Diabetes can take a toll on your lower extremities. We see patients with neuropathy, Peripheral Artery Disease (PAD), ulcers, balance issues, swelling and more. Sometimes these issues are also seen in non-diabetics who have neuropathy due to a different cause such as chemotherapy or other medication use, alcoholism, certain diseases or even for idiopathic reasons (meaning there is no known cause). Read on for answers to common questions surrounding neuropathy, and lower extremity involvement as it relates to diabetes or the other conditions listed above.
Peripheral Neuropathy can have a lot of different effects on the lower extremities.
A common side effect of diabetes is peripheral neuropathy. In the feet, peripheral neuropathy affects sensory nerves causing tingling and numbness, autonomic nerves causing increased dryness of the skin or increased sweating, and also motor nerves that affect the muscles. The effect on muscles can cause weakness and problems with proprioception, or monitoring where your body is in space. This in effect causes imbalance, and this is why some diabetic patients feel that their diabetes progression has also affected their balance.
Swelling in the lower extremities without occurance of an injury can be a symptom.
When swelling is noticed in the legs, ankles and feet of both sides of the body (also called edema) and does not correlate with an injury, it is often due to heart and kidney failure and problems with veins in the legs. If left untreated, this can cause pain and even lead to open wounds on the legs which can be difficult to treat. If you have a recent increase in swelling in both legs, contact your primary care doctor and if the conditions above are not at play they may send you our way for further evaluation!
What are foot ulcers and why should I be concerned?
An ulcer on the foot is an open wound. If you examine your feet and see an open wound, or a piece of hard skin, or a blister, or an area of redness, please have it checked right away. If it is open, then it is considered an ulcer and you are in danger for further complications such as an infection, which if not treated, may travel to the bone. Long standing ulcers that do not heal sometimes go on to need surgical intervention, IV antibiotics, and even amputation if not treated. If you have an open wound that you think may be an ulcer, please have it checked right away.
What type of patients are most at risk for foot ulcers?
Patients with diabetes or poor circulation are those we most often see develop foot ulcers. Diabetes affects the way that the nerves in our feet function and in severe cases of nerve damage (peripheral neuropathy) it is impossible to feel if a sore has begun to develop. This is very dangerous as the sore can get deeper and deeper and become infected before the patient even realizes it!
Why shouldn't I go barefoot?
It is advisable never to go barefoot if you have diabetes. Due to decreased feeling, or peripheral neuropathy, if you step on a foreign object and pierce the skin or cause an injury on the bottom of your foot, you may not feel it. In addition, if you do have a break in skin due to an injury, many times decreased blood flow and other factors in the blood may prolong wound healing. So don't take a chance by going barefoot; always wear the shoes prescribed by your podiatrist. For more information about diabetes and your feet, visit us at Prairie Path Foot and Ankle Clinic.
What is the best way to avoid getting foot ulcers?
For diabetics, blood glucose management should be at the forefront of your ulcer prevention plan, including a healthy, balanced diet and reducing or quitting smoking altogether. Also, washing feet every day, keeping them dry and moisturized and wearing proper fitting shoes. As a diabetic, you want to make sure to inspect your feet every day, and this includes both the tops, bottoms, and between your toes. Due to peripheral neuropathy, you may not be able to feel if there is a blister or area of soreness on your feet that can potentially progress to a serious infection. If you see something questionable on your foot such as an area of redness or irriration, or inspect your nails and see an opening in the skin or anything you are not sure about, call our office and make an appointment.
How do I get rid of this ulcer and won't it just go away with time?
NO! Diabetic wounds are a SERIOUS issue that need serious care. These wounds need to be seen by a doctor who is well trained in how to heal these wounds and how to handle the complications of diabetes. Do not try Dr Scholl's inserts or rubbing an essential oil on your wound. Your sore is a complex problem that needs a complex plan of care, including methods to take the pressure off, optimizing your nutrition, checking your vascular status, and monitoring you closely for infection. Most importantly the faster you get it healed, the less risk of losing part of your foot.
Your doctor may recommend a special shoe or boot to help with healing of the wound. Whether you have a sore from a diabetic wound or ulcer, or a wound or opening in your foot due to an injury or procedure, it is important to wear the surgical shoe that is dispensed by your podiatrist. The shoe has a rocker bottom sole in order to help with walking, and has velcro across the top of the foot and ankle with an open toe. The shoe allows for even distribution of weight so if there is a sore on the bottom of the foot, any areas of increased pressure will be alleviated. It is important to wear the shoe as directed and as long as the doctor has prescribed; don't walk barefoot or change shoe gear without the doctor's directions!
If my ulcer is healed, why do I need to come back?
Once we have worked so hard to heal the open sore, or ulceration, we have to work equally as hard to prevent it from coming back. This may include regularly scheduled foot exams for your feet; the amount of time between visits will be determined by your doctor. We also work with our staff to continuously evaluate your shoe gear and make appropriate changes in the shoe prescription or the inserts as needed. As time goes on, different activities, changes in lifestyle, and progression of diabetes can all affect the condition of your feet.
