Diabetes and the Nervous System
According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.
Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation. With a diabetic foot, a wound as small as a blister from wearing a shoe that's too tight can cause a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When your wound is not healing, it's at risk for infection. As a diabetic, your infections spread quickly. If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror.
When your feet become numb, they are at risk for becoming deformed. One way this happens is through ulcers. Open sores may become infected. Another way is the bone condition Charcot (pronounced "sharko") foot. This is one of the most serious foot problems you can face. It warps the shape of your foot when your bones fracture and disintegrate, and yet you continue to walk on it because it doesn't hurt. Diabetic foot ulcers and early phases of Charcot fractures can be treated with a total contact cast.
The shape of your foot molds the cast. It lets your ulcer heal by distributing weight and relieving pressure. If you have Charcot foot, the cast controls your foot's movement and supports its contours if you don't put any weight on it. To use a total contact cast, you need good blood flow in your foot. The cast is changed every week or two until your foot heals. A custom-walking boot is another way to treat your Charcot foot. It supports the foot until all the swelling goes down, which can take as long as a year. You should keep from putting your weight on the Charcot foot. Surgery is considered if your deformity is too severe for a brace or shoe.
Diabetic Ulcers Frequently Asked Questions
Courtesy of APMA
What is a diabetic ulcer?
Diabetic ulcerations are often one of the first signs of complications from diabetes in the lower leg. These ulcers (or sores) can stem from a small wound or cut on the foot that is slow to heal. If left untreated, ulcers can grow larger and become harder to successfully treat. Often, ulcers can become infected, and can lead to partial or full amputation of the foot or lower leg.
Won't I know it when I have a cut or wound on one or both of my feet?
Not always. Those with diabetes can often experience what is called "diabetic neuropathy" -- a numbness or lack of sensation of the lower legs and feet. Neuropathy can often make the beginning stages of diabetic ulcers difficult to feel. This is why it is important to have a physician check both feet at routine exams, and to have yourself or a family member check your feet daily for signs and symptoms.
What are the warning signs?
As neuropathy makes it difficult to feel sensation in the limbs, waiting for pain in the feet to detect ulcers is usually not an option for those with diabetes. Chief warning signs to look for include irritation, redness, cracked and dry skin (especially around the heels), and drainage on socks. If you experience any of these symptoms, you should be evaluated by a medical professional.
Where do diabetic ulcers most often occur?
Typically, diabetic foot ulcers occur at points of increased pressure, such as the ball of the foot or the bottom of the big toe. However, ulcers can appear anywhere on the foot or ankle.
I have heard of the term "diabetic hotspot." What is that?
Diabetic hotspots are specific areas of the foot in individuals with diabetes, which have increased skin temperatures compared to the rest of the foot, usually due to increased pressure. These temperature differences have been shown to help healthcare providers predict where a diabetic ulcer will present before it actually does.
If I discover what I think is a diabetic ulcer, is it too late to save my lower limb?
No; if discovered early and treated by a podiatrist or primary care physician, many ulcers can be successfully healed without resorting to amputation. Additionally, several new technologies used today may increase the healing rate of diabetic wounds. One such technology used by Associated Podiatrists is Dermagraft, an advanced wound care product has successfully healed wounds in more than 50,000 patients. Contact Us for more information or to make an appointment.
How can I maintain a normal life but most importantly, a healthy diet as a diabetic?
Visit The Decadent Diabetic website and let Ward Alper encourage you to take back your life AND your table!
One of the causes of nerve pain or numbness in diabetics and non-diabetics may be related to lack of oxygen, which can ultimately lead to nerve damage.
MicroVascular therapy, or MicroVas, is a type of physical therapy which works directly and mechanically to improve blood flow through neuromuscular stimulation and deep muscular contractions.The therapeutic benefits of increased blood flow can help heal chronic wounds, decrease swelling, relieve chronic pain, and diminish the effects of neuropathy for both diabetic and non-diabetic patients. We are one of the only offices in the state to offer this new and effective therapy. At Associated Podiatrists, we have seen terrific results with no side effects. Come in for an evaluation to determine in Microvas would be of benefit to you.
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