Diabetes is a serious disease that affects millions of Americans,
and that number is going to astronomically grow as the baby boomer
generation ages further. Complications associated with diabetes can be
devastating, and can lead to organ failure and even death. Foot-related
complications in particular are very common in diabetes, and
unfortunately cause the majority of leg amputations performed by
surgeons. Comprehensive care by a podiatrist can identify foot problems
early before they lead to leg loss, and in many cases can prevent those
problems in the first place. This article will discuss the ways a
podiatrist can protect diabetic feet, and ultimately save a diabetic's
limb and life.
Diabetes is a disease in which glucose, the body's
main source of 'fuel', is not properly absorbed into the body's tissues
and remains stuck in the bloodstream. Glucose is a type of 'sugar'
derived from the body's digestion of carbohydrates (grains, breads,
pastas, sugary food, fruits, starches, and dairy) The body needs a
hormone called insulin, which is produced in the pancreas, to coax the
glucose into body tissue to fuel it. Some diabetics are born with or
develop at a young age an inability to produce insulin, resulting in
type 1 diabetes. The majority of diabetics develop their disease as they
become much older, and the ability of insulin to coax glucose into
tissue wanes due to a sort of resistance to or an ineffectiveness of the
action of insulin. This is called type 2 diabetes. Diabetes can also
develop from high dose steroid use, during pregnancy (where it is
temporary), or after pancreas disease or certain infections. The high
concentration of glucose in the blood that remains out of the body
tissue in diabetes can cause damage to parts all over the body. Organs
and tissue that slowly are damaged by high concentrations of glucose
stuck in the blood include the heart, the kidneys, blood vessels, the
brain, the nerve tissue, skin, and the immune and injury repair cells.
The higher the concentration of glucose in the blood, and the longer
this glucose is present in the blood in an elevated state, the more
damage will occur. Death can occur with severe levels of glucose in the
blood stream, although this is not the case in most diabetics. Most
diabetics who do not control their blood glucose well develop tissue
damage over a long period of time, and serious disease, organ failure,
and the potential for leg loss does eventually arrive, although not
right away.
Foot disease in diabetes is common, and one of the
more devastating and taxing complications associated directly and
indirectly with high blood sugar. Foot disease takes the form of
decreased sensation, poor circulation, a higher likelihood of developing
skin wounds and infections, and a decreased ability to heal those skin
wounds and infections. Key to this entire spectrum of foot complications
is the presence of poor sensation. Most diabetics have less feeling in
their feet than non-diabetics, due to the indirect action increased
glucose has on nerve tissue. This decreased sensation can be a
significant numbness, or it can be a mere subtle numbness that makes
sharp objects seem smooth, or erases the irritation of a tight shoe.
Advanced cases can actually have phantom pains of burning or tingling in
addition to the numbness. With decreased sensation comes a much greater
risk for skin wounds, mostly due to the inability to feel pain from
thick calluses, sharp objects on the ground, and poorly fitting shoes.
When a wound has formed as a result of skin dying under the strain of a
thick corn or callus, from a needle or splinter driven into the foot, or
from a tight shoe rubbing a friction burn on the skin, the diabetic
foot has great difficulty starting and completing the healing process.
Untreated skin wounds will break down further, and the wound can extend
to deeper tissue, including muscle and bone. Bacteria will enter the
body through these wounds, and can potentially cause an infection that
can spread beyond the foot itself. A diabetic's body has a particularly
difficult time defending itself from bacteria due to the way high
glucose affects the very cells that eat bacteria, and diabetics tend to
get infected by multiple species of bacteria as well. Combine all this
with decreased circulation (and therefore decreased distribution of
nutrients and chemicals to preserve foot tissue and help it thrive), and
one has all the components in place for a potential amputation.
