The foot is one of the greatest risk areas for diabetics with over 80,000 amputations performed in the United States per year. The neurological and circulatory systems are most affected in the lower extremities of diabetics.
The abnormal blood sugar in a diabetic affects the nerves by two mechanisms. The first being a direct injury to the nerve’s insulating cover. The second is a result of sugar crystals depositing within the nerve. This causes fluid to be absorbed into the nerve branches with resultant swelling. The nerve then exceeds the size of the tunnels it courses through causing entrapment and ultimate degeneration of the nerve fiber. Symptoms often begin with tingling and numbness in the toes eventually working up to the height of a pair of stockings. As the nerves begin to die there is often burning pain in the foot. These abnormal sensations are often most noticeable while lying in bed at night. The risk comes as protective sensation is lost and injuries occur without being noticed. Secondary infection then commonly develops, and if untreated advances to the bone and subsequently amputation is necessary.
The disease of diabetes accelerates arteriosclerosis with resultant obstruction of blood vessels. It is considered a small vessel disease, and therefore can interfere with blood flow into the vessels of the toes and ultimately the feet. This places the diabetic at great risk as they are unable to heal from the simplest of injuries.
All diabetics should develop a habit of daily examination of their feet looking for any breaks in the skin, blisters, redness or swelling. Also, one should never go bare footed. Always check the inside of the shoe before its application to ensure there are no rocks or sharp objects within the shoe.
Diabetic Foot Ulcerations
Diabetic foot ulcers most commonly occur on the bottom of the foot or toes. Treatment of an ulcer may include x-rays to determine if there is any bone infection, a culture may be taken to determine what type of infection the patient has, and cleaning of the infected tissue may be necessary. It is very important to contact one of our specialists here at the Foot & Ankle Institute if you are developing an ulcer on your foot. A diabetic foot ulcer that is neglected can become infected and lead to the loss of a limb. We are affiliated with Memorial Hospital’s Center for Wound Care and dedicated to the successful treatment of diabetic wounds.
We at the Foot & Ankle Institute are experts in the management of the diabetic foot from preventative care to surgical reconstruction. Additionally, Dr. Zimmerman has undergone specialty training at the Institute for Peripheral Nerve Surgeons, John’s Hopkins University, for the restoration of sensation in the diabetic foot. This procedure is truly a break through in the world of diabetes.
For more information visit the American Diabetes Association at diabetes.org