Ulcerations, infections and gangrene are the most common foot and ankle problems that the patient with diabetes must face. As a result, thousands of diabetic patients require amputations each year. Foot infections are the most common reason for hospitalization of diabetic patients. Ulcerations of the feet may take months or even years to heal. It takes 20 times more energy to heal a wound than to maintain a healthy foot.
There are two major causes of foot problems in diabetes:
Diabetic Nerve Damage (Neuropathy)
This causes loss of feeling in the foot, which normally protects the foot from injury. The protective sensations of sharp/dull, hot /cold, pressure and vibration become altered or lost completely. Furthermore, nerve damage causes toe deformities, collapse of the arch, and dry skin. These problems may result in foot ulcers and infections, which may progress rapidly to gangrene and amputation. However: Daily foot care and regular visits to the podiatrist can better prevent ulcerations which can lead to infections - which can lead to amputations.
Loss of Circulation (Angiopathy)
Poor circulation may be difficult to treat. If circulation is poor, gangrene and amputation may be unavoidable. Cigarette smoking should be avoided. Smoking can significantly reduce the circulation to the feet. There are certain medications available for improving circulation (Trental) and by-pass surgery may be necessary to improve circulation to the feet. Daily foot care and regular visits to the podiatrist can often prevent or delay the need for amputation.
In 2001, Dr. Parker became aware of new treatment paradigms and exciting techniques developed over decades of research. The application of these techniques may give hope to the diabetic patient and to the doctors who treat these disorders.
Loss of sensation in the extremities, as well as the burning pain of diabetic neuropathy, appears to be due, in part, to the compression resulting in ischemia of peripheral nerves around sites of anatomic narrowing such as the tarsal tunnel at the ankle and other specific nerves to the leg and foot. In appropriate patients, surgically decompression of these entrapped nerves has been shown in four separate geographical studies to restore pedal sensation and eliminate the pain of diabetic neuropathy in 80% of patients.
Dr. Parker is now performing computerized measurements of sensibility in the foot with pressure sensitive neurosensory testing in the office by certified technicians.
Patients with diabetic peripheral neuropathy may be candidates for the surgical decompression of lower extremity nerves and the restoration of the sensation to the insensate (numb) foot.
This could prevent the following scenario:
Insensate Foot » Ulceration » Infection » Amputation
Dr. Parker has special training in advanced techniques of peripheral nerve surgery under Dr. Lee Dellon, a full professor at John's Hopkins and Director of the Institute for Peripheral Nerve Surgery in Baltimore. He is also a charter member of the Lower Extremity Peripheral Nerve Surgery Fellowship Group. The subjective outcomes of the Society include relief of pain, restoration of sensation and decrease in medication. The objective outcomes being the prevention of ulceration, prevention of amputation, prevention of hospitalization for infection, and prevention of falls with hip fracture, all in the surgically decompressed extremity.
Dr. Parker is also a participant in the International Neuropathy Decompression Registry. The International Neuropathy Decompression Registry records prospectively the number of people who have had a surgical procedure to treat the symptoms of neuropathy. The surgical procedures are those described by A. Lee Dellon, MD, Director of the Institutes for Peripheral Nerve Surgery. The doctors who can enter their patients into this Registry are those who have been trained at one of Dr. Dellon's Advanced Lower Extremity Peripheral Nerve Workshops, implying that all surgical procedures done for the treatment of the symptoms of neuropathy will have been done with the same, consistent, surgical technique, and done with the same pre-operative indications and measurements, and followed with the same post-operative care and measurements. This Registry is sponsored by the Diabetic Neuropathy Foundation of the Southwest.
Preventative Diabetic Care
Do the Following to Protect Your Feet:
Examine Your Feet Daily
- Use your eyes and hands, or have a family member help.
- Check between your toes.
- Use a mirror to observe the bottom of your feet.
- Look for these Danger Signs:
- Swelling (especially new, increased or involving one foot)
- Redness (may be a sign of a pressure sore or infection)
- Blisters (may be a sign of rubbing or pressure sore)
- Cuts or Scratches or Bleeding (may become infected)
- Nail Problems (may rub on skin, cause ulceration or become infected)
- Maceration, Drainage (between toes)
If you observe any of these danger signs, call our office at once.
Examine Your Shoes Daily
- Check the insides of your shoes, using your hands, for:
- Irregularities (rough areas, seams)
- Foreign objects (stones, tacks)
Daily Washing and Foot Care
- Wash your feet daily.
- Avoid water that is too hot or too cold. Use lukewarm water.
- Dry off the feet after washing, especially between the toes.
- If your skin is dry, use a small amount of lubricant on the skin.
- Use lambs wool (not cotton) between the toes to keep these areas dry.
Fitting Shoes and Socks
- Make sure that the shoes and socks are not too tight.
- The toe box of the shoe should have extra room and be made of a soft upper material that can "breath".
- New shoes should be removed after 5-10 minutes to check for redness, which could be a sign of too much pressure. If there is redness, do not wear the shoe. If there is no redness, check again after each half hour during the first day of use.
- Rotate your shoes that you wear as much as possible.
- Ask our office about therapeutic (prescription) footwear, which is a covered benefit for diabetic patients in many insurance plans.
- Tell your shoe salesman that you have diabetes.
- See our office on a regular basis.
- Ask your primary care doctor to check your feet on every visit.
- Call our office if you observe any of the above danger signs.
Do Not Do These Dangerous Acts:
- Do Not Walk Barefoot. Sharp objects or rough surfaces can cause cuts, blisters, and other injuries.
- Do Not Use Heat on the Feet. Heat can cause a serious burn, especially if the patient has neuropathy.
- Do Not Apply a Heating Pad to the Feet.
- Do Not Soak Your Feet in Hot Water.
- Do Not Use Chemicals or Sharp Instruments to Trim Calluses. This could cause cuts and blisters that may become infected.
- Do Not Cut Nails into the Corners. Cut nails straight across.
- Do Not Smoke. Smoking reduces the circulation to your feet.