Diabetic Foot Problems

Foot disease is a prevalent complication of diabetes mellitus (DM) and is the most common cause of limb amputation in the United States. The lifetime risk of foot ulcers in DM is 15 to 25 percent and 5 percent of diabetics ultimately require amputation. Foot infections are now the leading cause of diabetes-related hospitalized days. Diabetic foot disease represents a significant cost for healthcare systems, much of which could be reduced through preventive measures.

The symptoms of diabetic foot disease include numbness and tingling in the feet that is worse at night. Foot infections manifest as redness, warmth, pain, and possibly pus around a foot ulcer. Diabetic foot disease develops for a number of reasons. Diabetic nerve disease decreases the sensation in the feet and allows undetected injuries and improper foot placement during walking, which can lead to deformed foot joints and calluses. Diabetic nerve disease also decreases sweating in the feet, and the lack of moisture can predispose to cracking, which can introduce infection. Decreased blood flow to the foot also reduces oxygen delivery to the tissue of the foot, resulting in ulcers with slower healing. Certain bacteria and fungi thrive in the hyperglycemia of diabetes, and the immune response to these infections is impaired in diabetics. Fungal infections like athlete's foot can cause cracks in the feet, upon which bacterial infections can superimpose. Often beginning around the nails, infections can range in severity from local skin infection (cellulitis) to infection of the deep tissue and even bone (osteomyelitis) to irreversible death of tissue (gangrene).

Studies have suggested that acupuncture may benefit diabetes patients with no adverse side effects.

Prevention with foot care is the most important intervention against diabetic foot disease. Diabetics should avoid tight-fitting shoes and may need insoles and special fitted shoes with extra depth and width. They should also wear loose-fitting cotton socks and avoid walking barefooted. The feet should be inspected daily, with a mirror if necessary, and care should be taken to avoid breaks in the skin during nail trimming, for example. The feet should be cleaned with lukewarm water and mild soap and patted dry. Diabetics should undergo yearly foot examinations by foot care specialists, including assessment of blood flow and neurologic function and inspection for ulcers and infection. Smoking cessation and tight glycemic control will slow the progression of foot disease.

Treatment of diabetic foot depends on its severity. Superficial ulcers may only require debridement (removal) of dead tissue, and superficial infections may respond to oral antibiotics. Detected by X-ray, magnetic resonance imaging (MRI), and/or bone biopsy, infection of deeper tissue or bone may require hospitalization for intravenous antibiotics, along with removal of the infected tissue and bone. Severe infections may spread to the bloodstream and cause major systemic illness. After the elimination of diabetic foot infections, relapses are common. Amputation of the leg either above or below the knee may be required for gangrene, from which the tissue will not recover. In other cases where diminished blood flow is the primary problem, vascular surgery may be able to restore blood flow to the leg.

...