Diabetic Foot

Overview

Diabetes is a condition of elevated blood sugar that affects about 6 percent of the population in the United States or about 16 million people. Diabetic foot problems are a major health concern and are a common cause of hospitalization.

Most foot problems that people with diabetes face arise from two serious complications of the disease: nerve damage and poor circulation. One of the more critical foot problems these complications can cause is Charcot arthropathy, which can deform the shape of the foot and lead to disability. When a diabetic person fractures a bone in the foot, they might not even realize it because of nerve damage. Continuing to walk on the injured foot results in more severe fractures and joint dislocations. Sharp edges of broken bone within the foot can point downward toward the ground, increasing the risk of chronic foot sores from the abnormal pressure

There are treatment options for a wide range of diabetic foot problems. The most effective treatment however, is prevention. For people with diabetes, careful, daily inspection of the feet is essential to overall health and the prevention of damaging foot problems.

Prevalence in NY

Around 1,717,067 individuals in New York, which accounts for approximately 10.7% of the adult population, have officially been diagnosed with diabetes. Additionally, there are approximately 456,000 people in New York who have diabetes but are unaware of their condition, significantly increasing their health risks. In New York, there are 5,228,000 individuals, constituting 33.5% of the adult population, who have prediabetes, characterized by blood glucose levels that are higher than normal but not yet high enough to be classified as diabetes. Each year, an estimated 117,032 people in New York receive a diabetes diagnosis.

Causes

If you have diabetes, your blood sugar levels are higher than normal. Over time, this can cause complications with other bodily functions, especially within the feet. In fact, diabetic foot ulcers, open wounds that occur in approximately 15 percent of diabetics, are the leading cause of non-traumatic lower extremity amputations in the United States. The causes of diabetic foot include the following:

• High blood sugar levels
• Nerve damage
• Poor circulation
• Infection
• Immune system problems

Symptoms

Although a patient with a diabetic foot pain typically will not have much pain, they may have other symptoms like:

• Changes in skin color
• Changes in skin temperature
• Swelling in the foot or ankle
• Pain in the legs
• Open sores on the feet that are slow to heal or are draining
• Ingrown toenails or toenails infected with fungus
• Corns or calluses
• Dry cracks in the skin, especially around the heel
• Foot odor that is unusual or won’t go away

Diagnosis

A physician will carry out a physical exam and foot exam to check for:

• Ankle reflexes
• Loss of sensation
• Changes in skin texture
• Changes in skin color

Other tests may include keeping a check on blood pressure and fluctuations in the heart rate. If the doctor suspects diabetic foot, they may run some diagnostic tests, such as:

• An electromyogram (EMG): It records electrical activity in the muscles
• A nerve conduction velocity test (NCV): It records the speed at which induced signals pass through the nerves

Treatment

Most types of diabetic feet get worse over time. The first step for people of any type is to bring blood sugars within a target range agreed with a doctor and manage high blood pressure and cholesterol levels.

Managing glucose levels will minimize the risk of diabetic foot. A key part of treatment focuses on reducing pain and managing some of the diabetic foot symptoms. Certain medications and types of physical therapy can help to control the pain of diabetic feet alongside other treatments. However, they cannot repair the nerves.

People should also avoid or stop smoking and limit their alcohol intake to a maximum of one drink a day for women and two for men.

Physical Therapy:

Electrical nerve stimulation is a painless type of physical therapy that might help to reduce feelings of stiffness and enhance the healing of foot ulcers.

Gait training involves relearning how to walk. It helps to prevent and stabilize foot complications, such as ulcers and injury. This type of physical re-education is crucial for people using prostheses after losing limbs as a consequence of this condition. When to See a Doctor?

If you begin to see blackened flesh around an area of numbness, see your doctor immediately to seek treatment for an infected foot ulcer. If untreated, ulcers can cause abscesses and spread to other areas on your feet and legs. At this point, ulcers can often only be treated by surgery, amputation, or replacement of lost skin by synthetic skin substitutes.

Summary 

Diabetes affects approximately 11.3% of the U.S. adult population, or about 37.3 million people, according to the CDC. Diabetic foot problems are a leading cause of hospitalization and contribute to around 85% of non-traumatic lower-limb amputations globally. Two major complications—nerve damage (neuropathy) and poor circulation (peripheral artery disease)—lead to serious foot issues, including Charcot arthropathy, which affects about 0.1% to 0.4% of diabetic patients annually. Due to neuropathy, up to 50% of people with diabetes may not feel pain from foot injuries, allowing the condition to worsen unnoticed. This can cause broken bones to increase pressure, leading to foot ulcers and chronic sores. Foot ulcers occur in approximately 15% of all people with diabetes.

 Preventative care is essential to reduce the risk of complications. Daily foot inspections are recommended, as they can reduce the risk of foot ulcers by 50%. In New York alone, 1.7 million adults (10.7%) have been diagnosed with diabetes, and an additional 456,000 are estimated to be living with undiagnosed diabetes, increasing their risk of complications. Furthermore, about 33.5% of the adult population (5.2 million) has prediabetes, which can progress to diabetes if untreated.

 Diabetic foot problems result from high blood sugar, neuropathy, poor circulation, infections, and immune system issues. Symptoms include skin color changes, swelling, unusual foot odor, and non-healing sores. Diagnosis involves physical exams, ankle reflex checks, and tests like electromyograms (EMG) and nerve conduction velocity (NCV) tests.

 Treatment focuses on managing blood sugar levels, which can reduce the risk of foot complications by up to 75%. Physical therapy, such as electrical nerve stimulation and gait training, can help reduce stiffness and improve mobility. Quitting smoking can decrease the likelihood of foot complications by 50%. In severe cases, where ulcers become infected, up to 20% of patients require amputation. Early detection and regular doctor visits are crucial to prevent these severe outcomes.

-Disclaimer-

This information is intended for educational purposes only and should not be considered a substitute for professional medical advice. If you have concerns about diabetic foot or any other medical condition, please see a doctor for an accurate diagnosis and personalized treatment suggestions.