Surgical treatment for Diabetic foot includes:
Diabetes is a metabolic condition that results in elevated blood sugar. Diabetes is categorized as either Type I or Type II.
In Type I Diabetes, also known as juvenile diabetes, the pancreas does not secrete insulin.
- These patients must take insulin from day 1 of their diagnosis
- This is an autoimmune condition that typically results in children and adolescents and in some cases can occur in early adulthood
In Type II Diabetes, also known as adult onset diabetes, insulin is not used properly due to insulin resistance. In advanced cases, the body does not make insulin.
- Type II diabetes is frequently associated with obesity, a sedentary lifestyle, and genetic predisposition
- In some cases, blood sugar can be managed with diet only
Most patients take oral medication to control blood sugar. In more advanced stages, insulin may be required to control blood sugar.
I have severe nerve damage in both my feet from Type II Diabetes. I also suffer with other foot and ankle problems from the disease and at one point almost lost part of my left foot. Thankfully, Dr. Stewart was able to save my foot and prevent me from losing my leg.”
– Bonita Mays
Why are diabetics at risk for problems with their feet?
Elevated blood sugar results in damage to both nerves and blood vessels. As a result, diabetics are at risk for developing both peripheral neuropathy and peripheral arterial disease (PAD).
The nervous system is divided into 3 components, each with a unique function.
- Autonomic nervous system
- Allows skin to sweat
- With peripheral neuropathy, the skin is dry and is more prone to cracking and open wounds. This provides an entry point for bacteria leading to infection
- Sensory nervous system
- Allows us to feel pain, sharp/dull, temperature, and sense of joint orientation
- With peripheral neuropathy, patients are unable to sense pain and are unaware of injury to the foot. Injuries include and are not limited to burns, stepping on a foreign body such as glass, and joint dislocation. Unfortunately, due to the inability to sense pain, patients frequently don’t recognize a problem until limb threatening infection sets in
- Muscular nervous system
- Controls muscle balance
- With peripheral neuropathy, muscle imbalance leads to prominent bone therefore leading to corns and calluses that are precursors to foot ulcers and infections
The signs of peripheral neuropathy include:
- Burning, tingling, and numbness in both the hands and feet
- Dry skin
- Toe deformities including hammertoes, mallet toes, and claw toes
- In advances cases, joint dislocation, also known as Charcot foot
Peripheral neuropathy is highly associated with diabetic foot ulcers. A foot ulcer is defined as a loss of the both layers of skin. Foot ulcers create a portal of entry for bacteria that can lead to infection and amputation. Diabetic foot ulcers cause 85% of all non-traumatic lower extremity amputations and 15% of diabetic foot ulcers result in lower extremity amputation. These statistics demonstrate how important it is for diabetic patients to be aware of the risk factors associated with the disease.
Peripheral arterial disease (PAD)
Peripheral arterial disease (PAD) occurs when there is decreased arterial blood flow to the lower extremities. With decreased arterial blood flow, tissues are deprived of oxygen and this can lead to such complications as pain, tissue death, infection, and lower extremity amputation. The diabetic foot is at higher risk for peripheral arterial disease.
Symptoms of peripheral arterial disease include:
- Cramping in the back of the legs with ambulation known as intermittent claudication
- Non-healing or delayed healing wounds
- In more advanced stages, pain with rest. This pain is typically relieved when the leg is held down in the dependent position
- In severe disease there is tissue death also known as gangrene
How do diabetics prevent complications including foot ulcers, infections, and amputations?
- All diabetics should establish a relationship with a podiatrist, like Dr. Stewart, for a baseline exam. Depending on the risk factors identified, Dr. Stewart will determine how often you should be seen. All patients should be seen at least annually
- If risk factors are identified, Dr. Stewart will provide routine foot care including reduction of nails and trimming of corns and/or calluses
- Avoid barefoot walking at all times and wear a hard-sole shoe. This will reduce the incidence of stepping on a foreign body or developing a thermal injury
- Check all shoes for proper fit and be sure there are no areas of friction or pressure
- Maintain tight glycemic control through diet and exercise
- Exercise on a regular basis to improve blood flow and control blood sugar levels
- Maintain regularly scheduled appointments with your primary care physician and if indicated your endocrinologist, vascular specialist, ophthalmologist, and nephrologist
- Check water temperature with your elbow as peripheral neuropathy can affect the hands
- Stop smoking
- Maintain a diabetic friendly diet
- Take all medications as instructed
- Know the signs of infection including redness, swelling, heat, pain, loss of function, elevated blood sugars, fevers, nausea, vomiting, and chills. If any of these occur, immediately contact Dr. Stewart or present to the nearest emergency room