Do you know what the most common reason a person with diabetes is admitted to the hospital? Diabetes is a disease that causes blood glucose levels (blood sugar levels) to be too high. The disease can cause serious problems with the heart, the kidneys, and the eyes. Yet, the most common reason for someone with diabetes to be admitted to the hospital is because of problems related to the feet.
What type of problems with the feet do diabetics need to be worried about?….What can be done to prevent these problems?….How can these problems be minimized once they have developed?
Circulation, Sensation, Blood Sugars
Three main factors underlie the foot problems related to diabetes:
- A decrease or loss in the ability to feel sensations with the feet
- Poor circulation
- High blood sugars
Many diabetics develop problems with nerves, particularly nerves in the feet. These problems are known as neuropathy (ner op a thee). If blood sugar levels are not well controlled over periods of time, nerve damage occurs. In some cases, just having diabetes long enough can cause this nerve damage, even if the blood sugar levels have been well controlled.
The nerve damage caused by diabetes will result in a decreasing ability of the feet to feel anything. This usually starts with a slight diminishment of sensation, but can progress to the point there is no ability to feel anything in the feet. In this case, there is complete numbness. Why is this dangerous? Our ability to feel the things that we touch is an important protection mechanism. This protection is lost when neuropathy is present.
Imagine stepping on a small piece of glass. Most of us would feel instant pain. We would then take action to remove the glass, clean the wound, apply a bandage and take pressure off the area so that the wound could heal. Someone with neuropathy would not feel the glass in their foot and would continue walking, possibly driving the glass further into the foot. This person would not realize there was a problem until a foot infection developed.
Imagine accidentally twisting your foot as you step off a curb, causing you to crack a bone in your foot. The pain would cause you to keep pressure off your foot and to seek medical care. However, if this happens to a person with numb feet, they would likely not notice the cracked bone and would continue to walk. Unfortunately, walking on a broken bone can cause very serious damage to occur, including significant permanent foot or ankle deformity and impairment.
These are not unique examples. Any podiatrist that works with diabetic patients can tell you of many similar cases that they have seen in people with diabetic neuropathy.
In some cases the nerve damage is associated with significant foot pain. Even though the feet are numb, the damaged nerves can cause pain that is usually most notable when sitting or lying down.
Every part of your body needs blood to survive. Blood brings the oxygen and nutrients to our tissues to keep them healthy and strong. In order to deliver the blood throughout the body, a huge network of blood vessels is required. This network is our arterial system.
Unfortunately, these vessels can become clogged and damaged. When this occurs, not enough blood is transported to the tissues of our bodies which leads to serious consequences. If the blood vessels to the heart become clogged, a heart attack occurs. Damaged blood vessels that transport blood to the brain can lead to a stroke. Diseased arteries to the legs and feet lead to pain, disability and even amputation.
Why do blood vessels become clogged? There are many causes, but people with diabetes are at much greater risk for developing clogged arteries and poor circulation.
High cholesterol and triglyceride levels in the blood are an important cause and diabetics are more likely to have elevated levels. Many people inherit the tendency to have high levels from their parents. However, eating a healthy diet is an important factor in keeping cholesterol and triglyceride levels in a good range.
Other factors that have been implicated in leading to hardening of the arteries include: cigarette smoking, high blood pressure and a lack of exercise.
Signs of Poor Foot and Leg Circulation
An important sign that someone is developing problems with the arteries in the legs is pain in the calf. This usually occurs after walking a particular distance. For example, someone may develop pain or cramping in the calf each time they walk for five minutes. Stopping to rest allows enough blood to return to the muscles and the pain goes away. Further walking will cause the soreness to return. This is known as intermittent claudication.
As the peripheral vascular disease worsens, the skin on the feet will become less supple and hair growth on the foot will stop. The skin will feel cool to the touch and may have a shiny appearance. Abrasions, skin cuts and other foot problems will be slow to heal or will not heal at all. In severe cases gangrene will develop necessitating amputation.
High Blood Sugars
For people with diabetes, keeping their blood sugar levels tightly controlled should be the foremost concern. When blood sugars are high, more bad things can happen to the feet.
High blood sugars cause healing to occur slowly or not at all. If a diabetic has an open sore or a cut on the foot, poor diabetes control may prevent the problem from healing. Also, high blood sugars make fighting an infection much more difficult for the body. If a diabetic has an infection in a foot, high blood sugars may prevent the healing of the infection and allow the problem to dangerously spread. This can occur even with the use of the best antibiotics.
Preventing Diabetic Foot Problems
Diabetics can avoid foot problems and amputations that are due to diabetes. If you have diabetes, please follow the guidelines below. These steps will take you a long way toward healthy feet and helping you to maintain an active, healthy lifestyle.
- Keep your blood sugars tightly controlled. Work carefully with the doctor that treats your diabetes to accomplish this.
- Inspect your feet daily. Look for areas of redness, bruising, swelling or rashes. If you notice new problems, call our office. Most foot problems are easier to treat the earlier they are found. Daily foot inspections are even more important if a person has numb feet (neuropathy). Your eyes have to take the place of your ability to feel. If necessary, use a mirror to see the bottom of your feet. If you have trouble seeing your feet, have a family member or a friend do the inspections for you.
- Do not go barefoot. Wear shoes even in your home to help protect your feet. Make sure you wear shoes that are supportive and fit well. Click here for Tips on Buying Shoes
- Get your corns or calluses regularly evaluated and treated. If you have corns or calluses, call our office to arrange to have them evaluated and treated. Calluses and corns occur when there is an area that has too much pressure on it when you are standing and walking. These areas often lead to diabetic foot ulcers so it is very important to have corns and calluses treated.
- Use a skin moisturizer daily. Pay particular attention to applying lotion to the bottom of the feet. Do not put any moisturizer between your toes. We have an excellent moisturizer available in our office.
- Do not smoke. If you smoke….quit. Smoking causes arteries to become damaged. Additionally, each time you smoke, the nicotine you inhale causes blood vessels to constrict. This means even less blood is reaching the tissues in your feet.
- Perform some type of aerobic exercise daily. Good examples are running, walking, cycling and using an elliptical machine. Any exercise that uses your legs and elevates your heart rate will work. Be sure to check with your primary care doctor before starting an exercise program. If you have foot problems, ask Dr. Helms or Dr. Bowers which forms of exercise would be best for you.
Diabetes and Feet
Many diabetics do have problems with their feet, but you can avoid these problems. Many diabetics have foot problems that cause them to be hospitalized, but you can prevent that. Many diabetics have a toe or foot amputated, but you can take the steps necessary to keep your feet. Take your diabetes seriously and let us help you to prevent diabetic foot problems.
We Can Help
Drs. Helms and Bowers are experts in diabetic wound care and in the treatment of the diabetic foot. If you have diabetes, give our office a call and let us help you keep your feet on a healthy path.