Prevent Wounds and Amputations due to Diabetes 

By Sahiba Singh, DPM, AACFAS

People with diabetes are 10 times more likely to have a toe, foot or leg amputated than people without diabetes, according to the American  Diabetes Association. The disease can cause poor blood circulation and nerve damage in the feet, making them vulnerable to developing ulcers, infections, deformities and brittle bones.

Burning or numbness in your feet and toes can be early signs of diabetic peripheral neuropathy, or nerve damage. Neuropathy in the feet can lead to permanent numbness, deformities of the foot such has bunions and hammertoes, and dry skin that can crack open causing difficult to heal wounds. Neuropathy also leads to loss of sensation with resulting inhibition of the body’s normal pain response. Simply walking, therefore, can apply a repetitive, unfelt pressure causing a wound and eventually making it larger and deeper.

Burning, tingling and numbness in toes can also be symptoms of thyroid problems, nutritional deficiencies, back problems and pinched nerves in the ankles. In the United States, diabetes is the leading cause of peripheral neuropathy and can lead to further foot complications.

A combination of poor blood circulation, neuropathy and uncontrolled glucose levels predisposes a patient to develop a myriad of different ulcerations, such as: pressure ulcers, venous or arterial ulcerations, traumatic wounds or hematomas.

Wounds can become very difficult to heal in a compromised patient. The longer they are present, the higher the risk of the underlying bone becoming exposed or infected. As the bone becomes infected, we begin the journey of amputations to remove the infected bone. Once an amputation is performed, the likelihood of new wounds is high as we are altering the mechanics of the foot.

Nerve damage cannot be reversed, although medications can treat the pain caused by neuropathy. Podiatrists and vascular specialists work closely to optimize the blood flow for best healing potential and monitor diabetes related risks to limb loss.

Daily self-exams are the best protection. Too often, patients fail to check their feet for small cuts or punctures that overtime ulcerate and become infected.

If you have diabetes, and see anything suspicious on your feet, consult your local foot and ankle surgeon for diagnosis and treatment. Early intervention of minor cuts and abrasions yield the most favorable outcomes.

An estimated seven in 10 diabetes patients have nerve damage that impairs feeling in their feet. Fifteen percent eventually will develop a foot ulcer. Among those with ulcers, one in four will lose a foot. Each year more than 86,000 amputations are performed as a direct result of diabetes, and studies show half of those who have one foot or leg amputated will lose the other within five years. “Proper diabetic foot care prevents foot loss” says Dr. Singh.

In some cases, amputation might be the preferred option. If vascular and podiatric surgeries can’t improve blood circulation and foot function, resolve infection or restore foot function, amputation may be the only solution that enables the patient to heal. Today, advances in prosthetics make it possible for patients to return to an active lifestyle, a necessity for keeping diabetes under control.

Foot problems are not an inevitable consequence of diabetes. The risk can be lessened significantly by following a few simple precautions:
• Keep your blood sugar under control to help
minimize cardiovascular and blood circulation
problems
• Lose weight, don’t smoke and adhere to prescribed dietary, medication and exercise regime
• At least once a day, examine your feet for cuts and other small wounds you may not feel
• Never walk barefoot, outdoors and indoors
• Wash your feet every day in lukewarm water;  dry carefully
• Do not cut your own toenails.
• Choose comfortable shoes with adequate room for the toes
• Wear clean, dry, non-bulky socks; change daily
• Shake pebbles or bits of gravel out of your shoes before wearing
• Seek treatment from a foot and ankle surgeon if minor cuts and sore spots don’t seem to be healing

At Family Foot and Leg Center, we are able to treat all wounds. Do not delay in being evaluated and treated, especially if you have diabetes. Let’s get your neuropathy under control, adequate blood flow to your extremities, and save those limbs. For more information on foot problems, contact Dr. Sahiba Singh, DPM at 239-430-3668. 

Dr. Singh is a podiatrist with Family Foot and Leg Center located at 6846 International Center Blvd, Fort Myers. She is a well rounded foot and ankle surgeon and earned her podiatric medical degree from Temple University School of Podiatric Medicine in Philadelphia, Pennsylvania. She completed a three year surgical residency at Geisinger Community Medical Center in Scranton, Pennsylvania.

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