Diabetes and the Feet
NOVEMBER 01, 2012
An estimated 15 percent of the 25 million people in this country who have diabetes will develop foot problems. In fact, every 30 seconds, a lower limb is amputated due to complications from diabetes worldwide. We asked Dr. John Giurini, Chief of the Division of Podiatry at Beth Israel Deaconess Medical Center, to answer these common questions.
How can diabetes impact the feet?
Dr. John Giurini: Diabetes is a metabolic disease that affects various organs in the body. In terms of the feet, it can lead to nerve damage, causing a loss of sensation in the foot where patients are unable to perceive any trauma or injury to the foot. It also affects the blood supply to the feet, causing a narrowing of the arteries, therefore a diabetic patient who develops lack of sensation and injures their foot, developing a sore, may have poor blood flow and have difficulty healing that sore.
What is neuropathy?
Dr. John Giurini: Neuropathy is perhaps the most common complication of diabetes. There are a number of different forms. First - lack of sensation. Most patients with this form of neuropathy can usually function normally but they can't perceive a sore or blister or even be able feel that they've stepped on a foreign object - even when it punctures the foot. For the most part, though, they can continue with their exercise program and activities of daily living. There is a form of neuropathy where the nerves that control muscle function are affected. Those patients will have trouble walking, they'll trip and fall. They develop what is referred to as a drop foot. There's a third form of neuropathy called neuritis or painful neuropathy. These patients have constant pain in the foot throughout the course of the day. In more severe forms, it will keep them awake at night, they can't sleep, and that can be very debilitating.
How common is neuropathy?
Dr. John Giurini: Very common. In fact, it's even thought that neuropathy can develop five to 10 years before the diagnosis of diabetes is made.
Can neuropathy cause serious problems?
Dr. John Giurini: Yes. Patients can step on a foreign object and not even know it until the foot is red and swollen. Other patients may notice they have a blister, but because it's not painful, they don't realize how severe it may be. There can be a deep infection - the bone could be infected - and they don't realize it because there are no signs or symptoms and often the first time they realize it is when a doctor asks, "how long has this sore been here?" It's not unusual for them to say "what sore?"
The problem is they may come in with a sore today that looks relatively benign but that could change in 24 to 48 hours. You could have bacteria that are really aggressive and within 24 hours you could come in spiking temperatures over 101 and having nausea and vomiting. So things can go from bad to worse in a very short period of time. In severe cases, this can lead to amputation.
Can neuropathy be treated?
Dr. John Giurini: Once neuropathy has developed, for the most part it is irreversible. You will have lost sensation in a portion of your foot and you cannot regain it. The best you can hope for is to prevent it from spreading. It usually starts in the toes and works its way beyond that. The best bet to stop it is to exercise, take medications, monitor your blood sugars carefully and eat properly. In fact, if you do those things, you can avoid a lot of the complications of diabetes.
What can I do to protect my feet?
Dr. John Giurini: We want people with diabetes to take care of their feet by inspecting their feet. The earlier you catch a problem, the much easier it is to treat it. If you see a blister today, get off the foot completely, put a dressing on it and notify your physician.
If a patient is unable to inspect their own feet because of poor eyesight, body weight or arthritis, get a family member involved. Also, inspect your shoes. Many times things get inside shoes - rocks, pebbles, foreign bodies that can cause irritation of the foot.
Finally, high risk patients should be seen by a foot care specialist every three months. Those at high risk would be patients with abnormal sensation or circulation or those with foot deformities. A lot of these problems are preventable by getting the diabetes under control, and inspecting the feet regularly.
Posted November 2012
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