Diabetes & Feet



· Over 600,000 Ontarians have diabetes and this is expected to double by 2016

· Diabetic foot complications account for 20% of all hospital admissions

· Diabetics who saw their foot specialist at least twice yearly reduced their risk of amputation by over 30%

· Canadian diabetic guidelines recommend at least one annual foot exam be performed by a foot specialist (chiropodist or podiatrist)


Diabetic Foot Complications


People with diabetes are prone to many foot problems, often because of two complications of diabetes: nerve damage (neuropathy) and poor blood circulation.

Neuropathy causes loss of feeling in your feet, taking away your ability to feel pain and discomfort, so you may not detect an injury or irritation.

Poor circulation in your feet reduces your ability to heal, making it hard for even a tiny cut to resist infection

Having diabetes puts you at risk for developing a wide range of foot problems:


• Infections and ulcers (wounds) that don’t heal can lead to a loss of your foot, your leg, or your life. An ulcer is a sore in the skin that may go all the way to the bone.
• Corns and calluses. When neuropathy is present, you can’t tell if your shoes are causing pressure and producing corns or calluses. Corns and calluses must be properly treated or they can develop into ulcers.
• Dry, cracked skin. Poor circulation can make your skin dry. This may seem harmless, but dry skin can result in cracks that may become sores.
• Nail disorders.
• Hammertoes and bunions. If left untreated, these deformities can cause ulcers.
• Charcot foot. This is a complex foot deformity. It develops as a result of loss of sensation and an undetected broken bone. Because of neuropathy, the pain of the fracture goes unnoticed and the patient continues to walk on the broken bone, making it worse.


Treating Foot Ulcers


The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible.  The faster the healing, the less chance for an infection

There are several key factors in the appropriate treatment of a diabetic foot ulcer:

· Prevention of infection.

· Taking the pressure off the area, called “off-loading.”

· Removing dead skin and tissue, called “debridement.”

· Applying medication or dressings to the ulcer.  Moist ulcers heal quicker. 

· Managing blood glucose and other health problems

There are several important factors to keep an ulcer from becoming infected:

· Keep blood glucose levels under tight control.

· Keep the ulcer clean and bandaged.

· Cleanse the wound daily using a  prescribed wound dressing or bandage

· Do not walk barefoot

· Do not get the ulcer wet via showering or bathing. Avoid whirlpools.


What Your Foot Specialist Can Do


A major goal of the foot specialist is to prevent amputation. There are many new techniques available to keep pressure off your wound and to perform preventative surgery.  Getting regular foot checkups and seeking immediate help when you notice something can keep small problems from worsening.


When Is Amputation Necessary?


The goals of treatment of diabetic foot problems are not only to save the life and limb, but also to get the patient healed and moving about as soon as possible. Amputation is selected on the basis of the patient’s condition and level of predicted healing. A return to normal life is especially possible today because of  advances in prosthetics.


Your Proactive Measures

You play a vital role in reducing diabetic foot complications:

Have your sense of feeling & circulation tested. Your foot specialist will perform various tests to see if you’ve lost any feeling or circulation to your feet.
Inspect your feet daily. If your eyesight is poor, have someone else do it for you. Inspect for:
– Skin or nail problems—Look for cuts, scrapes, redness, drainage, swelling, bad odor, rash, discolouration, loss of hair on toes, injuries, or nail changes (deformed, striped, yellowed or discolored, thickened, or not growing).
– Signs of fracture—If your foot is swollen, red, hot, or has changed in size, shape, or direction, see your foot specialist immediately.
Observe for changes in circulation. Pay attention to the color of your toes. If they turn red, pink, or purplish when your legs hang down while sitting, poor circulation may be a problem.
Nail cutting. If you have any nail problems, hard nails, or reduced feeling in your feet, your toenails should be trimmed professionally by a chiropodist or podiatrist.
No “bathroom surgery.” Never trim calluses or corns yourself, and don’t use over-the-counter medicated pads.
Keep floors free of sharp objects. Make sure there are no needles, insulin syringes, or other sharp objects on the floor.
Don’t go barefoot. Wear shoes, indoors and outdoors.
Check shoes and socks. Shake out your shoes before putting them on. Make sure your socks aren’t bunched up.


The Role of your Doctor of Podiatric Medicine in Diabetic Ulcer Prevention & Care

The old saying, “an ounce of prevention is worth a pound of cure” was never as true as it is when preventing a diabetic foot ulcer.

Doctors of Podiatric Medicine play an integral part of the diabetic treatment team.  They have documented success in the prevention of amputations.  The key to amputation prevention in diabetic patients is early recognition and  regular foot screenings, at least annually.