More than 20 percent of the patients suffering from diabetes mellitus will end up with foot problems. Foot ulceration is the leading cause of many of the diabetic-related lower extremity amputations every year. The three leading causes of foot ulcers are: neuropathy , mechanical stress that causes trauma and deformities .
Diabetic neuropathy is a peripheral nerve disorder and is a direct result of chronic hyperglycemia. Patients with poorly controlled glucose levels show a marked tendency towards diabetic neuropathy. In the beginning, the symptoms of neuropathy may be as slight as to go unnoticed. The occasional numbness, tingling or pain in the feet causes progressive weakness of muscles in the feet.
Deformity is one of the direct results of neuropathy and exacerbates the ulceration in the foot. This may happen because of two reasons:
- Neuropathy leads to loss of sensation in the nerves (partial paralysis of the small muscles in the foot). This diminished sensation leads to clawing of the toes. When the metatarsal heads on the bottom (plantar area) of the foot get exposed, this skin becomes calloused. Such calluses will force the skin to tear and fill with fluid. Soon infection seeps in.
- Charcot Foot, the second cause of deformity, is also a direct result of neuropathy. In this condition the bones in the foot are subject to trauma and will slowly disintegrate. The foot gets deformed and the bone in the middle portion of the foot begins to protrude. This bone and the area of prominence it produces then becomes the site of ulceration and infection.
Stress and Trauma :
A neuropathic foot is right to three mechanisms of stress related injury: ischemia, repetitive stress and direct trauma. Of these, repetitive stress is the most common cause of injury. Since neuropathy often results in the loss of sensation, a patient is unaware of the excess stress his foot is subjected to. In diabetics, the position of maximal loading in the foot correspondents to the site of calluses. Diabetics, as a rule, spread very low weight pressure on their toes as compared to normal people.
Ischemia means restriction in the flow of blood to a part of the body. In diabetics, the flow of blood to the extremities is strictly restricted. The lack of oxygen rich supply of blood to the foot means that the chances for infection are more and wounds would take longer to heal. This is the beginning of foot ulceration.
Direct trauma is often the result of some direct injury like stepping on a sharp object or injuring the foot on a stone. The wound refuses to heal.
Risk factors :
Foot ulcers are the major contributing factors when it comes to the mortality and morbidity of diabetic patients. Patients who develop foot ulcers may live with it for quite a while before they become aware of the intensity of the wound. As a result, most foot ulcers would have progressed well above the primary stages of infection. Such patients require long periods of hospitalization and complicated procedures to ensure recovery. If the ulcer does not respond to treatment, the patient absolutely risks the amputation of the foot, or even the entire leg.
Controlling risk factors can prevent ulcers from getting worse. Some ways to reduce the risk factors are:
- Manage your diabetes well on a regular basis.Lose weight if you are overweight.Wear comfortable foot wear and protect your feet at all timesUse exercises like Yoga to improve circulation in the feet.Examine your feet closely to pick up the first signs or symptoms of a wound or a sore.