April 7, 2015

Foot Care and Prevent Amputations – Part 3

I admit I do not appreciate people with diabetes that do not take care of their feet. Those that have been reading regularly, know that we have had problems with several of our new members that have had foot ulcers and heel cracks. Thankfully, we have taken care of those hurdles and our members are now more aware of problems that can happen to our feet.

Yes, foot problems are a common complication in people that have diabetes. This happens because too many people take their feet for granted and do not think they can have foot problems. When foot complications do occur, daily attention to your feet will ensure that the problems are detected before they become serious. It may take time and effort to build good daily foot care habits, but self-care is essential. In fact, when it comes to foot care, the patient is a vital member of the medical team.

Diabetes can lead to many different types of foot complications, including athlete's foot (a fungal infection), calluses, bunions and other foot deformities, or ulcers that can range from a surface wound to a deep infection.

Poor circulation can be caused by longstanding high blood glucose. This can damage blood vessels, decreasing blood flow to the foot. This poor circulation can weaken the skin, contribute to the formation of ulcers, and impair wound healing. Some bacteria and fungi thrive on high levels of glucose in the bloodstream, and bacterial and fungal infections can break down the skin and complicate ulcers.

More serious complications include deep skin and bone infections. Gangrene (death and decay of tissue) is a very serious complication that may include infection; widespread gangrene may require foot amputation. Approximately 5 percent of men and women with diabetes eventually require amputation of a toe or foot. This tragic consequence can be prevented in most patients by managing blood glucose levels and daily foot care.

People who have had a previous foot ulcer are more likely to have future foot complications. Nerve damage, poor circulation, and chronically high blood glucose levels also increase the likelihood of foot complications.

It is important to wear shoes that fit well. Shoes that are too tight can cause pressure ulcers. Going barefoot, even in the home, should be avoided as this increases the risk of injury to the foot.

People with type 2 diabetes should have their feet examined once per year. During a foot exam, a podiatrist checks for poor circulation, nerve damage, skin changes, and deformities. Patients should mention any problems they have noticed in their feet. An exam may reveal decreased or absent reflexes or decreased ability to sense pressure, vibration, pin pricks, and changes in temperature.

Special devices, including a monofilament or tuning fork, can help determine the extent of nerve damage. A monofilament is a very thin, flexible thread that is used to determine if a patient can sense pressure in various areas of the foot. A tuning fork is used to determine if a patient can sense vibration in various areas, especially the foot and toe joints.

Possible foot problems:
  • Poor circulation
  • Nerve damage
  • Skin changes
  • Deformities

Controlling blood sugar levels can reduce the blood vessel and nerve damage that often lead to diabetic foot complications. If a foot wound or ulcer does occur, blood sugar control reduces the risk of requiring amputation. Foot care is important, although patients should also continue to follow other general guidelines for managing diabetes.

Finally, good foot care will help prevent the majority of amputations.

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