A Step Ahead: If you’re diabetic that wound on your foot may kill you. Really.
By Ralph Napolitano, Jr., DPM, CWSP, FACFAS
We’re getting serious this month. It’s time to talk about diabetes and your feet. Diabetes is the disease in which the body’s ability to produce or respond to the hormone insulin is impaired. What results is abnormal metabolism of carbohydrates and elevated levels of glucose in the blood and urine. High “blood sugar” over time if uncontrolled can literally affect almost all parts of the body. Kidney problems, nerve damage in the feet and hands, vision loss and digestive problems is the short list. Globally a leg is amputated due to diabetes every 30 seconds. At least 371 million people have type 2 diabetes worldwide and 1 in 14 adults in the world will have diabetes by 2025. It’s an “expensive” disease to say the least. The global cost of diabetes is now 825 billion dollars per year, according to the largest ever study of diabetes levels across the world. The good news is diabetes is manageable. Not an easy disease to manage but definitely manageable by maintaining a healthy weight, exercising, eating the right foods and taking your diabetic medications exactly as prescribed by your doctor. Nonetheless, unfortunately diabetic complications are a reality for diabetic patients. One significant complication that really hits home for both the diabetic patient and their doctors is the diabetic foot wound. Let’s dive into this very serious topic.
Over time, consistently high blood sugar can damage nerves in the feet (as well as other organ systems and body parts as referenced). Such damage is not over night but progresses more rapidly than one may think. The warning sign is tingling in the feet and legs as well as pain. This is a sign that the nerves are being irritated and are at risk for permanent damage. The most severe form of nerve damage is sensation loss. Unfortunately this type of sensation loss is permanent and there is no known cure. This “protective sensation loss” puts the “neuropathic” foot at very high risk for injury since pain is not felt. Foot injuries of course range in severity and can be acute like a puncture wound or laceration or chronic from overuse (i.e. blisters). Frictional injuries in the feet can progress to open wounds known a diabetic ulcers. Such ulcers can become infected and can even result in systemic infection. Think about a bad branch on a tree. If severe enough, the limb is at risk for loss and the tree may die. This can be applied to the diabetic lower limb as well. Drs. Moulik, Mtonga and Gill in their paper “Amputation and mortality in new‐onset diabetic foot ulcers stratified by etiology” (Diabetes Care 2003; 26: 491–494) described just how serious a diabetic foot wound can be. As they expertly pointed out, diabetic foot wounds can literally be markers for death.
Treating diabetic ulcers can certainly be very challenging for the patient and their doctors. If such wounds are on the bottom of the foot, pressure relief is of utmost importance. Methods include walking boots, special shoe inserts and even casts fabricated for patients to walk in. Treating infected tissues with antibiotics and advanced dressing are also crucial as well as removing dead tissue. Good Circulation as well as controlling blood sugars are a must for healing diabetic foot wounds.
I’ve been providing wound care and treating diabetic foot wounds since I started practicing over 20 years ago. The bottom line is good foot care is crucial for the diabetic patient to avoid complications. Routine foot exams and foot care are part of my daily routine at OrthoNeuro. If you’re diabetic, it should be part of your routine too. Controlling your diabetes is certainly an accomplishment. I’ll leave you with the fortune cookie message from my lunch last week: “Every truly great accomplishment is at first impossible.” Yes, it can be done and we’re here to help.