Diabetic Foot

What is Diabetic Foot?

Several characteristic Diabetic Foot pathologies like infection, diabetic foot ulcer, diabetic neuropathy, diabetic arthropathy are collectively called Diabetic Foot syndrome.

What is diabetic neuropathy?

High blood sugar can injure the nerve fibers throughout the body but in diabetics mainly legs and feet are involved. The patient presents with pain and numbness in the extremities. The patient may have pain, disability or the condition may be fatal due to sepsis. It can be prevented by lifestyle changes and blood-sugar control.

Can diabetes affect other organs of the body?

Diabetes involves almost every organ of the body through more commonly it involves the digestive, urinary tract, blood vessels, and the heart.

How does Diabetic Foot patient present?

This is called peripheral neuropathy.

  • Feet and legs are involved before hands and arms
  • Symptoms are worse at night
  • There is numbness
  • Reduced ability to feel pain and temperature
  • Tingling or burning sensation
  • Cramps or sharp pain off and on
  • Increased sensitivity to touch – a weight of bed-sheet may be agonizing
  • Muscle weakness
  • Loss of balance and coordination
  • Serious foot problems – ulcers, infections, deformities

How do I know other organs are involved?

This is called autonomic neuropathy because the autonomic nerves control the heart, lungs, intestines, sex organs and eyes. They present as:

  • Lack of awareness that the blood sugar levels are low.
  • Urinary problems like urinary tract infection, retention of urine or urinary incontinence.
  • Constipation, uncontrolled diarrhea or a combination.
  • Show stomach emptying causing nausea, vomiting, and lack of appetite.
  • Difficulty in swallowing
  • Erectile dysfunction in men
  • Increased or decreased sweating.
  • Inability to adjust blood pressure and heart rate with a sharp fall on standing or sitting making one feel light headed or faint.
  • Problems regulating your body temperature
  • Changes in the adjustment of eyes from light to dark
  • Increased heart rate at rest.

Diabetes and muscle involvement.

This is called Rediculoplexus Neuropathy (Diabetic amyotrophy) It involves nerves of the hips, buttock, and legs. It presents as:

  • Elderly patients with type 2 diabetes
  • Generally unilateral but may be bilateral
  • Sudden severe pain in hips and thigh
  • Weakness due to atrophy of the thigh muscles
  • Difficulty to rise from the sitting position
  • Weight loss
  • Abdominal swelling if abdominal muscles are involved

Can there be a single nerve involvement?

This is called mononeuropathy.

  • Severe pain sudden in onset affecting specific nerves and takes a few weeks to disappear.
  • Difficult to focus eyes, double vision or aching eyes
  • Paralysis of one side of the face (Bell’s palsy)
  • Pain in any part of the leg
  • Pain lower back or pelvis
  • Carpel tunnel syndrome – tingling in the fingers, weakness in the hands and tendency to drop things

When do I need to see a doctor?

  • If there is a sore on the foot which is not healing or getting infected and red
  • Burning, numbness of hands and feet interfering with sleep or routine activities
  • Dizziness
  • Changes in urination, digestion or sexual function

Why does Diabetic Foot take place?

Exposure to high sugar levels damages the delicate nerves leading to neuropathy. High blood sugars interfere with the ability of the nerves to transmit signals. It also weakens the capillary walls that supply the nerves with oxygen and nutrients.
There is also inflammation of the nerves caused by an autoimmune response which means that the immune system mistakes its own part as foreign and attacks it.
Then there are genetic factors making people more susceptible to nerve damage.
Smoking and alcohol damage both nerve and blood vessels.

Who is more prone to Diabetic Foot?

  • People with poorly controlled blood sugars – it is vital that diabetes is kept under control
  • The length of time since the patient has had diabetes – the longer the time the more the damage.
  • Kidney disease – diabetes damages the kidneys and the increased blood toxins because of renal failure contribute to the nerve damage.
  • Overweight – Body Mass Index (BMI) over 24 increases the risk of diabetic neuropathy.
  • Smoking – damages the blood vessels reducing the blood flow to the legs and feet. This promotes nerve damage and delays wound healing.