Diabetic neuropathy is a group of nerve disorders caused by diabetes. People with diabetes can develop nerve problems at any time, but the longer a person has diabetes, the greater the risk of diabetic neuropathy. Diabetic neuropathy leads to numbness, pain, and weakness in the hands, arms, feet, and legs. Approximately 50 percent of those with diabetes have some form of diabetic neuropathy.

Neuropathic pain may have continuous and/or episodic (paroxysmal) components. The latter are likened to an electric shock. Common qualities of the pain include burning or coldness, "pins and needles" sensations, numbness and itching. "Ordinary" pain results from exclusive stimulation of pain fibers, while neuropathic pain often results from the firing of both pain and non-pain (touch, warm, cool) sensory nerve fibers serving the same area. The result is signals that the spinal cord and brain do not normally receive.

Nerve Damage

One problem is damage to nerves in your legs and feet. With damaged nerves in diabetic feet, you might not feel pain, heat, or cold in your legs and feet. A sore or cut on your foot may get worse because you do not know it is there. This lack of feeling is caused by nerve damage, also called diabetic neuropathy. It can lead to a large sore or infection.

 

Poor Blood Flow

The second problem with diabetic feet happens when not enough blood flows to your legs and feet. Poor blood flow makes it hard for a sore or infection to heal. This problem is called peripheral vascular disease. Smoking when you have diabetes makes blood flow problems much worse.

Impact on Diabetic Feet

These two causes can work together to worsen diabetic feet.

 

For example, you get a blister from shoes that do not fit. You do not feel the pain from the blister because you have nerve damage in your foot. Next, the blister gets infected. If blood glucose is high, the extra glucose feeds the germs. Germs grow, and the infection gets worse. Poor blood flow to your legs and feet can slow down healing. Once in a while, a bad infection never heals. The infection might cause gangrene. If a person has gangrene, the skin and tissue around the sore die. The area becomes black and smelly.

 

To keep gangrene from spreading, a doctor may have to do surgery to cut off a digit or part of the foot.


diabetes.emedtv

Written by/reviewed by: Arthur Schoenstadt, MD

Last reviewed by: Arthur Schoenstadt, MD

Diabetic Feet

Posted by Dr Maasi J Smith at 6/24/2008 10:02 AM and is filed under Diabetes

 

                                                                    Diabetic foot  



Diabetic foot is an umbrella term for foot problems in patients with diabetes mellitus. Due to arterial abnormalities and diabetic neuropathy, as well as a tendency to delayed wound healing, infection or gangrene of the foot is relatively common. Ten to Fifteen per cent of diabetic patients develop foot ulcers at some point in their lives and foot related problems are responsible for up to 50% of diabetes related hospital admissions.

Diabetic foot infection is a disease that is generally associated with damaged nerves and restricted blood supply due to diabetes, thereby causing deep sores and infections in the skin, muscles, or bones of the foot region.

Description

Diabetic patients are more vulnerable to foot infections. As the disease is often associated with low blood circulation and nervous disorders, people with high diabetes are more likely to be infected with foot diseases.
However, there is very little chance for the patient with a foot infection to realize the real importance of the situation; as he hardly gets a chance to feel any pain or discomfort in the region. In most of the cases, the ailment remains undiscovered, until, marked by some kind of weakness or fever occurring at frequent intervals.
Since, the root of the problem is related with the malfunctioning of the nerve cells, there are a number of problems that can arise due to the cause of the disease. Often it is found that the nerve cells controlling the sweating of glands do not work and as a result, the skin becomes dry, giving way to form calluses. These calluses are later on found to be the root of ulcers and other detrimental infections.

Diabetic foot disease is more commonly spread amongst those above 60 years of age. It is also found to be prominent amongst those with kidney or vascular disease, foot infections, excess and uncontrolled diabetes. People who have lost their sense of feeling or sensation or with some nervous disorder are all the more vulnerable to the effect of the disease.

Causes

One of the most predominant things behind the cause and spread of the infection is bacteria. Bacteria enter the skin conveniently through the cracks and fissures that are developed in the dry skin around the heels, corns and other regions of the foot . This in turn causes a slow and steady damage to the skin, tissue and bone in the various parts of the body. The bacterial sites may include, the blisters, corns, calluses on the skin; bunions, hammertoes, in the bones of the foot; any scar tissues from some earlier infection; and even in the ulcer affected regions of the foot.

Prevention

Prevention is by frequent podiatry review, good foot hygiene, diabetic socks and shoes, and avoiding injury.

Foot-care education combined with increased surveillance can reduce the incidence of serious foot lesions.
Footwear.

All major reviews recommend special footwear for patients with a prior ulcer or with foot deformities. One review added neuropathy as an indication for special footwear. The comparison of custom shoes versus well-chosen and well-fitted athletic shoes is not clear.

A meta-analysis by the Cochrane Collaboration concluded that "there is very limited evidence of the effectiveness of therapeutic shoes". The date of the literature search for this review is not clear. Clinical Evidence reviewed the topic and concluded "Individuals with significant foot deformities should be considered for referral and assessment for customised shoes that can accommodate the altered foot anatomy. In the absence of significant deformities, high quality well fitting non-prescription footwear seems to be a reasonable option". National Institute for Health and Clinical Excellence has reviewed the topic and concluded that for patients at "high risk of foot ulcers (neuropathy or absent pulses plus deformity or skin changes or previous ulcer" that "specialist footwear and insoles" should be provided.

Treatment

Foot ulcers in diabetes require multidisciplinary assessment, usually by diabetes specialists and surgeons. Treatment consists of appropriate bandages, antibiotics (against staphylococcus, streptococcus and anaerobe strains), debridement and arterial revascularisation.

It is often 500 mg to 1000 mg of flucloxacillin, 1 g of amoxicillin and also metronidazole to tackle the putrid smelling bacteria.

Specialists are investigating the role of nitric oxide in diabetic wound healing.  Nitric oxide is a powerful vasodilator, which helps to bring nutrients to the oxygen deficient wound beds. Specialists are using forms of light therapy such as LLLT to treat diabetic ulcers.

In 2004, The Cochrane review panel concluded that for people with diabetic foot ulcers, hyperbaric oxygen therapy reduced the risk of amputation and may improve the healing at 1 year. They also suggest that the availability of hyperbaric facilities and economic evaluations should be interpreted.

The appropriate treatment includes prior culture and proper detection of the infection. Then accordingly, some antibiotics are prescribed or if required, the infected tissue is removed from the site. Sometimes the doctors also make surgeries in the region of the ulcers to ensure an increase blood circulation in the region. In addition, the patients are also advised to keep a good diabetes check on their health.

Acupuncture is also practiced on the respective patient with a foot infection, in accordance with the degree of ailment. To enhance the body’s ability to fight infections, doctors often prescribe several vitamin-enriched herbs and vitamin C to the concerned patients. 

Questions to ask your doctor

Will this get worse?
What sort of daily care is needed to ensure a healthy foot?
What else can be availed, apart from regular treatment, to heal the wound?
Is there any Medicare coverage for diabetic shoes?
What kind of shoes are best to avoid any foot problems?

 

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