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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:

 

  1. Sensory (skin)
  2. Motor (muscle)

So, your nervous system regulates your muscles (skeletal, vital organs, eyes etc) and everything to do with your skin (sweating, sensation).

 

Since we are podiatrists, let’s look specifically at the foot. High sugar build up in the blood means sugar is deposited all around your body, destroying the nerve endings as it collects in the compact spaces of the micro-anatomy. A damaged nerve stops sending signals or slows down the signals sent, for example, you then won’t feel if you step on a nail, a creature bites you or your shoes were rubbing and blistering your skin.

 

Therefore nerve damage causes you to lose feeling in your feet meaning you may not feel temperature, pain, itchiness, foreign objects, not to mention your eyesight diminishes making you unable to see your feet. 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 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.

 

Diabetic foot problems that can occur

Corns & Callus

Areas of high pressure, skin thickens causing pain when walking. Needs mechanical debridement, offloading and care.

Blister

Skin lifts filling with fluid, due to friction and high pressure i.e. ill-fitting shoes.

May need sterile draining and dressing.

Ingrown Toenails

Nail corner digs into side of toe, breaking the skin. Spikes may be present from not cutting nails properly. It may be infected or recuurent, best to have it seen too sooner than later, minimize the nail bed damage.

Bunions

Lump at the side of your foot due to abnormal biomechanics and excessive forefoot pressure. You are lacking support along your foot.

Plantar Warts

Virus that enters the skin, builds up a lesion of thickened, distorted skin with black dots in the centre. These require treatment to avoid spreading them.

Hammer Toes

Weakness in your joints + nerve contractions may lead to toe deformities. These create high pressure areas and make it difficult to buy footwear.

Dry/Cracked Skin

Can be due to high blood glucose, nerve damage, poor blood circulation or neglecting the skin. Dry cracks become portals for infection.

Fungal Infections

These thrive in Singapore’s humid weather and with poor hygeine.

Infection

Redness, swelling, increasing pain and pus. This may need antibiotics.

Eye Sight

Unable to see your nails to trim them without injury.

Feeling

Unable to feel if you stepped on something, or if your shoes are rubbing.

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 Dr or Podiatrist will put you into a cast boot with minimal walking instructed. Surgery may be needed to reconstruct the bones.

 

Podiatrists would help you make diabetic orthotics for your shoes to hold the foot, protecting it after changing shape.

 

Yearly foot checks are recommended to monitor for nerve damage, lack of sensation, blood flow assessment, reminders on caring for your feet, trimming nails, reducing callus educating on footwear and making orthotics if needed. Specialists aim to keep you low risk of developing wounds and deformity.

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.

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