Diabetes is one of the most debilitating diseases affecting the population. This disease can lead to problems with blood flow, nerve function and skin integrity. The complications associated with diabetes can lead to foot deformities, ulceration or skin breakdown resulting in limb amputation. It is estimated that the cost of diabetic related medical conditions was $245 billion in 2012.
In order to understand how to effectively treat diabetes it is imperative that we understand some basic principles of the disease process. Diabetes is categorized into type 1 and type 2. Type 1 diabetes is typically diagnosed in children and young adults, and deals with the pancreas’s inability to produce insulin. Insulin is a hormone that transforms starches and other food sources into energy. Type 2 diabetes is the most common form of diabetes. In type 2 diabetes the body does not use insulin correctly and blood glucose levels rise. The pancreas makes insulin, but is not able to keep up with the necessary production to regulate blood glucose. For either type 1 or type2 diabetes, blood glucose levels rise, leading to a host of foot problems and potential long-term complications.
A multi-physician approach is the key to controlling this disease. Treatments will include oral or injectable medications to regulate blood glucose.
Routine foot and ankle examinations by patients and podiatrists are required to ensure that any potential or current problems are swiftly dealt with and handled appropriately. During your foot and ankle physical examination your podiatrist will evaluate your skin for any breakdown or ulcerations. The vascular and neurological status of your lower extremities will also be evaluated.
As the diabetic state progresses, our muscles can atrophy, leading to foot deformities. These deformities cause increased pressure along the dorsal and plantar surface of the foot that can lead to callus formation and possibly even a break in the skin called an ulceration. Ulcerations can be terribly difficult to heal if our blood glucose remains elevated. With any break in the skin the potential for infection rises exponentially. Ulcerations can easily lead to underlying bony infection and loss of a toe, a foot or even the entire lower limb.
Loss of normal nerve function in the lower extremities is yet another side effect of diabetes. This process, referred to as neuropathy, is often described as burning, numbness or tingling. Treatment for this condition may include the prescription of medication to mitigate symptoms, but proper blood glucose management is key to improvement. Once normal sensation perception is lost, patients are at risk for developing ulcerations of their feet.