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The Diabetic Foot
Five percent of the United States population suffers with diabetes mellitus. Once diagnosed, treatment consists of either dietary control, oral medication, insulin or a combination of these therapies. The effects of diabetes on the lower extremities, and the feet specifically, present a great challenge to the podiatrist.
Perhaps the most common consequence of diabetes to the foot is neuropathy. Neuropathy means functional disturbances or pathological changes in the peripheral nervous system. Neuropathy may cause unpleasant burning or tingling sensations, or may render the foot incapable of feeling any sensations.
At least 35% of all diabetics will develop neuropathy. Neuropathy is not related to the severity of the diabetes. Pain from improper fitting shoes and bony pressure go unnoticed, and ulcerations (breaks in the skin due to unremitting pressure) frequently result.
Diabetics have a decreased resistance to infection. When this is coupled with neuropathy an infection may worsen considerably before the patient is even aware of it. Neuropathy may also cause bony changes resulting in a condition known as Charcot's joint(an arthritic condition).
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Another major complication associated with diabetes is impairment of circulation. Many diabetics have decreased circulation in their feet. This causes the feet to feel cooler than normal. Because of poor circulation, many diabetics have problems healing from minor cuts or abrasions on the feet. The tendency is greater for diabetics to get infections. Once they get these infections, they usually take longer to heal. This is why diabetics should never try treating their own feet. They should avoid all over the counter products which claim to remove corns and calluses. Also they should never use a razor blade on their feet.
Podiatric treatment of diabetics is multifaceted. The diabetic should be examined at regular intervals. Corns, callouses, and nails (which are frequently thick and discolored) should be cut or pared down during these examinations. Pressure from bony prominences are usually treated with molded shoes or orthotics (a special type of shoe inlay). In certain cases, surgery may be necessary.
Diabetes is a disease with numerous medical and podiatric problems. While there is no cure, treatment is available and should be sought to pre vent the long term consequences of this disease.
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