Friday, February 22, 2008

Diabetic Foot Disease

Diabetes affects multiple areas of the body, including the feet. What are things that could happen with a diabetic foot?


Many things can happen to the body because of diabetes. Vision and kidney function can gradually worsen. There is increased risk for a heart attack and stroke because of atherosclerosis. The feet are also susceptible to damage, but they can be overlooked. The effects of diabetes in the feet are multiple and can result in later difficulties. The following is a hypothetical example to illustrate this.


Living with Diabetic Foot

Suppose a patient has diabetes that is uncontrolled because he does not consume the recommended diet and take the necessary medications. One day, he decides to take a walk outside in his backyard. He also decides to walk barefoot. In the process, he steps on a small but sharp piece of glass. It does not get lodged into his skin, but he still gets a cut from it.


Naturally, one would feel the pain, discard the glass piece, and thoroughly clean the cut on the foot before dressing it with a bandage. With this man who likely has diabetic feet, he probably does not know that he stepped on a piece of glass. That is because there is damage to the nerves (peripheral neuropathy) from diabetes. In addition, he might have trouble placing his feet on the ground because he cannot feel where the ground is.


But it doesn't end there. An infection may occur where the cut is. It could be infection of the soft tissues (cellulitis) or even the bone itself (osteomyelitis). Diabetes impairs function of the immune system so that a diabetic is more prone to active infections than a nondiabetic. By this time, this man might finally look at his foot and notice some redness, swelling, or oozing from the wound. If not, he might seek medical attention when he has a fever or, with a more serious infection, a significant drop in blood pressure.


He can still take antibiotics for the infection, but what about healing of the wound? That might take some time. Diabetes causes impairment of blood circulation because of damage to the peripheral arteries (peripheral vascular disease). Perfusion of blood is an important factor in the process of wound healing. Now suppose his peripheral vascular disease worsens enough that his toes do not get any blood flow and die, resulting in gangrene. He would have to get them surgically amputated because they can be a source of infection later on.


If this continues, he might need amputations of the lower leg, either above or below the knee. Life will definitely change after an amputation, especially an amputation of both legs. Don't forget the other effects of diabetes. In the most severe case, uncontrolled diabetes leads to being a blind amputee on dialysis with an increased risk for cardiovascular events, like heart attack and stroke.


Preventive Measures

The preceding should be a reminder of what diabetes can do: worsening vision, kidney failure, increased risk of heart attack and stroke, peripheral vascular disease, peripheral neuropathy, and impaired immune system function. More importantly, it is a reminder about minimizing these effects with tight control of blood glucose levels. The importance of this cannot be overemphasized.


This article is contributed with permission of author of site of