Top 20 Questions About Diabetes & Your Feet

By: Jagdeep Takhar, Chiropodist, Jun 12, 2018
  Article
Diabetic health, the foot clinic brampton

Diabetes & Your Feet, what you need to know!

What is diabetes?

Diabetes is a disease that lasts a lifetime. It is a disease of the pancreas. Pancreas, located behind the stomach, are responsible for releasing a substance known as insulin into the blood. Insulin is a crucial substance for the body to maintain equilibrium as it helps to use sugars and fats which are broken down into the different types of foods we consume. However, when a person has diabetes, the pancreas either does not make insulin/ make only very little insulin (Type 1 Diabetes) or the insulin that it makes does not function in the way it is supposed to (Type 2 Diabetes).

For additional information visit: https://www.diabetes.org.uk/Diabetes-the-basics/

What is a diabetic foot ulcer?

Diabetic foot ulcers are common in people with diabetes, affecting approximately 15 percent of diabetics. It is an open wound or sore that is usually located on the bottom of the foot. Research has shown that the development of a foot ulcer can be prevented. Six percent of people who develop a foot ulcer will be hospitalized because of an ulcer-related complication such as an infection. They can affect your feet down to the bones and are most commonly found under the balls of your feet and under your big toes. There are three main types of classifications of foot ulcers – neuropathic, neuro-ischaemic or ischaemic.

For additional information visit: http://emedicine.medscape.com/article/460282-overview

Who is at risk of developing a Diabetic Foot Ulcer?

Anybody who has diabetes is at risk of developing a diabetic foot ulcer. However, it should be noted that certain demographics are more at risk than others. For example, Native Americans, African Americans as well as Hispanics are more likely to develop foot ulcers that are led on by diabetes. Older men also have a higher risk. Patients suffering from diabetes-related eye, kidney and heart diseases, as well as people who use insulin, are more likely to get a diabetic foot ulcer. People who lead an unhealthy lifestyle such as using alcohol/tobacco or being overweight can also increase the chances of developing a foot ulcer. People with foot deformities also have a higher chance of getting an ulcer in their foot.

For additional information visit: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2888355/

How do the microorganisms enter the foot?

Microorganisms are the things that can complicate the foot ulcer. It most commonly enters the foot through an open wound. It can also enter the foot through cracks in the space between the toes, direct puncture, or through paronychia. However, this is less frequently seen. Most of the infections are due to a break in the skin. Diabetic foot ulcers are usually caused by sensory and motor neuropathy as well as vascular insufficiency (when blood does not go to your foot properly). It is important to prevent breaks in the skin, especially in the areas where continuous mechanical stress occurs (such as the base of the foot). The area of the ulcer might start out like a blister, but with continuing irritation, it will develop into an ulcer. Well-fitted shoes can prevent foot irritation.

For additional information visit: http://microbiologyonline.org/about-microbiology/microbes-and-the-human-body/routes-of-transmission

How do diabetic foot ulcers form?

Diabetic foot ulcers usually form because of a combination of factors. They can form because of trauma, poor circulation, foot deformities, lack of sensation in the foot or irritation (such as pressure or friction). It is dependant on the duration of diabetes as well. People who have had diabetes for several years can also develop a condition known as ‘neuropathy’ where there is a reduced or a complete lack of ability to feel pain in the feet due to nerve damage. This is due to the high levels of blood glucose the body has to handle over a long period of time which can also reduce the body’s ability to heal and also reduce the body’s ability to fight off potential infection. A diabetic person might not even be aware of the problem as the nerve damage can occur without pain.

For additional information visit: http://www.healthline.com/health/diabetic-foot-pain-and-ulcers-causes-treatments

Why should a foot ulcer be treated?

