• Diabetes can lead to serious foot problems such as neuropathy (nerve damage which causes reduced or loss of sensation) and wounds called ulcers. People with diabetes are also more prone to skin conditions and infections

• These in turn can lead to toe, foot, and whole leg amputations if a bone infection or gangrene sets in;
  in certain cases, this can even result in death

What causes it?

• Neuropathy is caused by damage to the nerves of the foot from uncontrolled sugar levels and, in some cases, the natural attrition of the disease on the body over time in people whose sugar levels are in reasonable control
• Neuropathy can lead to secondary conditions such as bunions, hammer toes, and Charcot foot (collapse of the Charcot joint in the middle of the foot)
• Ulcers are typically caused by excessive friction or pressure and cuts or scrapes to the foot that do not heal. People with neuropathy often cut or injure their feet unknowingly because of the lost sensation, and this can lead to an ulcer because often it injury goes on undetected. Corns, callus, blisters and other signs of abnormal friction and pressure on the foot may eventually lead to an ulcer
• Soaking feet or use of moisturizer between the toes can lead to skin breakdown that can cause an ulcer; foot powder has the same effect since it traps moisture, and should also be avoided

Signs and Symptoms

• Symptoms of neuropathy include numbness, loss of feeling, tingling, burning, and sometimes pain in the feet and hands
• Ulcers may begin as a blister, discolouration, bruise, cut, or sore that does not begin to heal within two days

Prevention and Treatments

• Prevention is the best medicine; regular foot care and foot health check ups with your Chiropodist are important to help prevent foot complications from diabetes
• Always wear shoes or footwear inside and outside of the house; avoid walking barefoot or wearing open back/open toed sandals
• People with neuropathy should avoid hot baths due to the risk of burns from lack of feeling
• Inspect feet daily for signs of infected nails, discolouration, callus and corns, and for blisters, bruising, cuts, or sores that do not start to heal in two days; have someone help you or use a mirror to do this
• Use of a high-quality moisturizer daily but never between your toes; your Chiropodist can recommend lotions available at your local drug store or provide moisturizers specifically created for this purpose
• Prescription custom orthotics to help cushion and adjust for any structural foot problems that may be causing potentially harmful pressure or friction points
• Special padding to offload specific problem areas of the foot, as well as pads, shields, and splints to protect and cushion
• Possibly prescription custom footwear
• In cases where ulcers develop, specialized wound care incorporating surgical debridement (scalpel reduction of dead tissue to promote healing) of the tissue and wound dressing is often effective in preventing further degeneration of the skin and promoting healing. Chiropodists receive intensive training in diabetic wound care and are often found at the lead of their field in this area. Click here for before and after photographs of ulcer treatment.
   

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