diabetes
Diabetes is a medical condition that can affect the feet.
If you have diabetes it is absolutely essential that you see a podiatrist,
as many of its potential foot problems are preventable. If blood sugar
is well controlled, the risk of complications is greatly reduced. Diabetes
is a multi-system disease - many different organs and parts of the body
are involved. Diabetics are best managed by a multi-disciplinary team.
This will usually include the general practitioner, internist or diabetic
specialist, podiatrist, dietician and specialty nurse. Vascular and
orthopedic surgeons may become involved in later stages.
Some of the problems that diabetics may have in the lower
extremity include:
Decreased blood flow to the feet and/or toes. This
makes the foot more prone to infections that may not heal.
Reduced sensory perception to the feet. This may eventually result
in loss of all sensation - something as simple as stepping on a pebble
in the shoe could lead to life-threatening tissue damage and when combined
with decreased blood flow may result in gangrene or loss of limb.
Progressive structural deformities. These can lead to pressure
points, painful callouses and pain with walking.
Skin changes including dryness, poor skin tone, athlete's foot,
calcium deposits in tendons and excessively hot or cold feet.
Ulcerations - these are sores that don't heal easily. Often they
exist under thick callouses, usually on the bottom of the foot (where
they can't be seen easily). Ulcerations in diabetics may be difficult
to heal. They must be treated by a professional.
Loss of balance and stability in walking. This is due to nerve
damage resulting from long term diabetes, often because it was not treated
adequately or recognized for many years.
Charcot Foot presents as a red, hot, swollen foot - sometimes
with collapse of the arch. There may be much pain or very little pain.
This problem is serious and must be evaluated by the diabetic specialist
immediately. The podiatrist can also diagnose this problem and refer
to the appropriate specialist.
What a podiatrist will do for a diabetic?
Initial assessment will involve evaluation of blood flow
to the feet and sensory perception in the feet. These 2 factors will
help to predict how likely it is that complications may arise. High
risk diabetics should see a podiatrist every 4 to 6 weeks. Lower risk
diabetics may only need to see a podiatrist every 6 to 12 months.
Structural deformities will be evaluated and a treatment
plan offered to help reduce the problems associated with structural
deformities, which include corns, callouses, ulcerations and pain. Often
a soft accomodative insole is helpful. Padding of bony prominences is
essential. Advice about footwear is given.
Wound care is provided for diabetics who have existing
ulcerations. Sometimes this includes surgical procedures to reduce bony
deformities. This type of care is highly specialized and is best provided
by a podiatrist who is specially trained in this area.
Podiatrists can save a diabetic's life, literally. The
smallest problem such as an ingrown toenail in a high risk diabetic
can progress to serious life-threatening complications. Early recognition
and treatment in addition to preventive foot care is priceless.
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