The diabetic foot
In diabetes foot treatment one of the main causes of ulceration is poor tissue oxygenation, which is caused by blocking of the large or small vessels. This can lead to very slow wound healing and make infection more likely, which can in severe cases lead to gangrene in the foot. Obviously early intervention in these cases is a priority as loss of limb can be a main cause of early morbidity. Where the circulation is severely compromised it is very difficult for the infection to clear. Foot ulcers affect 1 in 10 of Diabetes sufferers.
Common causes of foot ulceration in diabetic foot treatment
- extrinsic pressure from tight shoes.
- prolonged heel pressure.
- intrinsic pressures from chemical mediators of infection within the body.
- walking in bare feet and treading on a pin or sharp object which may not be felt due to loss of sensation.
- foot type - high arch or flat feet need to be adjusted for with orthoses.
- calluses and hard skin can cause ulceration.
- blisters are a common source for infection.
- check both feet for athletes foot. Especially in between the toes and on the plantar surface of both feet.
Steps to prevent foot problems in the care of diabetes
It is important that if you have poor circulation that your feet are checked on a regular basis by either a Podiatrist or other medically trained professional. The lower limb foot pulses will be checked, with the skin and nails for any signs of poor foot circulation. Proper accommodative footwear must be worn to avoid any shearing forces, which causes blistering of the skin.Good foot wear is often neglected but is so important for helping to prevent foot related problems. The feet should be checked daily for any changes in skin colour, blisters and calluses etc. All these could lead to ulceration and possibly gangrene, with loss of limb often resulting. Orthoses are advised to correct any problems with the gait or excessive foot pressures. Paddings or strappings are great for easing excessive foot pressure and shearing forces which can lead to foot ulceration. Heel pads can help to offload the heels and provide some will needed cushioning. Foot cream should be used daily to avoid dry and cracked skin, which can be a common source of foot infection. The feet must be dried thoroughly between the toes and the underneath to avoid athletes foot. Diabetes can be controlled with regular exercise, healthy eating and an aggressive treatment regime to control the blood sugars. Avoid smoking as this can cause many health problems. Shoes should be checked for any signs of wear and inside for foreign objects such as sharp edges.
Loss of sensation - diabetic neuropathy
Loss of sensation can develop in the feet over time. This condition is known as Diabetic neuropathy which manifests itself as peripheral neuropathy and usually affects the sensory nerves in the legs. Again it is important to have a regular test for this condition by a podiatrist or other medically trained professional.
Why it is vital to check for loss of sensation in diabetic foot treatment
If the nervous system becomes damaged it is possible for the feet to go numb. This can become painful in the early stages with a condition sometimes developing known as painful neuropathy. It is possible that your skin may be damaged through trauma or infection, even callus formation or standing on a pin and you could be totally unaware of the seriousness of the situation. As a foot ulcer could easily develop and you may be unaware due to the loss of sensation. Neuropathy can cause the heels to crack and the skin to dry out. Pressure from daily walking may go unnoticed. Your Podiatrist will grade your feet from low risk to high risk, if you are more at risk of ulceration.
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