Description

Diabetes is a chronic condition associated with abnormally high levels of sugar (glucose) in the blood.

Type 1 – Insulin dependent, the body does not produce insulin and requires daily injections. Most commonly occurs in young adults and children.

Type 2 – Non-insulin dependent, the body does not produce enough insulin or does not use the insulin properly. This is controlled through diet and/or doctor prescribed medication, most often occurring in older adults. Obesity, poor diet and lack of exercise are contributing factors.

Diabetes is becoming more prominent and epidemic. Foot problems commonly develop in people with diabetes and can quickly become serious as a diabetic’s foot is sensitive to the elements. Therefore, it is always important for the diabetic person to check their feet daily, at least twice a day, to monitor any changes that may occur. The effects of Diabetes on the body and especially the skin, are important monitors of the diabetic condition. The skin becomes thinner, and hair loss is prevalent on the lower limbs. If needed, a diabetic should ask for assistance to check their feet, or acquire a mirror that allows them to check the bottom of their feet.

Nerve damage can occur and a person with diabetes may not be able to feel his or her feet properly (peripheral neuropathy). Normal sweat secretion and oil production that lubricates the skin of the foot is hindered. This can lead to abnormal pressure on the skin, bones and joints of the foot during walking, breaking down of the skin, allowing sores or ulcers to develop. The skin is not able to react normally against any abnormalities and can quickly turn to ulcers.

The immune system of a diabetic can impair these wounds to heal because of poor circulation and damage to blood vessels (peripheral vascular disease). Bacterial infection of the skin, connective tissues, muscles and bones can occur. Poor blood flow makes it difficult for antibiotics to reach the infected site easily and puts a diabetic at higher risk to develop gangrene and therefore at higher risk of amputation.

Symptoms

Some of the symptoms experience with the diabetic foot include; Burning, tingling or pain in the feet, loss of sensation, heat, cold or touch, changes in skin color or foot shape, loss of hair on the toes, feet and lower legs, blisters, ulcers, sores, ingrown toenails and thickening of the toe nails with color change (yellowing)

Pedorthic Management

Those with Diabetes must always be cautious with their footwear.

• Diabetic appropriate socks, without ridges or seams, are usually recommended
• Orthopedic footwear – properly fitted with cushioned liners, deep and wide toe box, no seams
• Footwear modifications – excavations, stretching, rocker soles, carbon fiber plates, balloon patches, medial or lateral flares

• Custom made orthotics – total contact, which combine support and cushioning, are of great benefit to the diabetic patient. While offering protection, the orthotics also off-load those areas of the foot, where weight- bearing is excessive, and aid those areas that would be prone to difficulty and pressure

Other Treatments/Modalities

• Diabetic persons should always have their toenails looked after by a professional. Toe nail trimming can be tricky business for a diabetic, visiting a professional such as a Chiropodist, Podiatrist, or specially trained foot care nurse is good practice.
• These professionals should also be consulted to remove corns, calluses and warts.
• Check feet daily for changes in the skin (color, redness, blisters, cuts or bruises)
• Wash feet using mild soap and warm water (dry feet thoroughly, especially between the toes)
• Avoid sitting with legs crossed
• or standing in one place for long periods of time