Common Pedal Problems in Diabetic Patients - Symptoms, Diagnosis and Management

Introduction

Diabetes increases the chance of having a range of foot problems, including the possibility of issues escalating to extremely serious complications. In addition, the risk of ulcers and amputations increases two- to-four-fold with age and illness duration. Due to two factors, people with diabetes are more likely to experience foot problems.

• Neuropathy (Nerve Damage) - Causing a sensory loss in the feet, a sense of pain, and discomfort, making it challenging to feel irritation or injury.

• Poor Circulation - Lowering the capacity to heal, making it challenging for even a small wound to resist infection.

What are the Most Common Pedal Problems in Diabetic Patients?

The most common pedal problems in diabetic patients are listed below:

1. Non-healing Infections and Ulcers: Cuts or blisters can quickly develop into ulcers that get infected, go all the way to the bone, and fail to heal because of poor circulation and neuropathy in the foot. This is a common and life-threatening consequence of diabetes that can result in amputation or prove fatal.

2. Neuropathy:

   • Distal Sensorimotor Peripheral Neuropathy: Up to 50 percent of older persons with type 2 diabetes have this condition, making it a prevalent complication of diabetes. The ability to feel pain and warmth protects the tissue from damage. Losing the ability to feel predisposes them to injury besides being unsteady and increasing the chance of falling. Motor neuropathy also increases the likelihood of an imbalance between the foot's flexor and extensor functions.

   • Autonomic Neuropathy: In the absence of peripheral arterial disease, this condition leads to warm feet because of vasoconstriction and reduced sweat (dry foot skin, increasing the likelihood of callus development linked with increased risk of ulcer).

3. Poor Blood Flow: Diabetes frequently causes the blood arteries below the knee to constrict and reduce blood flow. This may result in tissue death and hinder wound healing. Ulceration may result due to the coexistence of neuropathy and peripheral vascular disorders.

4. Corns and Calluses: When neuropathy is present, it can be challenging to feel the pressure the shoes are exerting, which can lead to corns or calluses. Calluses and corns also have the potential to develop into ulcers.

5. Hammertoes and Bunions: Hammertoes and bunions can occur from a nerve injury that affects the muscles in the foot, which can also cause muscle weakness and loss of tone. These abnormalities might also result in ulcers if neglected

6. Dry and Cracked Skin: Poor circulation and neuropathy can cause dry skin, which can lead to fissures that might become sores and could get infected.

7. Deformity: If a diabetic patient has a foot deformity and also has other risk factors, they are more likely to get an ulcer. Clawing of the toes is common and increases the pressure on the metatarsal head, and the balls of the foot, which in turn causes disintegration from repeated, mild stress to an insensate region. Other examples include Charcot deformities and the bunion or the hallux valgus.

8. Charcot's Foot: Charcot neuroarthropathy risk may increase with recurrent, undetected mild injuries. For example, a red, warm, and swollen foot might indicate Charcot neuroarthropathy in people with sensory neuropathy. It is a fracture-dislocation process that affects the bones, joints, and ligaments of the foot and ankle in people with peripheral sensory neuropathy. A patient with painless unilateral swelling and without a history of recent trauma makes up the standard presentation. Surgery and, occasionally, amputation may be required due to the seriousness of the condition.

9. Nail Disorders: Loss of sensation can make it difficult to detect fungal infections and ingrown toenails, which curl into the flesh on the sides of the nail. They can cause infections if not managed appropriately.

What Are the Symptoms of Pedal Problems in a Diabetic Patient?

The symptoms of foot problems in diabetes might differ from person to person and can rely on the specific problems a person is dealing with.

Symptoms might include:

• Lack of sensation.

• Tingling (painful) or numbness.

• Blisters or other lesions without pain.

• Variations in temperature and skin color.

• Red streaks.

• Sock stains with or without drainage.

The following are some additional symptoms that may appear if an infection develops:

• Fever.

• Chills.

• Uncontrollable blood sugar.

• Shock.

• Redness.

Anyone with diabetes with signs of an infection, especially on their feet, should seek help immediately.

How Are the Common Pedal Problems in Diabetes Diagnosed?

The diagnosis of common pedal problems in diabetes is done in the ways listed below:

• Clinical examination to check for peripheral pulses and severe sensory loss.

• Inspecting the skin for ulceration and gangrene.

• Examining the history of recent changes in the feet.

• Blood glucose level.

• Performing X-rays to inspect damages in the underlying structures.

• Tests for nerve damage and sensation.

• Blood tests to look for signs of systemic infection.

How Are Common Diabetic Pedal Problems Treated?

The foot and ankle surgeon can aid in the healing of wounds to avoid amputating limbs. Several modern surgical procedures, such as joint restoration and wound healing innovations, can preserve feet and legs. Ensure regular foot exams and seek assistance immediately. Timely detection can prevent minor issues from worsening. The foot and ankle surgeons collaborate with other medical professionals to prevent and handle diabetes-related problems. The severity of the issue determines the best course of treatment for diabetic foot problems. Numerous surgical and nonsurgical procedures could be useful.

• Regular clinical visits as part of their care and to have a regular foot examination.

• To ensure good vascular supply and treat soft tissue and bone infection. Standard care through debridement is recommended for four weeks because wounds that do not reduce in size by more than 50 percent after four weeks have a decreased likelihood of healing by 12 weeks.

• Removing calluses and ingrown toenails.

• Negative pressure wound therapy.

• Hyperbaric oxygen, all of which can improve complete healing and some of which may treat biofilm, prevent bone infection and limb loss, and improve patients' quality of life

• Prescribing antibiotics and immobilization devices.

• performing an arterial bypass to aid blood flow to the area.

• For treatment of Charcot's foot patients are treated with antibiotics, surgery, or amputation for infection, or they have multiple ultrasound examinations for deep vein thrombosis before the correct diagnosis is made.

How Can the Common Pedal Problems in Diabetes Be Prevented?

The prevention of pedal problems in diabetes can be done in the ways listed below:

• Every day, check the feet or have someone else do it to look for any changes or injuries. Check for skin or nail problems including cuts, rash, redness, drainage, swelling, bad odor, discoloration, loss of hair on toes, injuries, or nail changes, signs of fracture include swelling, redness, warmth, and a change in size or shape.

• Do not dismiss leg pain.

• Wash the feet daily. It will help prevent infections by keeping the feet clean.

• Be cautious when trimming the nails; keep the toenails short and straight across. Having rounded nails increases the risk of infection.

• Control blood sugar as the risk of diabetic foot problems is increased by uncontrolled blood sugar levels.

• Avoid smoking since smoking has a detrimental effect on the tissues' blood supply and flow, which exacerbates diabetics' foot ailments.

• Do not go barefoot. Always protect the feet by wearing supportive footwear and socks. A podiatrist may suggest special shoes to assist in avoiding abnormalities. Apply socks loosely enough to avoid limiting blood flow.

• Corn should never be shaved since this raises the chance of infection.

• Test the sensations of touch and circulation. And it is advised to people with diabetes that when they are seated, occasionally raise the feet and move the toes, and get plenty of exercises to increase blood flow to the feet. These activities support healthy blood flow to the foot.

Conclusion

Diabetes patients should never disregard even minor foot signs or symptoms since they are more prevalent and might result in serious complications. To avoid any pedal issues, routine blood sugar checks, medical foot inspections, and self-care are advised.