Given the enormous physical stresses to which your feet are subject over a lifetime, it is not surprising that minor foot disorders are common. Warts, calluses, athlete's foot and insignificant injuries go almost unnoticed, or at most, are considered a nuisance.
However, persons with diabetes must learn to take special notice of even the most minor foot injury. In those diabetic individuals with problems of poor circulation or loss of feeling in the feet, even trivial injuries to the skin of the feet may result in infections that may have serious consequences.
Bacteria are found everywhere on the skin. Normal, undamaged skin is an excellent protection that prevents most bacteria or germs from entering the tissues to cause an infection. There are two conditions, which can occur as complications of diabetes, that are responsible for a tendency toward the development of ulcerations and infections in patients with diabetes:
A. POOR CIRCULATION:
This condition arises when the blood vessels become too narrow. This narrowing limits the flow of blood and the supply of oxygen to the tissues of the feet. When the circulation of the blood is hampered, the skin may develop cracks or ulcers (open sores), thus permitting bacteria to enter and establish an infection. Once bacteria have established themselves, the blood-poor tissues may be unable to stop the spread of the infection and permit proper healing to occur.
B. LOSS OF FEELING:
This is another common complication of diabetes resulting from damage to the nerves which carry pain sensations from the foot to the brain. Diabetic patients with this condition may be unable to sense any discomfort, even from a pebble in the shoe, or in more serious cases, from a tack or nail completely embedded in the sole of the foot. This inability to feel abnormal pressures or pain in the foot can easily result in repeated injuries and skin damage. Damaged nerves can actually keep you from knowing or feeling the exact position of your foot without looking at it.
For a number of reasons, patients with diabetes may not respond normally to infection. In part, this is due to a defect in the ability of the body's white blood cells to engulf and kill bacteria. In many people, this poor resistance to infection may be exaggerated when the diabetes is poorly controlled, especially when blood sugar stays above 200.
One result of this poor resistance is that the usual signs of an infection, such as swelling and redness, occur after a long period of time in diabetes patients...and often only after the infection is far advanced. In some diabetic patients, the only clue that an infection is present is the sudden and unexplained rise in blood sugar levels, especially in those patients who have been previously well-controlled with medication.
Overweight patients put excess stress not only on their hearts, but also on their feet. Individuals who are significantly overweight should, therefore, discuss a weight reduction program with their physician. For individuals with high serum cholesterol levels, special diets or even medication may be necessary to bring this important factor into the normal range.
With diabetic patients, achieving reasonable control of blood sugar levels is crucial. While good control of diabetes will not always prevent the complications which can lead to serious foot problems, some of the body's defense mechanisms against infection appear to be more effective when diabetes is well-controlled.
Smoking should be strictly avoided! In fact, tobacco use may speed up the development of blood vessel disease and may decrease blood flow in various parts of the body--heart, feet, eyes, and kidneys are prime locations.
Minor breaks in the skin of your feet should be cleaned with mild soap and warm (not hot) water. The skin should be carefully dried by gentle patting with a soft towel and avoid rubbing. Afterwards, an antiseptic such as Betadine Solution, Merthiolate (or Merchurochrome), or Neosporin ointment should be applied. A small dressing, such as a band-aid or sterile gauze, should be applied for protection.
Avoid using rubbing alcohol or peroxide on any open wound, as both have been shown to interfere with normal wound healing.
Burns, puncture wounds, deep cuts, and wounds which are jagged or soiled with dirt or other contaminants should NOT be treated at home. Many injuries of this type require treatment with antibiotics, a tetanus shot, or even surgical intervention.
In spite of good general health measures and meticulous foot care, deeper ulcers or infections do develop. Prompt detection of these conditions will help to minimize the damage that might occur.
However, some diabetic patients with nerve damage may not feel any pain at all in their feet or lower legs, even in the presence of a severe infection.
Any ulcers in the foot, no matter how small or seemingly insignificant, should be brought to the prompt attention of your doctor. Other things that should be brought to your doctor's attention are ingrowing toenails, athlete's foot, cuts and scratches that do not show any sign of heeling, and burning in the toes or soles of the feet.
Infections often cause a disturbance in blood sugar regulation. Therefore, any unexplained loss of blood sugar control (as detected in home blood sugar kits or urine sugar tests) should be discussed with your doctor without delay. This may be a sign of an unnoticed or undetected infection. When blood sugar is over 200, injured body parts do not heal well, and infected body parts do not respond well to infection.
Individuals with diabetes are at increased risk for developing ulcerations and infections of the foot. Reasonable hygienic measures and precautions to avoid foot injuries will help a great deal in minimizing the risk of avoidable complications. Diligent inspection of your feet for possible problem conditions...and prompt medical attention when disorders are discovered...will help to lessen the impact of problems when they do occur.
Remember, diabetic patients often have special problems with their feet. Anything which appears to suggest an infection or the beginnings of an ulcer should be reported to your doctor immediately.
DR. CHRIS ALBRITTON
2501 S. Willis
Abilene, TX 79605
325-695-8990