Millions of people are diagnosed with diabetes each year. Unfortunately, controlling your blood sugar is not the only long term worry that we have when treating diabetes. Diabetes not only effects a patient’s blood sugar, but people with diabetes can also have trouble with their kidneys, heart, and of particular interest to podiatrists, their feet.
Many people with diabetes develop problems with their feet. This is largely due to the development of neuropathy. Neuropathy is defined as nerve damage or loss. People with diabetes who have high blood sugars for long periods of time can develop nerve damage due to the accumulation of sugar hi-products (called sorbitol). Sorbitol accumulation blocks nerve function which can lead to neuropathy. This usually begins in the feet, at the end of the toes, due to the fact that this is the part of the body furthest from the heart. If not treated, it can progress rapidly and ends up involving the entire foot.
Many people think that neuropathy only involves the loss of sensation in their feet, but your podiatrist knows that this is only part of the problem. Sensory neuropathy involves loss of sensation in the extremity. This is usually symmetrical in nature and generally non-reversible. Podiatrists use different techniques to measure loss of sensation including tuning forks and a monofilament (a small thin wire). There are many patients who can be touched with the tuning fork or wire and not feel a thing. Without feeling in the extremity, patients can injure their foot or cut their foot, and not know due to lack of feeling. Thus, these injuries can go undetected and lead to much more serious problems.
Additionally, some people with diabetes may develop painful neuropathy. When people have painful neuropathy, not only are they losing feeling in their feet, but as the process develops, they also have severe burning pain which can keep them awake at night.
Our nerves also provide motor function (muscles need nerves to work properly). Motor neuropathy involves loss of motor function (movement) in the extremity. Due to the death of the nerves, the muscles in the feet begin to waste. Patients with motor neuropathy may develop bony protrusions in areas on their feet. This can lead to areas of abnormal pressure in your shoes which the patient won’t feel (due to sensory neuropathy) and can lead to sores and ulcerations. Nerves also provide temperature (autonomic) control and many people with diabetes may have an autonomic component to their neuropathy as well. This is seen in the skin of the feet when the skin becomes very thin and often very dry due to the loss of autonomic control.
Patients with neuropathy may also develop what is called peripheral vascular disease. Peripheral vascular disease is a complication of diabetes, and means that there is poor blood flow to the feet. This is a large problem because if a patient with diabetes develops a wound, often due to lack of feeling, and has poor vascular supply to their feet, then they may have trouble healing this wound.
As one can see, diabetes is not only a problem with blood sugar, but involves many different organ systems. It is very important for people with diabetes not only to be seen regularly by their primary care doctor and endocrinologist, but also to be followed closely by a podiatrist.
At Westside Podiatry, our team of podiatrist excels in caring for our patients with diabetic issues. If you are have been recently diagnosed with diabetes, or are looking to add a podiatrist to your current scope of diabetic care, give us a call today!