the number of years that you have diabetes.

The onset of neuropathy is gradual and often people who develop this complication are unaware of it in the beginning. Often it occurs between 7 and 10 years of having diabetes, although in some cases it can occur sooner where blood sugar levels have not been so well controlled.

If you have lost feelings in your feet then it is possible that you may unknowingly damage your feet. You may stand on sharp objects like a nail, piercing the skin even down to the bone without realising. If unnoticed and not treated appropriately this can have potentially serious consequences and could lead to an amputation. Such an outcome is less likely if you seek expert advice from your podiatrist or visit your diabetic clinic.

This explains why your podiatrist checks your ability to feel pressures on the soles of your feet and toes every year. If you are forewarned that you have lost or are losing feeling then you will be able to reduce the risk of problems occurring by undertaking daily inspections of your feet and taking precautions such as not walking bare footed or sitting too close to fires.

Occasionally people with loss of feelings can sense a burning pain in their feet. This can be severe and worse at night, they can find contact from socks and shoes can cause discomfort. This is called painful peripheral neuropathy. If you experience these symptoms it is advisable to consult your podiatrist since it is possible in many cases to alleviate the symptoms.

Diabetes can also affect blood supply to and within your feet; this can delay healing and increase your risks of infection. Because the implications of poor blood supply can have serious consequences for your feet, your podiatrist will routinely screen your feet for signs of poor blood flow

Diabetic Neuropathy

Diabetic neuropathy means damage of nerve fibres in people with diabetes. How the nerves are injured is not entirely clear but research suggests that high blood glucose changes the metabolism of nerve cells and causes reduced blood flow to the nerve. There are different types of nerves in the body. These can be grouped as:

· Sensory (detect sensation such as heat, cold, pain)

· Motor (contract muscles to control movement)

· Autonomic (regulate functions we cannot control directly, such as heart rate and digestion)

The most common type of diabetic neuropathy affects the nerves in the legs and is usually known as peripheral neuropathy. This is the type of neuropathy that causes foot problems. It affects mainly the sensory nerves although the motor and autonomic nerves can also be involved with important consequences.

What problems can be caused by diabetic neuropathy?

Neuropathy can result in two sets of what superficially appear to be contradictory problems. Most patients who have neuropathy have one of these problems but some can be affected by both.

  1. Loss of ability to feel pain and other sensation, which leads to neuropathic ulceration.

  2. Symptoms of pain, burning, pins and needles or numbness, which lead to discomfort.

Patients with neuropathy lose their sensation of pain. As a result, they exert a lot of pressure at one spot under the foot when they walk, building up a callus at that site without causing discomfort. The pressure becomes so high that eventually it causes breakdown of tissues and ulceration. The patient hardly notices any pain.

Therefore a typical neuropathic ulcer is:

· Painless · Surrounded by callus · Associated with good foot pulses (because the circulation is normal) · At the bottom of the foot and tips of toes

Please note if neuropathic ulcers occur elsewhere in the foot, it is usually due to footwear that is too tight.

Keep Your Feet Healthy – Top Tips

Following a daily routine to keep your feet clean and free from infection will help prevent potential foot problems. You should also make sure your footwear fits well and doesn't put pressure on or rub any part of your foot. A good way of ensuring this is to get your feet measured. People who suffer with neuropathy can often be wearing shoes that are a size too small.

If you can see and reach your feet cut them after a bath when the nails are softer. Remember to cut them following the shape of the toe, and not too short. File them, if that is easier

To keep corns and hard skin under control use a foot file, emery board or pumice stone. Don't cut corns for yourself, or apply 'over the counter' lotions or acids unless prescribed by your Podiatrist or Healthcare Practitioner. If you have previously been advised that you can use ‘over the counter’ lotions check each year that this is still okay.

Any minor cuts or abrasions should be covered with a clean dry dressing, and blisters should be left to dry out on their own. If they burst, apply a clean dry dressing, but do not burst them yourself. Seek Podiatric treatment if they do not heal quickly. Wounds (called ulcers) should be assessed and treated as a matter of urgency within 24hours, especially if there is redness or swelling around the area, or were you have previously been warned to seek immediate attention

Please consult your Podiatrist.