Diabetic foot can affect anyone with diabetes and refers to any complication or pathology which occurs as a direct result of diabetes mellitus. There are various complaints including ulcers, infection and neuropathic osteoarthropathy, also known as Charcot’s Foot. The two main problems that frequently affect diabetics – nerve damage and poor circulation – can both lead to blisters and skin lesions which, if left untreated, can become infected and cause serious problems, in very extreme cases to the amputation of toes or feet. Prevention and appropriate foot care are therefore essential in order to detect problems early and minimise the consequences through appropriate therapy and care. Let’s first try to understand the causes and see what you can do to take good care of your feet.
The most frequent component of diabetic foot is diabetic foot ulcer. An ulcer is a sore or wound that does not heal: the skin has broken down and the tissue beneath is exposed. Diabetes interferes with the body’s natural wound healing process which means that lesions and blisters that heal quickly in a healthy person can quickly become infected if you have diabetes. Ulcers frequently start as the result of small cuts, blisters, or burns. They can also occur due to an ill-fitting shoe, a stone or a rough edge in your shoe that continuously rubs against your foot until the skin blisters or breaks. Diabetes patients are also prone to nerve damage (neuropathy) which occurs as a result of having higher blood sugar levels over an extended period of time. Chronic nerve damage can cause dry skin, and on your feet this can result in calluses and cracked skin. When the skin cracks bacteria can enter and cause infection. As nerve damage also leads to a loss of sensation in the feet, the blisters and sores which appear on calluses or other numb areas of your feet may go unnoticed and as you continue to walk on the “injured” foot their condition is aggravated and the wounds can easily become infected by bacteria.
Treatment for foot ulcers
If left untreated the consequences of foot ulcers can be serious, but luckily ulcers usually respond very well to treatment. If you suspect that you have a foot ulcer, speak to your doctor straightaway. The first step will be to put a protective dressing on the ulcer to prevent infection and give it the chance to heal. A nurse will replace the dressing regularly. You may also be referred to a podiatrist to remove any hard skin that could prevent the ulcer from healing, and if there is infection you may be prescribed antibiotics. Depending on the position and severity of the ulcer you may be advised to wear special diabetic shoes, or may be fitted with a brace or cast to take pressure off the ulcer and allow it to heal faster. In some cases a hospital stay for specialist treatment could be necessary, e.g. a small operation to remove dead tissue or to drain off pus. In order to prevent ulcers it is very important that you check your glucose levels regularly and keep them under control. You should also inspect your feet every day and check for cuts, blisters or any other changes. As poor-fitting shoes are the main source of cuts and blisters on your feet, take care to choose your shoes wisely. Always wear leather, suede or canvas shoes and avoid shoes made of plastic or other materials that don’t allow your feet to “breathe”. Make sure your shoes fit well, aren’t too tight and don’t rub. Shoes with laces or Velcro are ideal, so you can adjust them easily as needed.
Neuropathic osteoarthropathy
Neuropathic osteoarthropathy is another condition which can affect the feet of diabetics as a result of damaged nerves. Also called Charcot’s foot (after Jean-Martin Charcot, a French neurologist), this condition causes weakening of the bones of the foot in patients who have significant nerve damage. As the bones get weaker micro-fractures can occur and in severe cases this may cause the joints to collapse. As a result of the nerve damage you will have reduced sensation in your feet and may not be able to feel pain, trauma or changes in temperature. This means that you will likely continue walking on the injured foot, compounding the fracture and making the injury worse. As you continue to walk your foot may also change shape and become deformed. These deformities are a further risk factor for foot ulcers to occur. If your foot starts to feel hot or swollen after a minor bump or trauma it could be a first sign of Charcot’s foot. The foot may or may not be painful, there may be redness and/or swelling and the affected foot may feel warmer to the touch than the other. If you notice these symptoms you should contact a doctor immediately for advice.
Treatment for Charcot’s foot
In the early stages where the bones are weaker but not fractured your foot may be put in a cast to limit damage and prevent deformity. The cast will immobilise your foot and give it the chance to heal. In more advanced cases, surgery may be needed to realign the broken and deformed bones.
Foot care
If you are a diabetes patient it is very important that you take good care of your feet by following a good foot care regime. You should also inspect your feet daily to check for any possible signs of ulcers or other problems and discuss any symptoms you find with your doctor. If you have a podologist or a diabetologist, discuss any issues or doubts with him, otherwise please speak to a doctor at your NephroCare centre.
You should consult a doctor if you have any of the following symptoms:
Sore, red, swollen, or painful lesions or blisters on toes or feet
Cracked skin which doesn’t heal
Nail tenderness or thickening
Foot or nail fungus
Any signs of infection, swelling, or discharge
Changes to existing ulcers or surrounding skin
If you carry out these checks regularly you will be able to detect any potential problems early, and by initiating prompt and effective treatment you can minimise the development of complications. If you have difficulties seeing or reaching your feet to do this, ask a member of your family to help you check your feet every day or speak to a doctor or nurse at your dialysis centre. Remember: It is also very important that you talk to your doctor if you are having difficulty keeping your glucose levels under control.
Your daily foot routine
• Check for foot injuries every day
• Wash your feet daily with soap and warm water and dry carefully.
• Keep your feet warm and dry. Use a neutral cream to keep your skin soft and prevent it from cracking, Use antifungal spray or talcum powder to prevent fungal infections
• Cut your nails regularly and use a pumice stone (never use sharp instruments) to remove calluses
• Don’t walk barefoot,
• Choose comfortable leather or canvas shoes
• Disinfect your shoes regularly (with a formalin swab
• Don’t smoke: smoking reduces oxygen supply to your feet and increases the risk of complications.
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