Foot Care for the Diabetic
By: Paul E. Eckstein, D.P.M.
Board Certified in Foot Surgery,
American Board of Podiatric Surgery, Specialist, Diabetic Conditions of the Foot
Diabetes is a complex metabolic disorder affecting 17 million people in the United States. Many people have diabetes but are unaware of their condition. Diabetics have an increased risk of heart disease, stroke, blindness, kidney disease and foot problems. .
Twenty-five percent of diabetic emergency room and hospital admissions are due to a serious infection in the feet.
Diabetic foot complications are a serious health care problem. It is estimated that next year 5 to 15% of diabetics will require a leg amputation. More than 50% of these people will require a second leg amputation. Studies also show that half of these people will likely die within 5 years after their leg is amputated. The vast majority of these complications are preventable by proper patient education and treatment by a podiatrist or other healthcare professional with experience in diabetes care.
No one factor by itself will definitely cause a foot infection or diabetic foot ulceration. When patients with diabetes present to our office with an infection or a diabetic foot ulcer usually many of these factors have occurred together and most of the time they could have been prevented. For example, a person could have a large bunion deformity loss of protective sensation and poor circulation for years without any ill affects. Usually a precipitating event is needed such as tight fitting shoes or trauma for an infection or ulcer to occur. Unfortunately, too often a patient with a history of diabetic retinopathy (vision problems), poor circulation and neuropathy (loss of feeling, position sense or deficits in the autonomic nervous system) will discover they have a problem long after it occurs. Daily self foot inspections and the prompt treatment at the podiatrist could prevent problems or treat them effectively.
When a patient with a history of diabetes visits their doctor’s office for an initial exam, they should be carefully evaluated. Their circulation, skin, nails, muscle bone, joint and nerve function should be checked. The doctor should watch how they walk, examine their shoes and listen carefully to the patient. A good doctor will carefully debride patient’s toe nails and their calluses, relieve negative pressure on the feet by padding, custom made orthotics, prefabricated walkers or if necessary surgical correction of any foot deformities. A doctor familiar with diabetic ulcerations and will classify and treat them according to their location, size and depth and treat infections of the foot when they occur. They will also work closely with other members of the healthcare team. Diabetes is a complex disorder which we take seriously.
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