Diabetes

Diabetic patients are particularly at risk for significant foot problems that can lead to the loss of their feet or legs. The most common cause of hospitalization for the diabetic patient is foot infections. Foot related problems for the diabetic patient are responsible for significant time off work. Foot ulcerations can take weeks or months to heal.

The doctors at Bay Area Podiatry are experts in the treatment of diabetic foot disorders, infections, and limb saving techniques. Both doctors are members of the American Diabetes Association and attend regular educational meetings dealing with the treatment of the diabetic's foot conditions.

There are two conditions that are associated with diabetes that put the patient at risk. The first is called neuropathy, which is a nerve condition that frequently affects the feet. There is a gradual loss in the patient's ability to perceive the protective sensations. The protective sensations are the ability to feel pain, to feel the difference between hot and cold, sharp and dull, vibration, and excessive pressure. This loss of sensation can become quite profound. Patients can step on sharp objects or cut themselves and not feel pain. They may burn themselves with scalding water and not be aware of it, and they can develop pressure sores and infections and experience little or no pain.

Because of this condition, diabetic patients must be constantly aware of their feet and inspect them daily. They should avoid walking barefoot and always check the temperature of their bath water or foot baths prior to immersing their feet. Special care should be taken when trimming the toenails. The sharp trimming of corns and calluses and over-the-counter corn removers should be avoided. Shoe gear must be appropriately fitted to avoid areas of irritation. Frequently this condition causes a burning pain that makes sleeping difficult. Other patients may feel like their feet are ice cold and have difficulty warming them. These patients must not use heating pads or hot water bottles to warm their feet or they risk burns to the skin that may not heal and could lead to the loss of their foot or leg.

The other condition is called angiopathy, which is the loss of blood circulation to the feet and legs. Loss of circulation results in prolonged healing of cuts or sores on the feet. In severe cases it can lead to gangrene and limb loss. This condition is often accompanied by thinning of the skin, loss of hair growth and color changes to the feet. The feet are cool to the touch and can be very sensitive, making it painful to walk for even short distances.

Of course, the diabetic may have both of these conditions. In this situation, the patient is at significant risk of limb loss and must be monitored very closely.

Common problems the diabetic might encounter are ingrown or fungal toenails, thick calluses on the bottom of the feet, or corns on or between the toes. These relatively simple problems are the precursors of more significant problems. Our recommendation is that diabetic patients have their feet checked on a regular basis by a podiatrist. If they notice any areas of possible skin irritations, sores, or infection, they should be treated professionally by a podiatrist. If they notice a change in the shape of their feet, the arches falling, or notice swelling of sudden onset, they should be seen by a podiatrist. The diabetic patient's best defense against infections and possible loss of feet or legs is prevention by daily inspection and having regular foot exams.

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