Diabetic Foot Conditions
Diabetes affects your whole body and with uncontrolled diabetes, you will be seeing a podiatrist quickly as the damage to the foot is immense.
Too much blood glucose (sugar) can cause irreversible damage to your nervous system, this may not sound much but let’s look closer at what your nervous system does for you. Your nervous system is vast and runs from your head to your toe but there are two main parts we focus on:
- Sensory (skin)
- Motor (muscle)
So, your nervous system regulates your muscles (skeletal, vital organs, eyes etc) and everything to do with your skin (sweating, sensation).
High sugar build-up is very harmful to the organs of the human body. It causes the destruction of nerve endings as it collects in the compact spaces of the micro-anatomy. A damaged nerve retards the signals sent to the brain and as the conditions worsen, the nerves may stop communicating with the brain completely.
When this happens, diabetic patients will start to lose sensation and may not be able to feel temperature, itchiness or even pain in their feet. This loss of sensation usually results in undetected ulceration and the development of wounds.
On the contrary nerve damage can cause immense pain and foot deformities such as hammer, claw, and mallet toes, high arches and bunion development. This leads to high-pressure areas across the feet.
If wounds develop (due to increased pressure or injury) then increased blood sugars will feed any infection present making the wound worse. The longer you have a wound the greater the chance of infection. Or even a small fungal infection may enter your skin and become a rapidly spreading soft tissue infection or sepsis.
Excessive blood sugars contribute to reduced blood flow (high cholesterol, high blood pressure, sedentary lifestyle). Basically, not enough blood flow means a wound cannot be supplied with the nutrients and oxygen it needs. This is called Peripheral Arterial Disease (PAD). Patients suffering from PAD have a high chance of developing gangrene (tissue death).
Treating small wounds or sores quickly reduces your chances of developing an infection. It is not that getting a wound means it won’t heal, it just takes longer to heal. Long-term uncontrolled diabetes may need surgical intervention to improve circulation, remove infected tissue or amputate areas of tissue death.
Charcot Foot
Uncontrolled diabetes means you may not be able to feel excessive pressure on your feet and blood supply to the foot may be reduced. This may soften and shift your bones while weakened muscles make you unbalanced. The soft tissues and foot joints become destroyed with fluid collecting and the foot deforming. Charcot foot occurs quickly.
You may or may not sense pain meaning you may continue to walk on your foot leading to bone fractures. However, you may have warm, swollen feet. This is a serious diabetic foot complication and your Doctor or Podiatrist will put you into a cast boot with minimal walking instructed. Surgery may be needed to reconstruct the bones.
Podiatrists would design diabetic custom orthotics to support the diabetic foot, protecting it from further deformity.
Annual diabetic foot screenings are highly recommended for diabetic patients to check their feet for any signs of nerve damage, lack of sensation and undetected diabetic wounds and ulcers. The podiatrists will also conduct a blood flow assessment and provide regular reminders on diabetic foot care. Nail trimming and debridement services on diabetic feet should only be performed by qualified podiatrists.
How to care for your feet
- See your podiatrist yearly
- Check your feet daily, use a mirror if you can not reach
- See your podiatrist if you are having foot problems
- Regulate your blood sugars, see your doctor and dietician if you are struggling
- Wash and dry your feet thoroughly, daily, especially between the toes
- Try not to soak your feet as this dries out the skin causing your skin barrier to weaken
- Use emollient daily to help soften your skin
- Avoid putting creams between your toes, this will increase bacterial and fungal growth
- File or slowly trim your toenails, as long as you can see and feel your feet
- Wear supportive footwear outdoors
- Wear cushioned, supportive sandals in the home
- Be aware of shoe shape when buying footwear
- Buy footwear at the end of the day as your feet swell
- Break in new shoes slowly
- Don’t keep still for too long as the circulation can reduce
- Quit smoking
Smoking and diabetes is a dangerous mix, as it:
- Reduces blood supply to limbs by narrowing and hardening blood vessels
- Increases cholesterol and blood pressure
- Increases disease risk for heart attack, nerve disease, kidney disease and amputation.
Singapore Diabetic Foot Centre (SDFC) is a specialised service by East Coast Podiatry. SDFC employs a specialised podiatric method to rapidly heal various diabetic foot conditions for the prevention of lower limb amputation.
