Foot problems are a common complication of Diabetes and are a leading reason for diabetes-related hospitalization. Additionally, diabetes is the leading cause of amputation in the lower leg and foot. Technology, research, and most importantly diligence by patients can greatly improve this situation and diminish the risks associated with diabetic foot problems.
Foot problems in people who are diabetic are usually caused by three factors: neuropathy, poor circulation and decreased ability to fight infection. Also, foot deformities and trauma play major roles in causing ulcerations and infections in the presence of neuropathy or poor circulation.
Diabetes can often lead to peripheral neuropathy (nerve damage), a condition in which nerve function deteriorates in the extremities, leading to a gradual loss of feeling in the hands, arms, legs, and feet. Patients may experience numbness, tingling, and weakness in the extremities, as well as shooting pains, or a burning sensation. Many times there is an inability to sense pain in the affected areas. This is often problematic because pain is what enables the patient to know when something is wrong. Without it, a patient may not seek timely treatment for bruises, cuts, blisters or burns that heal slowly or poorly because of diabetes-related circulation problems. For this reason, minor skin problems of the feet can become worse and lead to infection.
People with diabetes often have circulation disorders (peripheral vascular disease) that can cause cramping in the calf or buttocks and the symptoms can progress to severe cramping or pain at rest, with color and temperature changes (the feet may turn bright red when hanging down and constantly feel cold).
Poor circulation, results in reduced blood flow to the feet, and can restrict delivery of oxygen and nutrients that are required for normal maintenance and repair. As a result, healing of foot injuries, infection or ulceration is impaired.
Diabetics are generally more prone to infections than non-diabetic people.
Infections often worsen and may go undetected, especially in the presence of diabetic neuropathy or vascular disease. Often, the only sign of a developing infection is unexplained high blood sugar, even without fever. The combination of fever and high blood sugar often warns of a severe infection requiring hospitalization. Lesser degrees of infection are often treated on an outpatient basis.
Another common foot condition that can occur with diabetics is Charcot foot. Jean-Martin Charcot (1825-1893) was the first to describe the disintegration of ligaments and a joint surface caused by disease or injury and is where the condition gets its name. The technical term for Charcot foot is neurogenic arthropathy. Neurogenic arthropathy is a progressive degenerative arthritis that results from nerve damage. (Neuropathy).
In Charcot foot, pain perception and the ability to sense the position of the joints in the foot are impaired or lost, and muscles do not have the ability to support the joint(s) properly. Loss of motor and sensory nerve functions cause minor traumas such as stress fractures and sprains to go undetected and untreated, leading to ligament laxity (slackness), joint dislocation, bone erosion, cartilage damage, and deformity of the foot. The bones most often affected are the metatarsals and the tarsals, located in the forefoot and midfoot.
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