Diabetic Foot Problems, Diabetes of the Foot

Diabetics comprise a large number of patients seen in our practice everyday. Why do people with diabetes have foot problems? To begin with, a basic understanding of Diabetes Mellitus (DM) will help shed some light on the reasons.

Diabetes Mellitus (DM) is one of the most common metabolic (relating to the chemical processes which occur within the body) diseases affecting the human body. DM is a systemic (affects the entire body system) condition where the percentage of glucose (the body's fuel source=sugar) in the blood stream remains above normal levels (hyperglycemia).

DM can either be present at birth (congenital-Type I) or acquired during one's lifetime (acquired-Type II). In patients with DM there is a reduction in the amount of insulin, or the insulin does not function properly. Insulin is normally produced within the pancreas and allows the glucose (sugar) we intake to be converted into usable energy for our bodies.

This increase in circulating glucose (or highly fluctuating levels) affects many parts of the body; namely, the eyes, the kidneys, and the feet. In the eyes, patients with DM develop what is called diabetic retinopathy. This degenerative process slowly steals the vision of diabetic patients and can lead to total blindness. In the kidneys, progressive destruction of the glomeruli slowly reduces the ability of the kidneys to cleanse the body of its own toxins and many patients end-up on dialysis and/or needing a kidney transplant.

In the feet, long-standing DM affects almost all organ systems-the skin, the blood vessels, the nerves, and the bones. The skin of diabetics looses much of its elasticity, becomes dry and unhealthy, and allows the foot to become more prone to infections. The blood vessels become more prone to arteriosclerosis (hardening of the arteries) and over time, can lead to varying degrees of ischemia (tissue death due to poor circulation). The nerves become prone to a condition referred to as peripheral diabetic neuropathy. Symptoms range from mild numbness and/or tingling to severe burning pain, to complete anesthesia (no feeling at all). This leaves the foot vulnerable to unknown injuries, increased risk of infections, and many times amputation of parts of the foot and/or the entire leg. The bones are prone to osteoporosis (weakening, or thinning of the bones) due to diminished blood flow from arteriosclerosis and diminished nerve supply from neuropathy.

As you can see, DM is an extremely destructive condition/process. Not only when it comes to patient's feet, but many different organ systems within the body. Early diagnosis of Type II DM is the most important criteria to prevent and limit the long-term problems associated with this disease.

Once the definitive diagnosis of DM has been established by a credentialed medical professional, THE MOST IMPORTANT thing you can do to limit the progress of the destructive processes to your feet is to manage your diabetes properly. You must work closely with the medical doctor who is treating your diabetes. If you do not have a doctor-get one immediately! Maintaining your appropriate diet, taking your medication as prescribed, monitoring your blood sugar, and getting sufficient exercise are paramount to preventing potential long-term podiatric problems.

Dr. Tompkins sees his diabetic patients routinely depending on the level and severity of the patient's individual DM condition. My professional opinion is.the minimum number/level of routine podiatric evaluations in patients with DM should be three times a year (once every four months). This is irregardless of the fact that the patient may feel that he/she has 'no problems'.

During these visits, Dr. Tompkins will provide any evaluation and/or treatment necessary to limit the possibility of developing these potential long-term complications. One important point to note is. DO NOT attempt to treat any foot ailment on your own. If you have any problems and/or questions before your next scheduled appointment, call the office immediately to be seen earlier!!

If you have been diagnosed with Type II DM, the following is a partial list of the things you should do to help prevent foot complications from occurring:

Work closely with your medical doctor. Follow his/her instruction(s) carefully.
If you do not see a medical doctor routinely, mention this to Dr. Tompkins (or your foot specialist) immediately.
Inspect your feet EVERYDAY-use a mirror if needed to see the bottom!
DO NOT perform any treatment on your feet i.e. no 'bathroom surgery'!! Call for an appointment, no matter how insignificant it may seem.
Use a good moisturizer (EucerinC is an example) on your feet and legs daily after bathing. If you have especially dry skin, or the skin is cracked or has a lot of hyperkeratosis (calloused skin), then your foot specialist may prescribe additional medications to be used.
Wear good, supportive shoes-ask Dr. Tompkins, or your foot specialist if unsure. Tennis, or athletic shoes provide excellent shock absorption and are the most supportive shoe gear. Dr. Tompkins refers patients to Roger Soler's Sports for this type of shoe.
Don't wear the same pair of shoes all-day, everyday. Alter your shoe gear periodically.
Wear good, clean, socks everyday. White, cotton socks are the best. ThorloC is Dr. Tompkins preferred brand.

In closing, many of the long-term podiatric complications associated with DM can (and are) prevented by simply educating yourself about the disease itself. Education is the single most important issue facing health care professionals when dealing with DM. An informed patient is a better patient!

Conditions of the Foot by Dr. Mark H. Tompkins

Diabetic Foot

Conditions of the Foot
by Dr. Mark H. Tompkins