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Diabetes
People with diabetes are at high risk for developing problems with their feet. More than half of diabetics lose sensation in their feet due to nerve or blood vessel damage, and can hurt themselves without knowing it. To make things worse, diabetes slows healing and weakens the immune system, so what may seem like an inconsequential injury can quickly become a major problem. Even the smallest of foot and ankle injuries such as a blister or ingrown toenail can lead to infection and tissue death. One of the most serious complications of the diabetic foot is Charcot foot, a deformity that develops when people fracture bones in their feet without realizing it and then continue to walk on the injury because they don't feel any pain.
Diabetic Foot Problems
Patients with diabetes have an elevated risk of serious foot problems. There are several reasons for this since diabetes involves: poor circulation, a damaged immune system and the possible development of nerve damage (neuropathy). Blood circulation in the feet is weaker than elsewhere in the body to begin with because of distance from the heart and the force of gravity. Further impaired circulation in diabetic patients may slow healing to a dangerous level.
Causes of Diabetic Foot Problems
Poor circulation makes for slow healing and immune deficiencies allow infections to develop. In addition, diabetic nerve damage may keep patients from sensing heat or injury, and retinopathy which impairs their visual acuity, making detection of injury more difficult. These factors combine to make patients with diabetes highly susceptible to complications from foot problems.
Diabetic neuropathy results from blood sugar levels that are elevated for a long period of time. Nerve damage may sometimes result in pain, but more often results in tingling, numbness, burning, or the inability to experience normal sensation. Diabetics frequently miss the sensory signals, such as extreme temperature or pain, designed to alert the body to possible injury.
Diabetics need to take precautions such as: not walking barefoot, wearing properly fitted shoes, inspecting their feet daily, and carefully treating small injuries, like blisters or calluses, as soon as they appear. It is very important for patients with diabetes to have regular medical and podiatric examinations.
Because even minor abnormalities or injuries may lead to serious complications in patients with diabetes, diabetics need to pay close attention to any and all of the following:
- Blisters
- Ingrown toenails
- Corns
- Bunions
- Hammertoes
In diabetics, seemingly inconsequential wounds can quickly become infected or develop into ulcers. Ulcers are wounds that destroy tissue and do not heal on their own. Because patients with diabetes may have poor circulation and skin that is excessively dry, they are more prone to injury. Furthermore, because of nerve damage, they may not feel irritations, such as those caused by ill-fitting shoes, that may lead to such injury. This is why daily inspection of the feet is so important.
Treatment of Diabetic Foot Problems
For patients with diabetes, it is necessary to treat wounds, even small ones, as soon as they are detected. Such wounds often appear on the bottom of the feet, particularly susceptible because they are weight-bearing. Diabetic wound treatment usually follows a protocol that includes:
- Relieving pressure on the affected area
- Cleansing the area thoroughly
- Removing dead skin cells, a process known as debriding
- Applying medication
- Dressing the wound
If a wound is severe, it may be necessary for the patient to wear specially designed footwear, a brace or other device in order to alleviate pressure and promote healing.
Complications of Diabetic Foot Problems
Without proper treatment, diabetic foot problems can have grave consequences, including serious infection of skin or bone tissue. Once tissue becomes necrotic, gangrene can development. If gangrene sets in, amputation may be necessary.
Risk Factors for Diabetic Foot Problems
Apart from the disorder itself, risk factors for diabetic foot problems include:
- Having kidney or eye complications of diabetes
- Having poorly regulated blood glucose
- Having peripheral neuropathy
- Smoking
- Drinking alcohol
- Being overweight
While diabetic foot problems are common, patients with diabetes can usually avoid serious complications through vigilance and early intervention.
Pediatric Foot Disorders
While children are affected by many of the same foot problems as adults, there are certain conditions that pertain specifically to children, many of which develop during the first few years of life.
Some of the foot problems most commonly affecting children include:
- Clubfoot - Clubfoot involves the foot turning inward to the side, resembling the head of a golf club. This condition can affect one or both feet and is usually present at birth, although the cause is unknown.
- In-toeing - Also known as pigeon toes, in-toeing involves walking with the feet turned inward. This condition usually occurs between 8 and 15 months, when the child begins to walk, and usually affects both legs.
- Heel pain - Pediatric heel pain is often caused by a disorder called calcaneal apophysitis, and is most common in children between the ages of 8 and 14 years old. Unlike adult heel pain that tends to improve as the day goes on, pediatric heel pain is often worse with walking and activity.
There are many treatment options available for pediatric foot problems. The best treatment for your child will depend on his or her individual condition, but may include stretching exercises, casting, orthotics and surgery. Many children can successfully overcome their foot problems and may play sports and continue to grow unaffected. Parents should bring their children to see a doctor at the first sign of foot problems in order to prevent the condition from causing permanent damage.