You should immediately seek the help of a medical professional (preferably a podiatric) after you spot an ulcer on your foot. Patients with diabetes should seek treatment for foot ulcers otherwise it can further complicate the disease and lead to unwanted consequences such as an amputation or a severe infection. An ulcer left treated is very vulnerable to getting an infection. When a foot ulcer is infected, it can develop into an abscess (a pocket of pus), or a spreading infection of the skin and cellulitis, or a bone infection or a gangrene (an area of dead tissue caused by poor circulation). Treating a foot ulcer early can reduce health care costs, improve quality of life and function of the body.
For additional information visit: https://www.drugs.com/health-guide/foot-ulcers.html

How can you treat a foot ulcer?

There are different ways one can treat a foot ulcer. The first way is known as ‘off-loading’ where the pressure is taken off the area of the foot with an ulcer. In this method, patients will be asked to use special footgear, crutches or wheelchair to reduce the irritation and pressure to the ulcer area. The second method is known as “debridement” where the dead skin and tissue is removed. The third method is to apply dressings and topically-applied medications such as skin substitutes, growth factors, and ulcer dressings. As proper blood circulation is needed to heal a foot ulcer, your podiatrist might order evaluation test such as noninvasive studies. Managing blood glucose is another crucial aspect of treating a diabetic foot ulcer. Sometimes surgery is also used to treat a foot ulcer – especially in cases where the patient suffers from a foot deformity such as hammertoes.

For additional information visit: http://www.healthline.com/health/diabetic-foot-pain-and-ulcers-causes-treatments

Is Antibiotic Therapy Indicated for All Patients With Diabetic Foot Ulcer?

Antibiotic Therapy is not indicated for all patients that have been diagnosed with a diabetic foot ulcer. It is only indicated in patients whose foot ulcer has purulent discharge (pus) or shows signs of inflammation. This therapy is also conducted if the ulcer is suspected to have an underlying osteomyelitis. However, if the ulcer persists for more than two weeks even with no signs of infection, careful examination should be performed. Parenteral antibiotic therapy is only used for patients who have moderate to severe infections in their foot. The duration of the therapy varies from patient to patient with patients without osteomyelitis only having to do therapy for 2-4 weeks.

For additional information visit: http://emedicine.medscape.com/article/237378-treatment#d9

Which Patients With Diabetic Foot Infections Can Be Treated in the Office?

Patients who have non-limb-threatening infections can be treated in the office using an oral agent. Patients who have mild superficial infections can also be treated in the outpatient setting. Most of the patients will not have a very complicated case of the ulcer. These patients do not have purulent discharge (pus) with their skin infection and they will also not have cellulitis, systemic toxicity or osteomyelitis. Patients who have marked tissue necrosis with or without gangrene, bacteremia, shock and systemic toxicity should be immediately hospitalized and treated with the much more aggressive management of infections as well as glucose control.

For additional information visit: http://emedicine.medscape.com/article/237378-treatment

How to prevent a foot ulcer?

There are several ways one can prevent a foot ulcer. The most obvious way is to maintain a healthy life. This involves reducing factors that increase the risk of developing an ulcer such as high blood glucose and high cholesterol. It also means that one should quit smoking and/or be drinking alcohol as it only makes your body more vulnerable to diseases. You should also see a podiatrist on a regular basis and should consult with them to make sure that you are wearing the appropriate type of shoes and socks. You should also do routine checks of your feet at least once a day to check for potential problems such as bruises, blisters, redness etc. You should immediately report a problem to a medical professional no matter how trivial it may seem.

For additional information visit: http://patient.info/health/diabetes-foot-care-and-foot-ulcers

What causes diabetes?

Health care providers have been unable to pinpoint one specific cause of diabetes. While they do know that type 1 diabetes is a disease where the immune system destroys cells in the pancreas, they do not know what causes such behavior. However, many scientists suspect that genetics might play a huge role in the passing of type 1 diabetes. Most researchers have narrowed down some triggers that increase your chances of getting type 1 diabetes. Some of these triggers include viral/bacterial infection and chemical toxins within the food. Your chances of getting type two diabetes increases if you are overweight, take certain types of medicines, are old and are pregnant. Being pregnant puts additional stress on a female’s body which causes some women to develop diabetes, however, blood sugar levels do often return to normal after childbirth.

