Diabetes, a disease where the body does not produce its own insulin (Type I) or where the body improperly uses its own insulin (Type II), results in increased blood sugar levels. Seven percent of Americans or 20.8 million people in this country are living with diabetes. This is a life-long disease that can severely affect the body's major organ systems, particularly the feet and ankles.



Oftentimes, symptoms of diabetes such as numbness and tingling first appear in the feet. This is due to decreased sensation called neuropathy. Poor circulation and increased infection rates are common among diabetics and this combined with neuropathy is a recipe for disaster in the lower extremities.

A diabetic ulcer usually comes from a simple corn, callus or blister. This occurs due to increased friction on a bony prominence such as a hammertoe or bunion. Ulcers and infections can also result from unknowingly stepping on a sharp object such as a piece of glass or needle while walking barefoot. One may only discover this occurrence after noticing blood or pus draining from their feet.

Ulcerations can lead to a raging infection and ultimately loss of a toe or toes, part of the foot or even the leg or legs. Another complication of diabetes is Charcot Joint, which is found in diabetics with neuropathy. Charcot causes a complete collapse of the joints in the foot most commonly in the mid-foot area leading to a permanent foot deformity known as rocker-bottom. Those with Charcot are also prone to ulcerations and amputations from this deformity.

Early detection and prevention are key factors in effectively dealing with the diabetic foot. A simple comprehensive foot exam by a local podiatrist at least once or twice a year can identify problems early and dramatically decrease the amputation rate. A podiatrist is frequently the first physician to identify the initial signs and symptoms of diabetes.

Management and prevention of diabetic complications is a team effort of physicians and a compliant patient. It is important for diabetics to check their feet every day, never walk barefoot, wear comfortable shoes that are not too tight and check shoes for any foreign objects. Feet, ankles and lower legs should be well moisturized. The skin on the bottom of the feet and especially heels are prone to dryness and cracking. A thick cream with at least a 10-20% urea moisturizing agent instead of plain lotion is best for this area as the skin is tougher and thicker on the soles of the feet. However, the area in between the toes should be kept dry.

Fungus like warm, moist environments and fungal infections can occur with increased moisture in between the toes. Sock selection is also important. Seamless socks help prevent friction and skin irritation. White socks are preferred as any drainage or blood spots can become clearly visible immediately. Synthetic socks are also better at wicking away moisture keeping the area in between the toes dry. Those with thick fungal nails should have a podiatrist cut their toenails to prevent cuts and bruises that can ultimately lead to ulcers and amputations.

If you are diabetic and notice any changes in your feet or ankles such as bleeding, a callus, or ulcer, it is imperative that you seek treatment from your local podiatrist immediately to avoid a serious infection and possible amputation.