Your Podiatrist

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Diabetes and the feet

           All of us are likely to have problems with our feet, but diabetics may develop serious problems more quickly and have more complications, especially when circulation or nerves are impaired. A random survey of diabetic patients in the outpatient clinics of a Veterans Administration hospital found 50 percent with circulation and nerve damage plus some type of foot deformity. When circulation is poor, the tissue in the foot is less able to fight infection. When nerves are impaired, an injury can occur without pain and, as a result, may go unnoticed. The key for the diabetic is to view all foot problems as potentially dangerous and to prevent them or seek podiatric care as soon as they occur.


Problems of Juvenile Diabetics

            Cuts, scrapes, blisters, ad puncture, wounds, are a part of childhood. To prevent such injuries, diabetic children should always wear some kind of footwear. If foreign bodies such as splinters become lodged in the foot, or if an infection or puncture wound occurs, the child should be treated promptly by a professional.

            Ingrown toenails can cause infections which, tend to be especially severe in diabetic children. To treat the problem, the podiatrist may drain the infected area, relieve the pressure, prescribe an antibiotic, and recommend special home care to help the infection heal. If the child suffers repeated infections, surgery may be necessary to prevent the nail from becoming ingrown again.


           Athlete�€™s foot is a fungal infection common in young people. It or other skin rashes are not promptly treated secondary bacterial infections that require vigorous treatment with antibiotics may develop.

           Structural changes in the feet of normal children also occur in the feet of children with diabetes and these problems can be far more serious because the disease causes changes in the nervous system. These changes in turn may prevent the child from experiencing or expressing pain or discomfort and will require evaluation on a continuing basis to prevent serious bone and joint changes as the child grows.


Problems of Adult Diabetes

            Concerns of adult and maturity-onset diabetics are somewhat different from children. Foot problems neglected in youth cause more problems, and can be compounded by circulation disorders and changes in sensation (diabetic neuropathy).

            Poor circulation often happens as we get older, but complications can occur earlier in life. Chronically tired or painful feet may mean circulation is poor. Symptoms such as numb, tingling, cold, or blue feet and swelling that will not go down, indicate poor circulation. Cramping may occur at night, during rest, or while walking a short distance. Smoking and stress usually increase the severity of these symptoms. An examination by a podiatrist will reveal any circulatory deficiencies.

          Diabetic neuropathy can cause insensitivity or a loss in the ability to feel pain, heat, and cold. If precautions are not taken, a hot bath can be a potential for a burn. Position sense is also often lost with neuropathy, so the feet strike objects in their path. Diabetic neuropathy can also affect the muscles of the feet, causing deformities such as hammertoes.

          When insensitivity is present, serious problems, such as ulcers and gangrene, can occur without pain. The infection can go unnoticed and appropriate care delayed until too late. By the time the trouble is discovered, amputation may be necessary to save the Person�€™s life. Daily observation of the feet is necessary by the diabetic or a responsible family member or other party.

          Ulcers can be caused by lack of blood circulating to the foot, lack of soft-tissue protection, excessive callous tissue, infection, and pressure points caused by deformities. Some causes of injury and ulcers are: wearing ill-fitting shoes; performing �€œself surgery;�€ applying electric heating pads or hot-water bottles; and using ingrown-toenail and Some corn remedies. If the circulatory response is adequate, most diabetic ulcers can be healed if diagnosed and treated early.

         Skin changes in the foot can be caused by diabetes. Dehydration is common since the diabetic usually has less natural lubrication than the non-diabetic. Fissures and cracks in the skin develop and itching can become severe. Scratching can cause breaks in the skin that may become infected. Dryness can be helped by using a good skin cream daily on every part of the foot except between the toes.