Diabetic foot problems, such as ulcerations, infections, and gangrene, are the most common cause of hospitalization among diabetic patients. (Ingrid Kruse, 2006) Diabetic ulcers go hand in hand with neuropathy. Patients often feel numbness or no pain at all in the ulcer area. Ulcers require constant management due to complications that can arise from loss of blood flow, lack of sensation and slow healing. Proper management can reduce the risk of amputation.
Some minimally invasive techniques are attractive to manage deformities in diabetics due to the smaller incisions required. Diabetics often have trouble healing post surgery due to the fluctuating levels of insulin.
Foot Complications associated with Diabetes
Foot complications account for more hospital admissions than any other diabetic problem. The two major outcomes of foot complications are foot ulcers and amputations.
Ulcers: It is usually a combination of problems rather than a single risk factors that causes ulceration. These include peripheral neuropathy (nerve damage), peripheral vascular disease, foot deformities (clawing toes), external trauma and peripheral oedema. The most common trauma in Western countries is inappropriate footwear
Patients with diabetes are at risk of developing multiple complications including damage to nerves and poor circulation. These complications make your feet at risk for harm or injury and is more likely to occur if:
• You have had diabetes for a long time
• Your blood glucose levels have been too high for an extended period
• You smoke
• You are inactive
Low risk feet:
Have normal sensation and good blood flow. However it is important to know that low risk feet can become high risk feet without symptoms, so regular checks are still important.
High risk feet:
Are those people who have had a foot ulcer or amputation in the past. Feet with calluses or deformities like claw toes also have increased risk, if poor feeling and/or decreased blood flow are also present.
Nerve damage (neuropathy) is a complication of diabetes that leads to a loss of sensation in the feet. When the nerve is damaged it no longer perceives pain due to numbness and therefore does not warn of injury. This is particularly true in the foot.
Diabetes can also cause damaged blood vessels, decreasing the blood flow to the feet. Poor circulation weakens bone causing disintegration of the bones and joints in the foot and ankle. As a result, people with diabetes are at a high risk for bones fractures in the foot.
When a diabetic fractures a bone in the foot, they may not be aware due to nerve damage. Continuing to walk on the injured foot results in more severe fractures and joint dislocations.
: Charcot foot is one of the more critical foot problems that can develop due to poor circulation and nerve damage. It is a condition which can deform the shape of the foot and lead to disability.
In order to minimise the chance of amputation there are a number of surgical options available.
It is best to see us earlier rather than later when you have deformity particularly if you have an open ulcer/wound on your foot.
Minimally Invasive Surgery: Severe deformities will often need corrective fusion in particularly when Charcot joints are established.