Various Foot Conditions in Diabetes - Things to Know

Introduction:

Diabetes is a condition in which the blood sugar or blood glucose levels shoot up to high levels. One of the most common issues faced by diabetic individuals is foot problems. This can happen when persistently high blood glucose levels affect the blood vessels and nerves in the feet. Due to nerve damage, a diabetic person may be unable to feel any pain if they have a cut, ulcer, or blister on their foot. This untreated wound could then get infected. Also, there may be poor healing of the wound since the damaged blood vessels can result in poor blood flow in the feet.

Who Might Suffer From Diabetes-Related Foot Conditions?

The chances of a diabetic individual developing a foot condition is about 15 %. Foot problems are common in diabetic individuals, especially among those who have:

• Had diabetes for a long time.

• Nerve damage or poor blood flow in the feet.

• A body mass index (BMI) of more than 25 which is indicative of being overweight or obese.

• High cholesterol or high blood pressure.

• Difficulty regulating blood glucose levels for a long period of time, including suffering from frequent episodes of hyperglycemia (elevated blood glucose level).

Why Do Various Foot Conditions Develop in Diabetic Individuals?

Having prolonged periods of elevated blood sugar levels can result in a type of nerve damage called diabetes-related neuropathy. Diabetes-related neuropathy can affect all parts of the body, but it most commonly affects the legs and feet. This can create a loss of sensation in the feet. When the feet feel numb, a cut, sore, or blister might go unnoticed. Unnoticed and untreated wounds can result in infection.

The blood flow to the legs and feet may also be affected by diabetes. Hence, diabetic individuals are prone to developing peripheral artery disease (a condition wherein the arteries become narrowed or blocked). Poor blood flow can, in turn, affect wound healing.

What Are the Various Foot Conditions That Diabetic Individuals Develop?

The following are the various foot conditions:

• Blisters: Diabetes increases the risk of developing blisters in various ways. Diabetic nephropathy can make it challenging for a diabetic individual to identify when their shoes no longer fit. This can alter the way a person moves, which increases the risk of developing blisters. Diabetic individuals may also develop spontaneous formation of blisters, which is referred to as bullous diabeticorum. The reason why these blisters appear remains unknown. Blisters can become infected, be painful, and can increase the risk of spread of infection throughout the body.

• Diabetic Ulcers: It is estimated that about seven percent of individuals with peripheral neuropathy develop diabetic foot ulcers every year. As discussed previously, nerve damage can prevent the individual from noticing the wound until it gets severe. Poor blood circulation can retard the healing process. Diabetic ulcers can make walking feel very painful. Shoes and socks can exacerbate the symptoms of ulcers.

• Diabetic Calluses: Areas of hard, thickened skin cells are called calluses. Large calluses on the feet can cause difficulty walking and can alter the fit of the shoes. One must keep the calluses clean and remove them when necessary so as to protect the feet.

• Foot Infections: Diabetic ulcers can get infected if they are not treated properly or if they are not kept clean. These infections have the ability to spread into the bloodstream, damage organs, and pose a threat to the individual's life. At times, tissue death (gangrene) can occur, and amputation may be required. Foot infections can cause damage to the underlying structures and can even affect the bones. This can alter the shape of the foot, causing difficulty walking and further pain. This condition is called Charcot's foot, and it can elevate the risk of developing more ulcers.

• Amputation: Foot problems due to diabetes can result in serious infections. In order to curb the infection from spreading and to reduce the damage to adjacent regions, healthcare professionals may recommend amputation (removal of a part of the body like a toe, foot, or a portion of the leg). The leading cause of amputation is diabetes.

• Death: Severe diabetic-related foot problems can pose a serious threat to life, especially when an infection spreads. Severe foot problems that create a need for amputation are a major risk factor for death, though the physician chooses to amputate the foot to prevent the infection from spreading. It is estimated that the five-year survival rate after amputation due to a foot infection is just 43 %.

What Are the Common Symptoms Experienced by Diabetic Individuals?

Foot symptoms of diabetes can differ with each person and specific issues. Some of the common symptoms are as follows:

• Numbness or tingling.

• Loss of feeling.

• Red streaks.

• Painful tingling.

• Wounds that cause no pain.

• Skin discoloration and temperature changes.

• Staining on socks.

• Wounds with or without drainage.

In case an infection develops, the following symptoms may be observed:

• Chills, fever, and feeling very sick.

• Uncontrollable blood sugar.

• Redness, shock, and shaking.

How Can Diabetes-Related Foot Conditions Be Treated?

Diabetes-related foot issues may be treated by a physician who specializes in the treatment of feet, called a podiatrist. The following are some of the treatment strategies:

• The wound will be cleaned thoroughly, and any pus or fluid from the ulcer will be drained

• Infected or dead tissue will be eliminated or cut away (debridement).

• Special bandages and ointments will be applied to absorb extra fluid, keep the wound protected, and aid healing.

• Using crutches or wheelchairs may be recommended to ease the weight on the affected foot (offloading).

• Oral or intravenous antibiotics may be prescribed to manage and eliminate infection.

Based on the severity of the infection, the healthcare professional may recommend hospitalization if necessary. This is because, at times, amputation may be considered necessary to prevent the spread of infection to other parts of the body.

If nonsurgical treatment does not work, then the following nonsurgical options may be recommended:

• Surgically stabilizing Charcot's foot.

• Removing ingrown toenails.

• Removing decaying or dead tissue.

• Amputating the affected leg, which may involve a single toe or may involve the leg above the knee.

• An arterial bypass may be performed for peripheral vascular disease, as this will assist blood flow to the affected area.

• An endovascular surgery with stent placement may be done. Stents are small devices that keep the blood vessels open.

How Can Diabetic-Related Foot Conditions Be Prevented?

Diabetic-related foot conditions can be prevented in the following ways:

• One must examine their feet every day, especially between the toes for any changes. For this, a mirror may be used or someone’s help can be obtained.

• The toenails should be kept trimmed and filed. The nails should be cut straight across to avoid ingrown toenails.

• The feet must be checked during every visit with the physician.

• Talcum powder or cornstarch should be put between the toes to prevent buildup of moisture.

• Proper blood flow to the feet must be maintained. The feet should be kept elevated while sitting and one must wiggle their toes often. One must stay active but must choose to do activities that are gentle on the foot like swimming or walking.

• Any corns or calluses should be smoothened.

• One must wash their feet every day in warm but not in hot water. After washing, the feet must be dried thoroughly including between the toes. Then, lotion must be applied to the tops and bottoms of the feet, but not in between the toes.

• Wearing tight-fitting socks and ill-fitting shoes must be avoided. Therapeutic shoes or shoe inserts can be worn by diabetic individuals to prevent sores or wounds.

• Cutting corns or calluses, applying chemicals, soaking the feet, smoking, and walking around barefoot should be avoided.

Conclusion:

Various foot conditions arise in diabetic individuals due to unnoticed cuts and infections that manifest due to numbness in that region. Diabetic individuals should have frequent checkups with the podiatrist to ensure that no complications arise. A physician might treat the feet through observation, sterilization, and immobilization devices like a walking boot. In case these measures are ineffective, surgery (amputation) might be suggested to remove the infected tissue that might possibly spread to other body parts. Diabetic individuals should monitor their feet regularly, keep them clean, and use supportive footwear to minimize foot issues and complications.