Amputations are performed when bacteria spreads along the body and
threatens death, when wounds and foot tissue will not heal as a result
of gangrene from advancing tissue death and infection, and when poor
circulation will not allow the tissue to thrive ever again. The
statistics following a leg amputation are grim: about half of diabetics
who undergo one amputation will require an amputation of the other foot
or leg, and about that same number in five years will be dead from the
heart strain endured when one's body has to expend energy to use a
prosthetic limb.
A podiatrist can ensure that all the above
complications are significantly limited, and in some cases prevented all
together. Podiatrists are physicians who specialize solely in the care
of foot and ankle disease, through medicine and surgery. The attend a
four year podiatric medical school following college, and enter into a
two or three year of hospital-based residency program after that to hone
their advanced reconstructive surgical skills, and to study advanced
medical. Podiatrists are generally considered the experts on all things
involving the foot and ankle, and their unique understanding amongst
other medical specialties of how the foot functions in relationship to
the leg and ground (biomechanics) allows them to target therapy towards
controlling or changing that function in addition to treating tissue
disease. A great majority of the problems that lead to diabetic
amputations start off as problems related to the structure of the foot
and how it relates to the ground and to the shoe worn above. Controlling
or repairing these structural problems will often result in prevention
of wounds, which in turn will prevent infection, gangrene, and
amputation.
To start with, a podiatrist will provide a diabetic
patient with a complete foot exam that takes into account circulation,
sensation, bone deformities, and skin issues, and pressures generated by
walking and standing. From this initial assessment, a protection and
treatment course can be created specific to the individual needs of the
diabetic for maintenance, protection, and active treatment of problems
that do develop. Commonly performed maintenance services include regular
examinations several times a year to identify developing problems, care
of toe nails to prevent a diabetic with poor sensation from
accidentally cutting themselves when attempting to trim their nails,
regular thinning of calluses to prevent wounds from developing, and
repetitive education on diabetic foot problems to ensure proper habits
are followed. Preventative services include using special deep shoes
with protective inserts in diabetics at-risk for developing wounds from
regular shoes, assessment of potential circulation problems with prompt
referral to vascular specialists if needed, and possible surgery to
reduce the potential of wounds to develop over areas of bony
prominences. Active treatment of foot problems performed by a podiatrist
involves the care and healing of wounds, the treatment of diabetic
infections, and surgery to address serious foot injury, deep infections,
gangrene, and other urgent problems. Because of a podiatrist's unique
understanding of the way the foot structure affects disease and injury,
all treatment will be centered around the principles of how the foot
realistically functions in conjunction with the leg and the ground. This
becomes invaluable in the struggle to prevent diabetic wounds and
infections, while allowing one to remain mobile and active at the same
time.
The essential goal of a podiatrist in caring for a diabetic
patient is to prevent wounds, infections, and the amputations that
result. This philosophy is called limb salvage, and it is accomplished
through the above listed methods. Because of the severity of foot
disease as a complication of diabetes, a podiatrist is an integral part
of a diabetic's care, and sometimes can even be the physician that
diagnoses diabetes in the first place if foot disease appears as an
early symptom of undiagnosed diabetes. For these reasons, all diabetics
should be assessed by a podiatrist for potential problems, and those
at-risk for foot wounds and infections should have regular foot
examinations and preventative treatment. As a final note, online
resources by podiatrists discussing diabetic foot issues abound,
including a regular blog by this author ( thediabeticfoot.blogspot.com
). While these resources do not replace a diabetic foot exam, they do
help educate diabetics on how best to care for their feet, and what to
do if problems develop. This can lead to better knowledge and
understanding of foot issues when diabetics begin to see a podiatrist
regularly, and can help prevent early foot complications from
developing.]
Dr. Kilberg provides compassionate and complete foot and ankle
care to adults and children in the Indianapolis area. He is board
certified by the American Board of Podiatric Surgery. He enjoys
providing comprehensive foot health information to the online community.
Visit the website of this Indianapolis foot doctor for more information.
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