My heel hurts and is red, is it ok to wait 2 weeks for my scheduled follow-up?
No! At our office, if a condition or issue is painful and red it should be evaluated sooner than 2 weeks. In some cases this means that you will be seen by one of our doctors OTHER THAN who you normally see. When an area is red and painful it could just be irritated, but it could also mean infection and/or an open sore, especially in an area where there previously was an open sore, we want to ensure that there is not infection as this can get bad fast and be a lot worse in 2 weeks!
Nothing hurts! Why should I come to see the Dr?
We understand that without pain, it's easy to brush off the serious nature of foot ulcers, but whether you suffer from neuropathy due to diabetes or another reason, that is the exact reason it's important! If you have even a small problem, you may not notice, but that small problem can quickly change to a big problem including bleeding or drainage on your sock, an odor or even an open wound itself. The reasons to get checked are:
- Reduce the risk of infection and amputation
- To improve your function and, of course, your quality of life
- To reduce your health care costs
Whatever motivation you need, make sure you get your ulcer treated properly!
What is PAD?
PAD stand for peripheral artery disease. It occurs due to a buildup of cholesterol and plaque in the arteries of the lower extremity. Many times, those patients who have the presence of heart disease, diabetes, are smokers, or have a family history may be predisposed to getting PAD (peripheral arterial disease).
Why should I see a Podiatrist and how often?
Having diabetes means that it is best to see a podiatrist. At your first evaluation, your foot doctor will assess your feet and assign a certain risk level to your foot health. In some cases, when circulation and sensation is optimal, follow-up on an annual basis is adequate. In cases where there are issues with circulation and sensation is not optimal, a visit every 9 weeks is recommended. Occasionally, a patient with diabetes may be found to have an ulcer on their first visit and if this is the case, you podiatrist will follow-up with you more closely.
When you come and visit one of the doctors for diabetic foot care at Prairie Path, we will ask you your latest blood sugar and may ask you if you know your hemoglobin A1c, or HbA1c. This is important because as a team approach, we need to make sure you are aware of how tightly your blood sugars are being controlled because in turn, this affects your other organ systems, your extremities, and your feet. The HbA1c is a test that gives an estimate of your "average" blood glucose level over the past 2-3 months. Ideally, your A1c goal number should be below 7.0%.
If I'm feeling better, do I have to keep my foot exam follow-up?"An ounce of prevention is worth a pound of cure." - Benjamin Franklin.
My sentiments exactly! If you are currently under treatment for a foot complication due to diabetes, it is important to follow through on the complete treatment plan in order to prevent the problem from recurring. This includes returning for monitoring during follow up exams and check ups. Although you may feel like your feet are doing fine, it is important for the doctor to make sure that the complicating factors that caused the problem in the first place are thoroughly addressed. Our doctors at Prairie Path Foot and Ankle Clinic can also identify issues that may cause future problems, and it is important to address those before they turn into potential problems. So even if you think you are doing fine, it is worth having an expert take a look at your feet and give you some recommendations to keep you that way.
How do I know or how does my Dr determine if I have good blood flow to my feet?
Similar to a doctor checking your wrist for a pulse, a podiatrist can check two main blood vessels that circulate blood to your feet. A weak pulse to your feet can be a sign of poor blood circulation. Other signs that can be indicative of poor blood flow are lack of hair growth, thin and shiny skin, brittle nails and dark skin discoloration. Symptoms you could be experiencing with poor blood flow include cramping in your legs after walking a certain distance or pain while lying in bed that is only relieved with hanging your legs to the side.
Is there special footwear for Diabetics?
In instances where circulation and sensation in the feet is sub-optimal, custom shoes and inserts are recommended and most often covered by your insurance carrier. Your podiatrist will perform a thorough exam to determine if there are certain risks factors, such as poor circulation, a history of ulcers or sores, a history of amputation, or documented neuropathy with other bony deformities of the toes or feet. Your doctor is able to write a proper prescription which may include accommodative orthotics. Sometimes, this is determined not to be needed and in those cases, there are socks with particular materials and less irritating seams that are recommended to prevent pressure or friction on fragile skin.
Information on the Diabetic Shoe Program:
The diabetic shoe program is a program through Medicare part B. If you have Medicare and you have diabetes, there is a good chance that you qualify. The shoe program will allow you to obtain a special in-lay extra depth shoe and up to 3 pairs of inserts per year. Beware of mail order catalogs or pharmacies that claim they can get you shoes that are covered! Medicare has specific guidelines that can only be determined by a physician. The only way to know if you qualify is to make an appointment at Prairie Path Foot and Ankle Clinic and our doctors can determine what shoe gear is right for you. We will write a prescription, if you qualify, to one of the certified pedorthists in the area that will work with your primary care physician and our office to get you shoes if you qualify.