For additional information visit: http://www.diabetes.co.uk/diabetes-causes.html

How is diabetes managed?

Although researchers haven’t found a proper cure for diabetes yet, they do recommend several ways to manage this disease. Most people manage diabetes through a combination of diet, exercise, and medication. Diabetics should also use home and office tests to monitor the levels of triglycerides (a type of fat), sugar and cholesterol in their blood. The method of managing diabetes also depends on the type of diabetes that one has. Type 1 diabetes is usually controlled with exercise, insulin shots and careful planning of meals whereas type 2 diabetes is controlled by medicines (taken by the mouth) as well as proper diet and exercise. Insulin shots, although taken by some, are less commonly used to manage Type 2 diabetes for patients.
For additional information visit: http://www.medicinenet.com/script/main/art.asp?articlekey=59972&page=4

What are the symptoms of diabetes?

Symptoms of diabetes also depend on the type of diabetes. The symptoms of type 1 diabetes usually come out of the blue and are quite severe. People might feel as if they have to urinate often, have a dry mouth, increased level of thirst and blurred vision. Symptoms of type 1 diabetes also include feeling weak and tired most of the time and experiencing weight loss despite eating an adequate amount of food and feeling hungry. Unlike type one diabetes, type two diabetes build up over time and can often go unnoticed. Symptoms of type two diabetes include increased thirst, increased need to urinate, itchy skin (often in the groin/ vaginal area), yeast infections, slow healing cuts or sores and dry mouth.
For additional information visit: http://www.healthline.com/health/diabetes/symptoms-in-women

When Is Limb Amputation Indicated?

Limb amputation is not indicated in all cases of diabetic foot ulcers. As healing does not occur in the presence of necrotic tissues or poor vascularity, surgical consultation and intervention are carried out to restore the function of the foot. Surgical debridement in the past has proven to eliminate the need for amputation for many patients. In order to avoid above ankle amputation, doctors amputate the transmetatarsal area or do the resection of a toe. While a ray resection (resection of a toe) can affect a person’s gait, it can be mended via proper orthotic management. However, if the diabetic foot ulcer extends beyond the midfoot, a below-knee amputation should be considered.

For additional information visit: http://emedicine.medscape.com/article/1232102-overview

What Is the Role of Hyperbaric Oxygen, Growth Factors, and Other Biotech Agents?

Hyperbaric oxygen is used in the treatment of foot ulcers. While it may delay the development of a rapidly advancing infection, it should not be used as a substitute for the removal of devitalized/ damaged tissue. As it has a low cost-benefit ratio and in some cases also interferes with surgical debridement, it should just be considered as a supplemental treatment for surgical intervention. The new modalities of treatment should be thought of as supplemental therapy to the adequate blood supply, antibiotic therapy, and surgery. Growth factors too are only effective when the dead tissue and debris is removed from the wound, when there is ample blood supply to promote healing and when antibiotic activity is present to decrease the chances of infection. Biografts are also used in the same ‘add-on’ manner and are only effective when basic wound care is already in place.

For additional information visit: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4317316/

What Are the Common Etiologic Agents Associated With Diabetic Foot Infections?

When a patient is suspected to have a diabetic foot infection, it is crucial to find out the depth of the infection as well as the antimicrobial agents for empiric therapy and it is also important to get the cultures. In superficial foot infections, the most commonly isolated bacteria are gram-positive cocci such as Streptococcus and Staphylococcus. On the other hand, for infections involving deep structures both aerobic as well as anaerobic bacteria are usually isolated. After the removal of devitalized tissue through surgery, a swab of tissue can be taken for culture. It is important to consider the role of both aerobes as well as anaerobes. However, it should be noted that since superficial swab cultures are misleading, they should not be performed.

For additional information visit: http://emedicine.medscape.com/article/237378-overview

Which Antibiotics Are Most Appropriate for the Office Patients With Diabetic Foot Infections?

