Diabetic Foot Problems
Foot problems that develop in people who have diabetes (e.g., ingrown toenails, calluses, corns) should be treated promptly by a podiatrist. In some diabetes cases, the body does not produce substances that are necessary to promote the healing process. Becaplermin (Regranex®) is a medication that may be applied to sores to stimulate the growth of tissue and skin.
Treatment for foot sores or ulcers that do not heal properly due to poor circulation may involve a vessel bypass. Blocked blood vessels (i.e., atherosclerosis) can be bypassed with a blood vessel graft. Improved circulation promotes healing.
In some cases, a skin graft may be performed. In this procedure, a piece of skin is surgically removed from a healthy part of the body and used to cover the wound. However, skin grafts on the soles of the feet can be problematic because if the cause of the wound is not corrected, the wound can recur. For example, if the wound is caused by a bony prominence in the foot, padding the area is necessary to prevent the wound from recurring.
In patients with diabetes, an infected wound is a medical emergency. Signs of infection include the following:
- Blood sugar that is difficult to control or that requires a higher than normal dosage of insulin
- Discharge (pus) that oozes from the wound
- Excessive sugar in the urine
Infection typically requires antibiotics; however, circulatory difficulties in patients with diabetes may prevent antibiotics from reaching the infection. Swelling can constrict blood vessels and further diminish circulation. In some cases, hospitalization and surgery is required. If surgery is necessary, the patient must keep weight off the affected leg and may require crutches, a wheelchair, or a specially designed full contact cast.
In patients with diabetes, infection can quickly progress to osteomyelitis (bone or bone marrow inflammation) and gangrene (tissue death), which often result in amputation (surgical removal) of the affected limb. According to the American Podiatric Medical Association (APMA), 14 to 24% of patients with diabetes require amputation during their lifetime.
Following amputation of a foot or leg, the body weight shifts to the other limb and additional problems may develop. In some cases, the degenerative process continues, necessitating further amputation.