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Newsletter Vol. 3
Newsletter Index | Cerebral Palsy | Dangerous Drugs | Diabetic Foot Care | In the News


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Ask The Expert

What do Diabetics need to know about foot care?
By Dr. Emanuel Fletcher, M.D.

Diabetes is a disease in which glucose levels in the body are disturbed.

If not kept under control it can result in several medical conditions including atherosclerosis, the buildup of plaque deposits in the blood vessels. This can progress to a partial or complete blockage of blood vessels. The most common side effect of atherosclerosis in diabetics is peripheral vascular disease.

Peripheral Vascular Disease is a reduction in blood flow to the lower extremities caused by blockage in the arteries. It usually affects the lower extremities, because they are the farthest from the heart. Symptoms include pain in the calves while in motion, loss of hair on the leg, discoloring of the toes and thickening of the toe nails, discolored and brittle skin on the extremities, and decreased pulsation in the blood vessels in the knee and foot.

With diabetics, any minor trauma can result in a problem in the foot. Even something as seemingly minor as cutting toenails or stubbing a toe can result in an infection.

If you are diabetic you should take care to keep your feet clean and insure they are neither too moist or too dry. Do not cut your toenails. Instead, file them to be even with the end of your toe, or see a podiatrist for nail care.

Diabetics should choose well fitting shoes in order to avoid callouses and blisters, and to avoid going barefoot. Callouses, blisters or any other foot injuries should be treated promptly.

A foot infection is a very serious matter and should be attended to immediately. Since there is increased sugar in the blood stream, it becomes a perfect environment for bacteria to grow.

With decreased circulation, a diabetic has more difficulty fighting infection than other members of the population. An infection in a diabetic spreads more rapidly, and can be far more serious.

Unless treated promptly and properly, a diabetic foot infection can lead to significant problems, including amputation. The first symptom of an infection is a minor abrasion or laceration that does not heal. The person will usually see his or her doctor due to redness, swelling and pain over the infected area.

Any infection in a diabetic must be controlled immediately. If there is an accumulation of pus, it should be removed and cultured. Topical and oral antibiotic treatment should be used. Once culture studies are returned, the physician or podiatrist can confirm that the correct antibiotic is being used to treat the specific type of infection at the site.

If an infection is severe enough, the diabetic patient should be hospitalized and treated with intravenous antibiotics. Hospitalization keeps the patient off of the infected foot, thus reducing trauma to the vulnerable area. IV antibiotics deliver medicine directly through the bloodstream to the tissue, thus providing the best opportunity to fight the infection.

Since there is hardly any tissue in the toe and foot, the spread of infection can be very rapid, especially in diabetics with poor circulation.

Before any procedure is performed on the foot, a podiatrist should know the patient’s blood sugar level, the peripheral pulses, and he should speak to the patient’s physician.

Once a podiatrist undertakes a surgical procedure he is responsible. If a diabetic has uncontrolled diabetes, procedures should not be performed due to risk of infection.

Normal blood sugar is 80 to 115. Blood sugar above this level is unacceptable and necessitates treatment.

A podiatrist or a physician treating a diabetic for foot problems has three obligations: 1) Control the infection, 2) Minimize the risk, and 3) perform any procedure as carefully as possible.

To minimize the risk, the podiatrist or physician must obtain a detailed overall history and contact regular treating physicians, and learn what variables concerning the patient’s past 24 hours exist in order to determine whether his diabetes is controlled or not.

With regard to procedures on a diabetic’s foot, they should be performed as carefully as possible, and some procedures should not be performed at all. If there is any question as to whether the diabetes is controlled or not, postponing procedures on the foot is certainly reasonable.

Prevention of foot problems through proper diabetic care, of course, must be the primary goal, but in the event that foot problems develop the use of antibiotics or surgical techniques, such as grafting of blood vessels can be used.

By being aware of the dangers of foot infections and implementing proper treatment, limb threatening infections can be avoided with proper medical care.

Dr. Emanuel Fletcher is an internist who has practiced medicine in Brooklyn for over 50 years.

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