As most patients with mild infections have gram-positive cocci causative agents such as Because Staphylococci and Streptococci, research has shown the use of oral narrow-spectrum agents to be highly effective. Amoxicillin/clavulanate 500 mg given every 8 hours or 875 mg every 12 hours orally has also seen to be effective. Clindamycin 300 mg every 6 hours and Cephalexin 500 mg every 5 hours given orally were also seen to be equally effective. However, it is important to note that use of antibiotics isn’t always the best way to treat foot infections. Depending on the condition, vascular augmentation, debridement, and pressure relief through shoe modification could be used as well.
For additional information visit: http://emedicine.medscape.com/article/237378-treatment

How can I monitor the development and progression of diabetic complications?

Diabetes can come with several types of health complications. This is why you need to make sure you monitor your health properly and seek the help of a medical professional as soon as you see something odd about your health. However, to catch the diabetic complications at the earliest stage you must test your urine and get a dilated eye examination at least once a year. Patients who have experienced symptoms of blurred vision in one eye or blind spots or have a history of eye diseases need to see the doctor more frequently. Blood pressure should also be maintained less than 130/80 as high blood pressure can make your body more vulnerable to kidney diseases. Feet should be regularly checked and if swelling, redness, calluses, skin breakdown or cracks are spotted, it must be immediately reported to the doctor.
For additional information visit: http://www.uptodate.com/contents/preventing-complications-in-diabetes-mellitus-beyond-the-basics

Which Diagnostic Test Is Most Useful to Detect Osteomyelitis? Which of the Tests for Vascular Disease Should Be Done Routinely on Hospitalized Diabetic Patients With Foot Infection?

A practitioner who is familiar with foot autonomy can proble an ulcer with a sterile metal probe to see if the bone can be reached. A radiograph is another type of examination that can be carried out to determine the presence of bone infection. However, due to the poor vascularity in diabetic patients, radiographic changes might not be observed quickly. Technetium bone scan and leukocyte scans can also be done but they should not be used as a routine screening tool. Surgical debridement is the most cost-effective and expedient method as it can not only determine the depth of the ulcer but also the extent of vascularity and the presence of osteomyelitis. If the bone is still viable, bone aspiration or biopsy should be performed to confirm the presence of osteomyelitis. MRI can also be used as a supplemental measure of detection.

For additional information visit: http://www.mayoclinic.org/diseases-conditions/osteomyelitis/basics/tests-diagnosis/con-20025518

Can I take both pills and insulin to control my blood sugar?

You can take both insulin and oral medication to control your blood sugar as long as your doctor has mentioned that it is okay for you to do so. When you take a combination of pills and insulin as directed by your doctor, it becomes easier to control your blood sugar. Combination therapies are especially useful for people who have type 2 diabetes. Most people taking combination therapy tend to take an oral medication during the day and an insulin injection at night. While insulin will help you get better control blood sugar, it is very crucial that you monitor your blood sugar more often to decrease the chances of low blood sugar reactions.

For additional information visit: http://www.diabetesaction.org/site/PageServer?pagename=tip_medication_insulin

Jagdeep completed her Honours Bachelor of Science degree from the University of Toronto in Human Anatomy and Biology. She then proceeded to complete a graduate program in chiropody at the Michener Institute of Applied Health Sciences.

Jagdeep is a Chiropodist licensed by the College of Chiropodists of Ontario. In addition, she is a member of the Ontario Society of Chiropodists (OSC) and Canadian Federation of Podiatric Medicine (CFPM). Her participation in these organizations has allowed her to expand her chiropodial/podiatric medicine knowledge through continuing education courses and forming community partnerships with health professionals. 

Jagdeep offers a full range of chiropodial/podiatric treatments with areas of expertise in diabetic foot care, biomechanics including custom foot orthotics, and soft tissue surgery at The Foot Clinic in Brampton, Ontario

You can also visit her website here