Diabetic Foot Care
Diabetic patients are at high risk for foot ulcerations and foot deformities due to sensory and motor peripheral neuropathy. Sensory peripheral neuropathy results in a loss of sensation to the extremities. Sensation loss starts at the toes, and may progress up to the knees. With loss of sensation, diabetic patients cannot feel pain that is caused by a pressure sore or cut. As a result, the skin can break down and an ulcer may develop. If the ulcer remains untreated, it may become infected. An infected ulcer increases the risk of a bone infection. Motor peripheral neuropathy results in the loss of strength to the intrinsic musculature of the foot. Muscle imbalances may then ensue, and contractures of the toes or an increased arch height may result. These foot deformities tend to have bony prominences that make shoe fitting difficult. These bone prominences are also at higher risk for skin breakdown and ulceration.
Daily foot exams are the first line of defense when it comes to diabetic foot health. Simply inspecting your feet daily for any wounds or signs of infection can significantly decrease your risk of an ulceration, soft tissue infection, or even bone infection.
Comprehensive foot exams will be provided during each of your appointments. During your initial consult, structural foot deformities will be addressed. Often times a custom accommodative orthotic or diabetic shoe will be recommended to offload any boney deformities and prevent skin breakdown in those areas. During your initial consult we provide diabetic foot education to bring awareness to the potential signs of infection or the development of an ulceration. Severe foot infections may necessitate an amputation of the infected bone. Nevertheless, appropriate management of your feet will prevent amputations at all levels. Systemic health is just as important as localized foot health. During each appointment we will discuss your blood sugar, insulin, diet, and activity levels. Our goal is to improve your health through diet and exercise to eliminate your need for supplemental insulin. Various studies have shown this to be possible (links).
Evaluate your wounds for signs of infection: redness, swelling, warmth, and pus. Wash wounds with antibacterial soap and water twice daily to remove bacteria. Think of cleaning your wound the same way as you think of removing bacteria from your teeth. If you have leg swelling, over the counter compression stockings can be ordered online or bought at a medical supply store. Most patients only require 10-20mmHg compression. If the over the counter compression is not adequate, prescription strength compression stockings may be warranted.
Persistent swelling should be managed by diuretics (aka water pills) prescribed by your cardiologist and compression therapy. Compression therapy varies depending on the severity of the swelling (see edema chart). Often times, multi layered compression in the form of unna boots (pic) is necessary get your legs back to baseline. Once at baseline, there can be a smooth transition to medical graded compression stockings. We offer various wound care modalities including: debridement, advance wound care dressing applications, compression therapy. We also treat wound infections. Most wounds can heal within four weeks after treatment starts. However, underlying bone infection or other systemic illnesses such as Diabetes, autoimmune disorders, or vascular disease can delay the healing of wounds. Fortunately, we have a lot of experience with complicated wounds and a high success rate when it comes to healing.