When we are talking about diabetes and your feet there are three main concerns: circulation, sensation and ability to fight off infection. All of these put you at risk for major complications, which is why diabetic foot care is so important. The earlier you address a concern, the more likely you are to avoid a serious problem. So let’s look at each one of these issues and how a diabetic foot exam can help.
Circulation: Slow Blood Flow
When you have diabetes, your body’s organs do not absorb sugar in your blood to be used as energy. This is because either you do not produce enough insulin, or your body does not recognize the insulin you’ve produced. This is a simplistic definition of diabetes. The sugar is eventually absorbed, but not where you want it. If it is absorbed into the outside lining of the blood vessel walls it can create plaque—similar to a cholesterol—which limits blood flow past that area. This occurs first in the small blood vessels in the tips of the toes then eventually in the larger blood vessels of the foot and leg. Part of your diabetic exam will include feeling the pulses in your feet and ankles, looking for skin that is warm, not dry, not shiny, and the presence of hair on the toes. These are all signs that there is decent blood flow to nourish the skin. Symptoms of circulation problems, also known as Peripheral Arterial Disease, or PAD, include pain into the back of your calf that limits how far you can walk, or pain at night that forces you to dangle your feet off the bed. Diagnosed early enough, PAD can be treated before problems occur.
When you live with diabetes, the ability to feel can be greatly reduced. In this case, sugar in the bloodstream eventually gets absorbed into the nerves. It becomes trapped inside and causes a chemical destruction of the nerve. This results in loss of sensation to the feet. Symptoms often show up before any diagnostic testing can record signs of the damage. The symptoms include pins, needles, and altered sensations (feeling like there is a rolled up sock under the ball of the foot), etc. These symptoms are initially worse at night, but they can progress until you have no sensation in the feet at all—this is called diabetic neuropathy. At this point, you are at an increased risk of developing ulcers (wounds), infections, and loss of balance. It is crucial to check your feet daily, especially the bottoms (soles). If you find it difficult to see, try using a mirror. This is important since a loss of sensation could inhibit you from noticing a blister from ill-fitting shoes, an abrasion from stepping on something, or an ingrown toenail that can lead to a dangerous infection. In addition to checking your feet daily, you should visit us regularly. During your exam, we will use a number of tests to determine your level of sensation. We’ll assess your reflexes, muscle strength, ability to determine 2 points, vibration, and light touch. These tests can help us determine the severity of your neuropathy.
Fighting Off Infection
The higher your blood sugar, the less able the main fighter cells of the body (AKA-white blood cells or WBC’s), can fight off infection. We cannot test this during our exam, but this emphasizes the importance of prevention. Once there is a problem (an ulcer or open wound), it can be difficult to heal and fend off infection. For all these reasons, we want to prevent any problems before they start.
So you can see how serious the effects of diabetes are on your feet. By having regular check-ups, your feet are closely monitored for PAD and the progression of neuropathy. Also if you have these risk factors, it is important for us to take care of your nails, corns, and calluses. We will keep a close eye on your feet and together with you, prevent these serious complications from occurring.
Let us become part of your healthcare team caring for your diabetes. Call Podiatry Care Specialists, PC at (610) 431-0200 for an appointment today at one of our southeastern Pennsylvania offices.