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What Causes Diabetic Foot Complications?

Updated: Feb 8

In this section Cypress Foot and Ankle specialist Dr. Christopher Correa discusses Diabetic foot care and complications. “Small problems need small fixes big problems need big fixes.” This is a phrase I expound to my diabetic patients all the time and it is a mantra that will never grow old. While diabetes causes many problems throughout the body there are two problems that affect the feet specifically which lie at the root of all of the other diabetic foot problems. Lack of blood flow and lack of sensation. In nearly all serious diabetic foot and ankle complications at least one of these two is involved in some way.

Blood Flow in the Diabetic

Poor blood flow otherwise known as Peripheral Arterial Disease (PAD) to the feet restricts the body’s ability to heal wounds and fight infections. The reason for this is simply a matter of access. If the blood cannot get to the foot in adequate amounts then none of the growth factors, white blood cells or antibiotics can either. A relationship with a good podiatrist can protect your feet from injury and a relationship with a good vascular specialist can help monitor your blood flow and reestablish it if necessary before any major complications occur.

Diabetic Neuropathy and Loss of Sensation

Loss of sensation is also a major issue. It’s hard to treat what you do not know about and advanced neuropathy in a long standing diabetic can lead to a complete loss of sensation sometimes as high as the knee. There was once a wise man who described referred to pain as a "gift". While pain is obviously something that everyone wants to avoid, it is good in the sense that it gets your attention and stops you from continuing whatever damaging activity you were doing. Think about walking barefoot on asphalt in Texas in August. If you can’t feel pain what would make you stop? In diabetes loss of sensation is particularly insidious because it does not happen all at once. Diabetic polyneuropathy starts at the tips of the toes and causes the loss of light sensory touch first. It then progresses in a stocking and glove distribution on both feet at the same time. This oftentimes leads to a patient who can feel their foot if it is bumped or if the examiner grabs a toe firmly but one where breaks in the skin, scrapes and burns are not felt at all. Any of these insults can lead to an ulcer causing prolonged accidental neglect – you usually do not treat the wound you do not know about. In these cases, wounds can fester for long periods until more severe symptoms set in.

For these reasons it is very important for diabetics to check their feet either personally or have a loved one do it every day to check for problems. This is also why it is so important to find a podiatrist who you trust and build a relationship with him/her. Not only will this facilitate getting seen sooner but affords the peace of mind to already have a planned "go to" person in mind when an unexpected problem occurs. Once you have found that podiatrist then yearly checkups should be done at a minimum and more frequently for those who are considered high risk. Diabetic patients should also have a low threshold for making an appointment. If you notice sudden changes in your feet such as new wounds, discolorations, new calluses, redness, swelling or pain you should make an appointment whether you believe the problem to be a big deal or not. Seeing your doctor early means that if pathology is present, it can be address early and there is less chance of a bad outcome.

Underlying all of this is maintaining tight sugar control. Elevated blood sugar affects the wound healing process, inhibits your ability to fight infections, worsens the already existing metabolic imbalance, worsens peripheral vascular disease, damages nerve promoting sensory loss and other neurological problems. Tight sugar control ensuring that you follow up with the doctor who is medically managing your diabetes on a regular basis is also very important. Blood sugar management can be somewhat of a moving target and what works today does not always work for ever. Your doctor needs to be kept in the loop so he/she can make adjustments as they become necessary - before a big problem occurs.

To reiterate, "small problems need small fixes big problems need big fixes". Say it daily and say it out loud. Diabetic foot complications can get out of hand quickly with some becoming acutely worse in the span of just 24 hours. Infections from either neuropathy or a lack of blood flow can set in and spread quickly. Establish a relationship with the experts at Select Foot and Ankle Specialists and let them help protect your feet.

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