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Diabetic Foot problems:
Local Doctor Stresses Vigilance in Diabetes Foot Care
Orange County, California, - With surging diabetes rates in the U.S., preventive foot care for people with diabetes is even more critical. Foot complications are the primary reason for hospitalization of diabetic patients in the U.S. Early detection of diabetic foot problems minimizes serious complications that can result in amputation.
This warning is particularly relevant during November, which is observed by the American Diabetes Association (ADA) as National Diabetes Awareness Month.
Patients and doctors need to understand that the majority of severe problems can be avoided with proper preventive care. Daily examinations by the patient with regular foot screenings by the patient’s doctor are vital to reduce amputation risk.
Research shows that diabetic-related amputations now total more than 67,000 annually and are rising. The American College of Foot and Ankle Surgeons (ACFAS) estimates diabetic foot ulcers - wearing away of the skin—precede nearly 85 percent of all lower limb amputations. In many cases diabetic patients ignore or are unaware of the warning signals because their normal sensitivity to pain is absent.
It is not uncommon for a patient to present, at first visit, a foot problem that already has severely progressed to the point where saving the limb is questionable. Amputation of one limb often leads to loss of the other. And with immobility comes the downward shift of overall health.
ACFAS has developed a list of recommendations for preventing diabetic foot problems:
- Check feet daily. Look for sores, bleeding or drainage that could signal a larger problem.
- Change shoes several times daily. Shoes precipitate 80 percent of foot problems. Changing shoes lowers the risk of subjecting feet to continual, damaging pressure.
- Do not walk barefoot. Minimize chances of infecting feet or exposing an open wound to germs.
- Do not neglect calluses—a significant risk factor for ulceration.
- Do not perform bathroom surgery. Self-treating even seemingly minor foot problems, such as blisters or ingrown toenails, can expose the foot to risk of infection.
Neuropathy Is Key Predictor for Amputation Risk in Diabetic Patients
Aggressive screening for evidence of nerve damage and sensory loss (neuropathy) can identify diabetes patients at the highest risk for severe, disease-induced foot problems, such as infection-prone skin ulcers and a debilitating deformity called Charcot foot. Left untreated, these complications put advanced-stage diabetes patients on a path to a lower-limb amputation.
The presence of neuropathy is the most critical predictor of which diabetic patients eventually will develop severe foot problems.
Simple neurologic testing combined with a thorough patient history are the most useful tools to identify diabetes patients with neuropathy and the highest risk for crippling foot disorders. Accordingly, doctors must screen more aggressively to identify patients at high risk for Charcot foot and foot ulcers to help spot early warning signs and seek immediate care.
Many foot and ankle complications associated with diabetes can be prevented or minimized with regular check-ups and daily patient inspections for sores, cuts and tiny puncture wounds. With early detection, doctors can institute measures to prevent foot deformity and eventual amputation.
A simple, non-invasive test performed by a podiatric foot and ankle surgeon or primary-care physician is effective in detecting neuropathy. A readily available instrument with a fine monofilament tip is used to pressure the bottom of the foot to gauge nerve sensation. Severity of numbness is the critical factor, and gradually increasing pressure gives a much better assessment of the extent of peripheral nerve damage and risk for Charcot deformity and foot ulcers.
All diabetic patients with severe peripheral neuropathy should be informed about their elevated risk for Charcot foot and be monitored regularly for neurologic deficits. Hopefully, we can more readily identify high-risk patients to prevent Charcot deformities and resultant foot ulcers and lower extremity amputations.
Charcot foot occurs in approximately 30 percent of diabetic patients with peripheral neuropathy, and it often is misdiagnosed in early stages as gout, septic arthritis or osteomyelitis. The first symptoms occur when the foot becomes hot, painful, swollen and red. Balance is affected, bones become soft and prone to fractures, and many patients are unable to wear shoes. Treatment at this stage is intended to slow progression of the deformity by minimizing the weight bearing load on the foot through cast immobilization walkers, rigid leg braces and custom orthotic insoles.
At more advanced stages, Charcot patients lose most of the sensation in the foot and are unable to feel pain. Muscles fail to support the ankle joint properly, the foot becomes unstable, and a reverse arch or rocker foot develops. Walking worsens the condition, as inflammation from pressure leads to further instability, ulcers and dislocation. Eventually, the foot may collapse. In these cases, surgery is the best option to correct the reverse arch and make it less prone to ulceration.
The American College of Foot and Ankle Surgeons (ACFAS) was founded in 1942. Headquartered in Park Ridge, IL, its membership includes 5,000 podiatric medical specialists. Its mission includes education, research, development of standards and promotion of proper foot and ankle care.
Routine Foot Exams for Diabetes Care
A Simple, Two-minute Check Can Prevent Foot Ulcers and Amputations
All diabetic patients should make sure their physicians check their feet during every office visit for signs of ulcerations that, left untreated, can lead to infection and ultimately result in lower limb amputations
It’s a simple exam that takes two minutes to determine if the patient is at risk for foot ulcers. And the easiest way to remember to get your feet checked is to remove your shoes and socks in the examining room before the doctor comes in, he added.
Most diabetic patients are vulnerable to foot ulcerations caused by poor blood circulation in the lower extremities and neuropathy that inhibits nerve sensation. Ulcers are the leading cause of foot amputations among people with diabetes and they are preventable in most cases if doctors routinely check their patients’ feet. It’s so tragic when someone undergoes an amputation that could have been prevented by regular, two-minute foot exams.
It is estimated that more than 86,000 lower extremity amputations are performed in the United States every year on patients with diabetes. More than 70 percent of them are caused by foot ulcerations that deteriorate to deep tissue infection, tissue necrosis and gangrene.
In foot exams performed by primary care physicians or podiatrists, patients should be checked for nerve sensation, skin irregularities (corns, calluses, punctures and areas of redness), swelling, drainage, and foot deformities that cause unnatural pressure points that are prone to ulceration. In cases of deformities such as bunions and hammertoes, diabetic patients should consult a podiatric surgeon to determine the best treatment option to reduce possible downstream risk for ulceration, infection or amputation.
Individuals considered at high risk for foot ulcers should have their feet checked every two to three months, but all diabetic patients should be checked at least twice a year. It doesn’t take long for infection to worsen and ulcers to occur without the patient being aware that anything is wrong, he said. Diabetes carries an enormous health care burden, but being diligent about foot care is a prudent and simple way to avoid one crippling complication of this disease.
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