Diabetes and Your Feet (Part 1)

Why do diabetics need to see the foot doctor? Regularly scheduled appointments for diabetic foot checks are essential to the health and wellbeing of our patients. Much like seeing your Dentist for routine teeth cleaning, seeing the Podiatrist can help to prevent problems from occurring in the future. Diabetic can be prone to foot sores called ulcers, infections and ultimately amputations. In today’s blog, I will discuss some of the ways diabetes effects the lower extremity and some ways we can help to prevent significant problems from manifesting.

The main effect diabetes has in relation to the foot and ankle is a triad of complications:

1. Poor circulation
2. Loss of sensation
3. Immune suppression

Poor Circulation: Increased blood sugar or glucose can causes injury to the small arteries in the lower body. As opposed to smoking and cholesterol, diabetes tends to effect the smaller arteries such as the dorsalis pedis and posterior tibial artery, the two main arteries in the foot and ankle. Injury to these structures occurs when the fasting blood glucose level is over 150mg/dl and can lead to poor circulation, resting leg pain, pain when walking, numbness, tingling and gangrene. When blood flow is severely compromised, it can lead to wounds not healing or even gangrene. As part of your diabetic office visit, circulation is tested and followed closely to keep these problems from occurring. Early intervention can help to restore blood flow before problems start.

Loss of Sensation: Known as diabetic peripheral neuropathy, sensation in the lower body is often caused by high blood sugar levels. Damage to the nerves directly or from damage to the small blood vessels that feed those nerves causes a loss of protective sensation. This may be a painful condition causing numbness, burning, tingling and muscle atrophy. Some patients have no pain, however, and may not know their sensation is compromised. Loss of sensation can cause diabetics to step on foreign objects like glass, needles, splints, thorns, etc and not know their foot is injured. This can also lead to a breakdown of the skin causing ulcers. Podiatrists check protective sensation via several tests during a diabetic exam to assess the risk for neuropathy. Medication may also be advised during the visit to help control painful symptoms.

Immune Suppression: Diabetes can also cause the immune system to function poorly. A diabetic may not mount the same immune response as a person without diabetes and can miss signs of infection. An infected diabetic foot may not appear red, hot or swollen until the infection has progressed much further than in a person not affected. A diabetic exam can help to identify risk factors and asses the foot for ulcerations.

Your Podiatric Physician may also cut the patients toe nails and trim callouses. These can be areas of high pressure which may lead to ulcerations. By seeing the doctor twice a year, you can help to prevent ulcerations, infections, hospitalizations and amputations. 

Chris Suykerbuyk, DPM, FACFAS