The Care Diabetics Should Expect From Their Foot Specialist

November 12th, 2011

Diabetics have special needs when it comes to their feet, as many serious complications can occur that may force a diabetic into the hospital with a foot infection (which may end up leading to an amputation). Diabetics should expect an expert level of medical care when it comes to their feet, as many of these complications can be prevented or controlled long before hospitalization needs to be considered. This article will discuss what diabetics should expect from their foot care specialists (podiatrists), and why each of these components are important.

Comprehensive Foot Examination and Routine Diabetic Foot Care

A full diabetic foot evaluation several times a year is a necessity for a diabetic, and this even may need to be performed every 9-12 weeks depending on the presence of certain risk factors. These risk factors include the presence of diabetic nerve disease (neuropathy), calluses, poor circulation, foot deformity (like bunions and hammertoes), a history of prior wounds, or prior partial amputation of the foot or toes. With this evaluation, a program of diabetic foot care education and reinforcement of self-care practices at home should be included to help diabetics keep their feet healthy at home or in public. Routine diabetic foot care should be a part of these regular visits to control the factors which seem to lead to infections and amputations. When a diabetic has nerve disease (which may not even be noticeable to them), the likelihood of developing skin wounds from simple acts like cutting one’s own nails or trimming one’s own calluses is fairly high. Routine diabetic care, which should include nail trimming and ongoing removal of all callus tissue as it thickens, will help to reduce this risk. Since most foot wounds in diabetics develop from areas of high pressure where calluses are found, the simple act of regular callus care can dramatically reduce the incidence of diabetic wounds.

Wound Prevention

As stated above, regular callus removal can significantly help to prevent foot wounds. However, this is not necessarily enough for some people to prevent wounds from occurring. Many diabetics also need the proactive use of dedicated extra-depth diabetic shoes to prevent the shoe itself from externally rubbing a wound into their fragile foot skin. With these shoes, a special insert made of a material called ‘plastizote’ needs to be used to help decrease pressure and friction from the bottom of the shoe on the sole of the foot. Shoe related wounds in diabetics are far too common, and for those with poor sensation and foot deformity that creates higher or wider prominences in the foot, the diabetic shoe is a necessity. At times the above mentioned foot deformities, which can include bunions, hammertoes, flat feet, bone spurs, and prominent metatarsals, are too prominent to simply be accommodated for in a special shoe. The use of prescription orthotic inserts made from a foot mold can help to restore proper pressure across the bottom of the foot, and can reduce the development and prominence of certain deformity conditions. For conditions that are already established, such as bunions and hammertoes, surgical correction needs to be considered if skin irritation or wounds develop over these areas despite proper diabetic shoes and skin care.

Wound Care

When wounds do develop, a diabetic should expect an aggressive limb salvage philosophy from their foot care specialist. Limb salvage is simply a way of practicing wound care that recognizes the absolute need to preserve the tissue of the foot and leg. When wounds and infections occur that are serious, it is all too easy or convenient to amputate the leg when the wound seems too difficult or time consuming to the patient to heal Unfortunately, the statistics five years following an amputation are not good: about half of all amputees from diabetic complications will be dead within those five years. This likely has much to do with strain on the heart due to the increased oxygen consumption walking with a prosthetic leg creates. Even if there is only a mild chance of success, a proper wound care program should include aggressive techniques to preserve as much of the foot as possible to prevent this from occurring. These techniques include frequent removal of non-healthy wound tissue, the use of proper dressing materials for the nature of the wound, as well as measures to control any infection or bacteria that may be simply creating an impedance to the healing process. Circulation of the leg must be adequate for healing, and any circulatory problem needs to be addressed by a vascular specialist. The use of devices to take away pressure to the part of the foot that has the wound is vital, as continued pressure on the bottom of the foot will delay or even prevent wound healing form occurring if the wound is on the sole of the foot. Prompt surgical care is necessary when wounds and infections become too serious for regular care. This surgical care can include the removal of all infected tissue and bone, as well as the draining of all abscess fluid, in an effort to save the rest of the foot and leg from a spreading infection. Sometimes amputation of part of the foot, such as a toe or front half of the foot, is necessary to save the rest of the leg. These limited amputations do not affect one’s mobility as a full lower leg amputation will, and usually only need a special insert in a protective shoe to prevent future problems from occurring.

Circulation Care

Diabetes is one condition of several that is associated with a greater risk for poor arterial circulation in the legs. Other conditions include high blood pressure, high cholesterol, obesity, advanced age, heart disease, and smoking. Many diabetics have several of these risk factors, and the likelihood of arterial disease is quite high in these individuals. This disease slowly builds over time, although acute clots can occur in the foot or leg if they have broken off from higher up in the circulation system. Poor circulation of the legs can lead to wounds due to a lack of nutrients getting to the tissues, which can result in severe pain, gangrene, and leg amputation. Unfortunately, the signs that this disease is present are very subtle until the very end when the symptoms become more severe and noticeable. Treatment at this stage is more difficult. Early identification of peripheral arterial disease (PAD), as poor leg circulation is known, is necessary in order to ensure early, successful treatment. This can be done through in-office non-invasive vascular testing, or as an outpatient in a hospital cardiology suite. A diabetic should expect their foot specialist to be well versed in this disease, and should expect screening and proper testing when several risk factors are present, or when the subtle signs of PAD are observed. Early referral for disease control and treatment from vascular specialists is vital for the long term survival of the leg or legs in question.

Specialized Diabetic Foot Disease Care

There are several conditions that are seen in few people outside of diabetics, and most significant one affecting the foot is severe neuropathy and joint disease. There is a condition called Charcot neuroarthropathy that can develop in some diabetics that leads to fracturing of several foot bones in absence of an injury. Poor sensation leads to excessive joint pressure, and can also lead to a washing out of some of the bone mineral in certain susceptible joints. Fractures eventually occur due to the weakness in the bones, resulting in a three month process of bone destruction. This condition is often mistaken for a typical fracture or even infection by many emergency rooms, and improper care can lead to a devastating deformity of the foot. The collapsing deformity greatly increases one’s risk for wound development. Expert foot specialty care is needed to recognize this disease, and to provide the proper months-long care needed to ensure proper healing of the foot. A diabetic should expect their foot care specialist to be quite attentive to the treatment needs of this condition, and should receive prompt and comprehensive care.

As one can see, the role of an experienced foot care specialist is vital to the well being of a diabetic. Diabetics can and should expect this comprehensive level of care, and many podiatrists are well trained and experienced in offering this complete approach to the diabetic foot as a sub-specialty. Most internists and primary care physicians are not well trained in the complexity of foot structure, function, and disease, and are more than happy to refer this level of care to the foot specialist. Diabetic patients should take advantage of this opportunity, as it may make the difference between healthy feet and an amputation.

Dr. Kilberg provides compassionate and complete foot and ankle care to adults and children in the Indianapolis area. He is board certified by the American Board of Podiatric Surgery, and is a member of the American Podiatric Medical Association. He enjoys providing comprehensive foot health information to the online community to help the public better understand their feet. Visit his practice website for more information.

Author: Scott Kilberg DPM
Article Source: EzineArticles.com
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Entry Filed under: DIABETES