Diabetes Diabetic Foot Care Maria M Buitrago DPM

Diabetes & Diabetic Foot Care Maria M. Buitrago, DPM, MS, FACFAS, FAENS

Diabetes • Diabetes mellitus is a chronic disease that affects about 29. 1 million Americans (~10% of the population) • It causes your blood sugar levels to be higher than normal

Diabetes • Diabetes Type 1 • Body produces less or no insulin • 5 -10% • Insulin • Diabetes Type 2 • Impairs the body’s ability to convert sugars, starches, and other foods into energy • 90 -95%

Diabetes • Diabetes is the 7 th leading cause of death by disease in the United States, 2010 • 2 out of 3 persons with diabetes die from complications from heart disease or stroke

Why are feet so important to those with diabetes? • • • Nerves Circulation Immune System (ability to fight infection) Kidneys Eyes

Nerves • Diabetes can damage the nerves in the feet – this is called peripheral neuropathy • Affects about half of all persons with diabetes • This can lead to a condition called “Charcot Foot”

Symptoms of Peripheral Neuropathy • Numbness, pain, tingling or burning in the feet • Pain at night • Cramping

Peripheral Neuropathy • The erosion with callus on the tip of the toe is typical of the type of injury which results with sensory neuropathy of diabetes

Charcot Foot • Diabetic complication where because of diabetic motor and sensory neuropathy, you can develop multiple midfoot fractures. The result is a misshapen foot as seen here.

Circulation • Diabetes can also affect circulation in the feet • Poor circulation can affect the ability of the body to heal when damaged

Gangrene • Form of necrosis that develops due to insufficient blood supply • Usually the result of atherosclerosis of the arteries of the leg

Gangrene

Immune System • Diabetics are also more prone to infection – the body’s immune system that normally fights infection responds slower • Cellulitis – infection in the skin.

Kidney Disease • Diabetes is the main cause of kidney failure in 44% of all new cases (2011) • In 2011, 49, 677 people of all ages began treatment for kidney failure due to diabetes

Kidney Disease • In 2011, a total of 228, 924 people of all ages with kidney failure due to diabetes were living on chronic dialysis or with a kidney transplant

Eye Disease • In 2005– 2008, of adults with diabetes aged 40 years or older, 4. 2 million (28. 5%) people had diabetic retinopathy, damage to the small blood vessels in the retina • This may result in loss of vision

Amputations • About 86, 000 lower limbs are amputated annually due to complications from diabetes • About 60% of non-traumatic lower-limb amputations among people aged 20 years or older occur in people with diagnosed diabetes

Amputations • The key to amputation prevention Early recognition Regular foot exams, at least annually

Warning Signs • Skin color changes • Elevation in skin temperature • Swelling of the foot or ankle • Pain in the legs

Warning Signs • Open sores on the feet • Ingrown and fungal toenails • Bleeding corns or calluses • Dry cracks in the skin, especially around the heel

Diabetic Foot Care • Wash your feet daily with lukewarm water and mild soap • Inspect your feet and toes daily for cuts, bruises, sores or changes to the toenails • Look after your health (loose weight, stop smoking, exercise and reduce alcohol consumption)

Diabetic Foot Care • Cut your toenails straight across, never cut into corners, use an emery board • Do not try to remove corns or calluses yourself and NEVER use commercial corn cures – they can burn the skin. • Don’t go barefoot

Diabetic Shoe Gear • Be properly measured and fitted for shoes • Poorly fitted shoes are a common cause of problems in the foot • Have your feet measured every time you buy new shoes (foot size and shape change over time)

Diabetic Shoe Gear • New shoes should be comfortable when purchased and should not need to be “broken in” • Shoes should fit both the length and width of the foot, with plenty of room for the toes

Diabetic Shoe Gear • Avoid shoes with high heels, pointed toes or tight around the toes (these put too much pressure on the foot and can contribute to ulcers) • Don’t wear anything that is too tight around the legs – this can constrict circulation to legs and feet

Diabetic Shoe Gear • Don’t wear shoes without socks – could cause friction blisters • Don’t wear sandals or other open-toed shoes – they don’t protect your feet • Wear well padded white socks – when you take socks off you can see blood

Diabetic Shoe Gear • Shop for new shoes at the end of the day because your feet swell • Change socks and shoes every day. Have at least two pair of shoes so you can switch them every other day

Diabetic Shoe Gear • Look inside your shoes every day for things like gravel or torn linings. These things could rub against your feet and cause blisters or sores

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