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Diabetes
is a disease in which glucose levels in the body are
disturbed.
If not kept
under control it can result in several medical conditions
including atherosclerosis, the buildup of plaque deposits
in the blood vessels. This can progress to a partial
or complete blockage of blood vessels. The most common
side effect of atherosclerosis in diabetics is peripheral
vascular disease.
Peripheral Vascular Disease is a reduction in blood
flow to the lower extremities caused by blockage in
the arteries. It usually affects the lower extremities,
because they are the farthest from the heart. Symptoms
include pain in the calves while in motion, loss of
hair on the leg, discoloring of the toes and thickening
of the toe nails, discolored and brittle skin on the
extremities, and decreased pulsation in the blood
vessels in the knee and foot.
With diabetics, any minor trauma can result in a problem
in the foot. Even something as seemingly minor as
cutting toenails or stubbing a toe can result in an
infection.
If you are diabetic you should take care to keep your
feet clean and insure they are neither too moist or
too dry. Do not cut your toenails.
Instead, file them to be even with the end of your
toe, or see a podiatrist for nail care.
Diabetics
should choose well fitting shoes in order to avoid
callouses and blisters, and to avoid going barefoot.
Callouses, blisters or any other foot injuries should
be treated promptly.
A
foot infection is a very serious matter and should
be attended to immediately. Since there is increased
sugar in the blood stream, it becomes a perfect environment
for bacteria to grow.
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With decreased circulation, a diabetic
has more difficulty fighting infection than other
members of the population. An infection in a diabetic
spreads more rapidly, and can be far more serious.
Unless treated promptly and properly, a diabetic foot
infection can lead to significant problems, including
amputation. The first symptom of an infection is a
minor abrasion or laceration that does not heal. The
person will usually see his or her doctor due to redness,
swelling and pain over the infected area.
Any infection in a diabetic must be controlled immediately.
If there is an accumulation of pus, it should be removed
and cultured. Topical and oral antibiotic treatment
should be used. Once culture studies are returned,
the physician or podiatrist can confirm that the correct
antibiotic is being used to treat the specific type
of infection at the site.
If an infection is severe enough, the diabetic patient
should be hospitalized and treated with intravenous
antibiotics. Hospitalization keeps the patient off
of the infected foot, thus reducing trauma to the
vulnerable area. IV antibiotics deliver medicine directly
through the bloodstream to the tissue, thus providing
the best opportunity to fight the infection.
Since there
is hardly any tissue in the toe and foot, the spread
of infection can be very rapid, especially in diabetics
with poor circulation.
Before any
procedure is performed on the foot, a podiatrist should
know the patient’s blood sugar level, the peripheral
pulses, and he should speak to the patient’s
physician.
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Once a podiatrist undertakes a surgical procedure
he is responsible. If a diabetic has uncontrolled
diabetes, procedures should not be performed due to
risk of infection.
Normal blood sugar is 80 to 115. Blood sugar above
this level is unacceptable and necessitates treatment.
A podiatrist or a physician treating a diabetic for
foot problems has three obligations: 1) Control the
infection, 2) Minimize the risk, and 3) perform any
procedure as carefully as possible.
To minimize the risk, the podiatrist or physician
must obtain a detailed overall history and contact
regular treating physicians, and learn what variables
concerning the patient’s past 24 hours exist
in order to determine whether his diabetes is controlled
or not.
With regard to procedures on a diabetic’s foot,
they should be performed as carefully as possible,
and some procedures should not be performed at all.
If there is any question as to whether the diabetes
is controlled or not, postponing procedures on the
foot is certainly reasonable.
Prevention of foot problems through proper diabetic
care, of course, must be the primary goal, but in
the event that foot problems develop the use of antibiotics
or surgical techniques, such as grafting of blood
vessels can be used.
By being aware of the dangers of foot infections and
implementing proper treatment, limb threatening infections
can be avoided with proper medical care.
Dr. Emanuel Fletcher is an internist
who has practiced medicine in Brooklyn for over 50
years.
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