Diabetes affects 30 million Americans and contributes to more than 250,000 deaths a year. The disease also accounts for more than 60 percent of lower-extremity amputations.
Many people mistakenly think the effects of diabetes are strictly limited to the body’s ability to produce insulin and regulate blood sugar. However, diabetes also affects the kidneys, eyes, heart, blood pressure, arterial blood flow, and the legs and feet — possibly resulting in blindness, heart attack, stroke, kidney disease or amputation.
Many diabetic patients have a more difficult time fighting infection and might not even be able to mount a typical immune response to an infection. A non-diabetic patient with an infection would experience fever, nausea, vomiting, diarrhea, chills, night sweats and malaise. A diabetic patient might have a severe infection yet feel completely normal.
Diabetics are at risk for developing diabetic peripheral neuropathy — either autonomic or sensory. Autonomic neuropathy causes muscle atrophy, which leads to muscle wasting, digital deformities such as hammer toes, fat pad atrophy, boney deformities and prominences. Sensory neuropathy causes decreased feeling, sensation and response to stimuli. Because of this, diabetics are at a higher risk for ulcers, infection and amputation.
Many diabetics also suffer from peripheral vascular disease, or decreased blood flow. This makes treatment more complex, because blood flow is crucial for healing wounds and infections. If a patient has diabetic wounds and/or infection and has peripheral vascular disease, the treatment prognosis is worse and further increases the risk of amputation.
Charcot neuroarthropathy, a process that involves bony destruction of the foot/ankle, is another serious complication of diabetes. It might present similarly to or mimic cellulitis (soft tissue infection), but an X-ray will reveal significant bony destruction and deformity. Once the Charcot process begins, patients are at extreme risk for boney deformity/prominences, ulcerations, infections and even amputations. If caught early, these problems can be avoided with various treatments.
It is crucial for a diabetic patient to establish regular care with a primary care physician, an endocrinologist, and a foot and ankle specialist. A few tips to avoid serious lower-extremity conditions are:
▪ Check your feet daily, and notify your health care provider at the first sign of a blister, sore or injury to the foot or leg.
▪ Dry between your toes well.
▪ Never go barefoot.
▪ Don’t cut your own toenails or trim or pick at calluses, blisters or sores.
▪ Test the temperature of your bathwater with your hands or elbows, not your feet.
▪ Wear diabetic shoes and inserts.
▪ Maintain strict glucose control.
Dr. Josh Hill, a podiatric surgeon with Baptist Health Medical Group Orthotics and Sports Medicine, practices at Baptist Health Richmond.