The Diabetic Foot

Feet, being the furthest from the heart, typically have the poorest circulation of the body. Changes in blood flow, within both the small and large blood vessels, may progress at different rates.  There can be palpable flow to the arteries in the feet, and simultaneously, complete occlusion to the digits, due to deposits of plaque within the capillaries feeding the toes.  On the other hand, there may be no palpable pulses noted in the foot and yet circulation is still excellent due to collateral propagation of vessels.  As a podiatrist that routinely treats diabetics, I have found that a diagnostic tool called a Doppler can, within a few minutes, determine the blood flow from the lower leg to the foot and from the foot into the digits.  Diabetics run a higher risk of calcification or hardening of the arteries, especially in the lower extremity, which will severely decrease blood flow to the foot.  Podiatrists work closely with Vascular Physicians in a joint effort to reduce the amputation rate amongst diabetics.  This collaboration, over the past decade, has significantly reduced the number of diabetic lower leg and foot amputations, due to earlier intervention, and new techniques in correction of peripheral arterial disease. 

Circulatory changes within a foot can also lead to a higher infection rate.  When blood vessels can’t deliver important nutrients or medications to an area, that area will be slow to heal.  Concurrently, a higher level of glucose in the diabetic patient will make them susceptible to various infections. With the reduction of circulation, the increase in vulnerability to infections, and finally the decrease in sensation called neuropathy, the diabetic foot is a disaster waiting to happen.  

Diabetic peripheral neuropathy is a condition that causes changes in the nerves within the foot, lower leg, and occasionally the hands and arms.  This condition may present as a tingling, or burning sensation in the toes or feet, numbness, or pain that may be more evident at night.  The cause of diabetic neuropathy is still under investigation but is likely due to a combination of several factors.  Most researchers agree that neurovascular changes can lead to damage within the blood vessels that carry oxygen and nutrients to the nerves. High blood glucose, abnormal blood fat levels, even low levels of insulin may affect the nerves.  Autoimmune factors that can cause inflammation to the nerves, inherited traits that increase susceptibility to nerve disease and lifestyle choices, such as smoking and drinking have an adverse effect on the chemical composition of nerve fibers.  Not only do diabetics have a tendency for higher infections, peripheral vascular disease and neuropathy, but since all parts of the body are involved, the skin, bones, soft tissue, ligaments, muscles are all susceptible to changes.  For the diabetic foot that means there can be physical changes such as bunions, hammertoes or even a complete breakdown of the medial arch.  A diagnosis of diabetes is distressing but with proper treatment, education and determination complications can be avoided.

Call Dr. Braun at Eastern Shore Foot Center and schedule your appointment today. Need diabetic shoes? Eastern Shore carries a wide variety of styles. Want more information? Visit us on the web. www.easternshorefootcenter.com or "Like" Us on facebook

Dr. Randell Braun - Eastern Shore Foot Center - 1913 US Hwy 98, Daphne, AL 36526

251-626-5065