Conditions - Diabetes
What is it?
Diabetes is a serious disease that can lead to devastating complications related to the feet and legs. Diabetes is a condition where the body does not produce insulin or when the insulin that it produces cannot adequately perform its normal functions. Insulin is a substance produced in the body that helps process the food we eat and turn it into energy.
Diabetes is classified into two different types: Type 1 and Type 2. Type 1 is usually associated with juvenile diabetes and is often linked through heredity. Type 2 is commonly referred to as adult-onset diabetes.
Diabetes disrupts the vascular or circulatory system which can affect how our body heals itself. Persons affected by diabetes may also lose sensation in their feet and this is called diabetic neuropathy. It can be very dangerous to lose the sensation in your feet, as you may not notice a “sore” until it is too late. Amputation in the population of persons affected by diabetes is much higher than in the general population because of these complications.
It is essential that persons affected by diabetes take special care of their feet in order to avoid these complications.
What causes it?
Foot problems caused by diabetes develop from a combination of causes including poor circulation and neuropathy.
Vascular disease in persons affected by diabetes causes a narrowing of the arteries that can lead to significantly decreased circulation in the lower part of the legs and the feet. This decreased circulation reduces the body’s ability to heal itself and persons affected by diabetes often develop sores or ulcers that can take months or even years to heal. The longer a sore is present, the more likely it is that infection can enter the body causing more serious problems.
Diabetic Neuropathy is a loss of ability to feel pain, heat and cold. Persons affected by diabetes who have neuropathy can have sores that they are not even aware of due to the insensitivity. Unlike a person who can sense if a stone is in their shoe and take steps to remove it, a person affected by diabetes with neuropathy may walk on the stone all day without noticing. This can cause severe problems. If these injuries are left untreated, complications could arise leading to ulceration and possibly even amputation. Charcot Foot is a common complication of diabetic neuropathy that leads to a massively deformed foot that requires special care to prevent ulceration over unusual pressure points.
It is extremely important for persons affected by diabetes to take the necessary precautions to prevent foot related injuries. It is imperative that the patient affected by diabetes makes daily foot checks a routine, as the consequences of not doing so increases the risk of serious complications. When a patient affected by diabetes takes the necessary preventative foot care measures, it reduces the risks of serious foot conditions such as ulceration and amputation.
How can a pedorthist help to treat it?
Footwear and orthotics play an important role in foot care for persons affected by diabetes to help prevent serious injury and help an injury to heal.
The materials used for orthotics for a foot affected by diabetes depend on the history of complications such as ulceration and the presence or absence of sensation on the foot. A person affected by diabetes who has no history of complication and has normal sensation should have an orthotic that will accommodate any abnormal mechanics to alleviate abnormal pressures on the foot. A person affected by diabetes with an ulcer and no sensation requires an orthotic that will redistribute pressure away from the ulcer site and allow it to heal. Plastazote is the most common material used to protect the insensitive foot affected by diabetes.
Footwear for the patient affected by diabetes is also key to preventing complications and should have the following features:
- Footwear should have toe box that is shaped like the foot and is deep enough to protect the toes from excessive pressure;
- Removable insoles are preferred for versatility in fitting, as they can be removed to insert orthotics if necessary, or modified themselves to relieve pressure;
- Rocker soles on the shoes help to reduce pressure in the ball of the foot, an area that is susceptible to pressure sores/ulcers;
- Firm Heel Counters are recommended for support and stability.
- Be sure to call your doctor immediately if a cut, sore, blister or bruise on your foot does not heal after one day.
What can you do to protect you feet on a daily basis?
- Wear shoes and socks at all times, even indoors.
- Always check the insides of your shoes before putting them on.
- Make sure that the lining is smooth and there are no foreign objects in the shoe, such as pebbles.
- Wear shoes that fit well and protect your feet.
- Protect your feet from hot and cold temperatures.
- Keep your skin soft and smooth and trim toenails straight across.
- Have a professional take care of your nails and skin if you cannot see well.