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DIABETIC FOOT

Diabetes is the failure of the body to use carbohydrates and sugars properly.  Nutrition to all the cells of the body becomes compromised.  Three common complications arise from diabetes:  Nephropathy (destruction of kidney tissue), retinopathy (destruction of the retina in the eye) and peripheral neuropathy (destruction of the nerves leading to the lower extremities). 

Pedorthists are involved with diabetics in the management of peripheral neuropathy.  Once damaged, nerves in the legs and feet not only lose feeling (sensory loss) but balance and gait are detrimentally affected.   Damage to the soft tissues leads to joint stiffness and loss of normal toe function.  The fat pad in the forefoot diminishes and skin growth in that area is deficient.  Heavy calluses and foot ulcers can develop in this area of tissue vulnerability.  Those with sensory loss in their feet can even have foreign objects in their shoes or sores on their feet without being aware of it. 

Progression of peripheral neuropathy and foot problems correspond to inadequate control of blood sugar levels.  The diabetic foot is at risk for very disabling results, such as a Charcot foot, ulcers and amputation if blood sugar levels are not controlled and proper foot care is not maintained.

Other names or similar foot conditions:

• Diabetes Type I and Type II
• Juvenile diabetes (Type I) and Adult on-set diabetes (Type II)
• Charcot foot (see that section for more information)

Symptoms:

• Sensory loss in feet
• Loss of position awareness and balance
• Damage to soft tissue of the feet
• Joint stiffness in feet and loss of normal toe function
• Callusing and foot ulcers

Signs to look for:

• Diagnosis
• Pain and burning in feet, even at rest
• Callusing
• Reddened areas on foot or open sores on foot

Possible Causes:

• Genetic component
• Viral infection may be causative in creating some cases of diabetes
• Failures of dietary and weight management issues an create Type II diabetes

Goals:

• Medical treatment and control of blood sugar levels
• Reduce pressures on the foot
• Protect tissues
• Eliminate calluses
• Support arch
• Footwear that protects and footwear for regular exercising

Solutions:

Arch Supports:

• Bio-Orthotics Winstep or Sundance exercising support with metatarsal lift (under Plastazote cushion

• Lower and thinner arch support with longitudinal and metatarsal support, such as the Bio-Orthotics Journey or Silhouette, for use when shoes cannot accommodate the Winstep or Sundance exercising support (under Plastazote cushion )

• Extra depth shoes with firm heel counter and high toe box

• For exercise, use shoes with titanium springs

• MBT physiological footwear

• Only wear pumps 1” or lower and only as absolutely necessary

• Do not go barefoot; wear house shoes with Plastazote cushion in them for relaxation at home

Other: 

• Copper diabetic socks

• Place cedar shoe trees in shoes after each wearing so shoes always fully dry out

Activities:

• Regular exercise program that promotes increased strength and circulation in lower extremities

• Rotation of weight bearing and non-weight bearing exercising, such as walking (weight bearing) and swimming or bicycling (non-weight bearing)

• Regular callus filing with pumice device (leaving cutting of calluses to a physician only)

• Regular skin care program to include exfoliating and moisturizing

This information does not constitute a diagnosis of your condition and does not take the place of a doctor’s care.  The information has been compiled from sources available to the general public and referenced below.  Copyright 2005 Carole Romig

Sources  Image:    Text:  D. Janisse, CPed, Editor, Introduction to Pedorthics