Diabetic Foot and Ankle Conditions

If a doctor has ever said you had an elevated blood sugar level - even just once when you were pregnant - you are at risk for diabetes. About 15.7 million people (5.9 percent of the United States population) have the disease. Nervous system impairment (neuropathy) is a major complication that may cause you to lose feeling in your feet or hands. This means you won't know right away if you hurt yourself. The problem affects about 60 to 70 percent of people with diabetes. Foot problems are a big risk. Like all diabetic people, you should monitor your feet. If you don't, the consequences can be severe, including amputation, or worse.

Minor injuries become major emergencies before you know it. With a diabetic foot, a wound as small as a blister from wearing a shoe that's too tight can cause a lot of damage. Diabetes decreases your blood flow, so your injuries are slow to heal. When your wound is not healing, it's at risk for infection. As a diabetic, your infections spread quickly. If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror. Feel each foot for swelling. Examine between your toes. Check six major locations on the bottom of each foot: The tip of the big toe, base of the little toes, base of the middle toes, heel, outside edge of the foot and across the ball of the foot. Check for sensation in each foot.

If you find any injury -- no matter how slight -- don't try to treat it yourself: seek medical attention and appropriate referral immediately. Here's some basic advice for taking care of your feet:

Modified from the AAOS
 

Diabetic neuroarthropathy (Charcot foot)
When your feet lose their feeling, they are at risk for becoming deformed. One way this happens is through ulcers. Open sores may become infected. Another way is the bone condition Charcot (pronounced "sharko") foot. This is one of the most serious foot problems you can face. It warps the shape of your foot when your bones fracture and disintegrate, and yet you continue to walk on it because it doesn't hurt.

Diabetic foot ulcers and early phases of Charcot fractures may be amenable to treatment with a total contact cast. The shape of your foot molds the cast. It lets your ulcer heal by distributing weight and relieving pressure. If you have Charcot foot, the cast controls your foot's movement and supports its contours if you don't put any weight on it. To use a total contact cast, you need good blood flow in your foot. The cast is changed every week or two until your foot heals. A custom-walking boot is another way to treat your Charcot foot. It supports the foot until all the swelling goes down, which can take as long as a year. You should keep from putting your weight on the Charcot foot. If bracing or casting does not resolve ulcers, pressure areas, or bony prominences, or the foot cannot be placed on the floor because of the degree of deformity, surgery may be necessary to correct the shape of your foot. This surgery is often extremely complex, requires breaking and realignment of the foot, and may takes months to completely recover from completely. The goal of surgery is to avoid recurrent ulcers of the foot and to provide a stable flat foot to walk on comfortably. This surgery is extremely demanding for both the patient and the surgeon and requires extensive expertise. Many patients can be treated with plates and screws placed on the bones to weld the joints together again but in some patients, large rings with wires are necessary and are placed on the outside of the foot and ankle. Dr. Vora has trained with national and international leaders and innovators in Charcot foot deformity treatment, and is skilled in the reconstruction of these disorders.

Modified from the AAOS
 

Diabetic neuropathy
Diabetic neuropathy is a problem for many patients with diabetes. The neuropathy (disorder of the nerve branches to hands and / or feet) can cause significant loss of protective sensation of the foot, and this, among other factors, may lead to the development of ulcers, infection, and major complications in the foot and ankle as the protective sensation of the foot may be compromised. In some patients, pain may also be present in the foot or ankle secondary to the neuropathy. This problem is a complex one, but fortunately often responds fairly to oral medications and other conservative treatments. For some patients, surgical procedures may be indicated to “release” the linings around the nerves most commonly involved in diabetic neuropathy. This is a procedure that does have risks and consideration should be thoughtfully given before proceeding with surgery understanding the realistic expectations regarding outcome, function, and gain that may be expected.
 

Diabetic foot ulcer
Ulcers of the foot in patients with diabetes are a major and significant problem for affected patients and our health care systems. Because of the loss of sensation (neuropathy), possible foot bony abnormalities (Charcot foot), problems with the normal sweat pattern and skin in diabetic patients (autonomic nerve problems), and many mechanical problems of the tendons and bones of the foot and ankle (most commonly, a tight Achilles tendon), patients with diabetes are at very high risk for ulceration of the foot. Once ulceration has developed, even if treated and resolved, the risk of further surgery, amputation, and other major complications is dramatically increased. The development of an ulcer requires immediate medical attention and specialist care.