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© Copyright 2019 by Jonathan Hook DPM, MHA. All Rights Reserved.

DIABETIC FOOT CONDITIONS

Diabetic Foot Conditions:

Diabetes is extremely common in our American society today and its prevalence is only projected to increase over time. Complications of diabetes mellitus presents a variety of foot and ankle conditions such as diabetic foot ulcerations, peripheral neuropathy, peripheral vascular disease, charcot arthropathy, infection, gangrene, and dysfunctional wound healing can be observed. The importance of pedal health and monitoring on a scheduled basis along with tight glycemic control is essential in the reduction of diabetic related complications.

Diabetic Wound Care and Total Contact Casting:

Ulceration of the diabetic foot is very common among uncontrolled diabetic patients which can lead to infection and amputation. Wound care is of the most important when trying to reduce the chance of infection and improve wound healing potential. Dr. Hook’s clinic at Mercy Hospital Wound Center has some of the most cutting edge products and treatment methods for healing chronic wounds. Total contact casting, which is a custom well-padded fiberglass cast, is one method utilized to heal chronic open wounds. The cast distributes weight along the entire plantar aspect (bottom) of the foot. It is applied in such a way to intimately contact the contour of the foot and properly offload weight being pressures causing the underlying ulceration. These casts are then changed weekly and patients can remain ambulatory until ulceration

is healed. Casting is continued until the ulcer is healed and the foot is ready for appropriate shoegear with custom orthotics. In certain clinical scenarios, skin graft and skin substitute grafts are utilized. These grafts integrate with chronic wound beds providing the growth factors and scaffolding to accelerate wound healing. When lack of improvement or healing is present, surgical options are available to remove any underlying pressure from a wound at the bottom of your foot.

To schedule an appointment at the Wound Center at Mercy Hospital please call or visit website:

(312)-567-5637

https://www.mercy-chicago.org/wound-care

Diabetic Charcot Foot:

Charcot Arthropathy is a condition characterized by fractures and dislocations of bones and destruction of joints in the foot and ankle with minimal trauma. This condition occurs due to complete loss of sensation in the lower extremity, also known as peripheral neuropathy. ​Initially, there may be swelling, redness and increased warmth of the foot and ankle. Later, when fractures and dislocations occur, there may be severe deformities of the foot and ankle, including collapse of the midfoot arch (often known as a “rocker-bottom” foot) or deformity and instability of the ankle and hindfoot. These deformities may cause ulcerations which can become infected and require antibiotics, hospital admissions, and even amputations. In the early stages of this condition, patients are typically immobilized in a cast called a total contact cast. To prevent further complications, different conservative modalities may be utilized such as custom molded diabetic shoes and Charcot restraint orthotic walker boots. These devices are fitted from a personal mold of the patients foot and assist to prevent ulcerations or to offload wounds to allow healing. When the deformity is to great and the patient is medically optimized, surgical reconstruction of charcot deformities may be considered. Surgical options range from realignment osteotomy and fusion (correction of deformity), ostectomy (removal of bony prominence that could cause an ulcer), tendon lengthening (correction of Achilles tendon contracture).The goal is to rebuild the foot so the patient has a stable plantigrade foot without pressure points causing ulcerations.

Caring For Your Diabetic Foot:

All people with diabetes should make sure to monitor their feet regularly. With a diabetic foot, minor cuts, wounds, or injuries can become major emergencies. A wound  as small as a blister from poorly fitting shoes can quickly cause a significant amount of damage. Diabetes may also decrease your blood flow to your extremities, so your injuries can be slow to heal, putting you at higher risk for infection. As a diabetic, your infection may spread quickly, and if you have any loss of sensation you may not recognize that the problem is getting worse.

 

Inspect your feet every day:

  • ​Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts, ingrown nails, and nail other problems. If you cannot inspect your feet yourself, have someone to help you, or use a mirror.

  • Feel each foot for increased swelling.

  • Examine in between your toes for any macerations or wounds.

  • Check six major locations on the bottom of each foot: 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, do not try to treat the condition yourself. Call Dr. Hook and have an appointment scheduled as soon as possible.

 

Further Care of Your Feet:

  • Wash your feet every day with mild soap and warm water. Be sure to check the water temperature with your hands prior to washing your feet.

  • Do not soak your feet.

  • When drying your feet, pat each foot with a towel and be careful between your toes.

  • Use a quality water based lotion to keep the skin of your feet soft and moist, avoid putting any lotion between your toes.

  • Avoid antiseptic solutions, drugstore medications, heating pads, or sharp instruments on your feet.

  • Always keep your feet warm with warm socks and shoes. Do not put your feet on radiators or in front of the fireplace.

  • Wear loose socks to bed.

  • Avoid getting your feet wet in snow or rain. If your feet get wet, be sure to dry your feet off as soon as possible.

  • Do not smoke cigarettes, if you need help quitting smoking discuss your options with your primary care provider.

 

Advice About Shoegear:

  • Never walk barefoot or in sandals.

  • Choose your shoes very carefully. Try on new shoes late in the day when your feet are larger, and buy shoes that are comfortable. Check how your shoe fits in width, length, back, bottom of heel and sole.

  • Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes.

  • Wear new shoes for only two hours or less at a time.

  • Don't wear the same pair of shoes every day.

  • Inspect the inside of each shoe before putting it on and feel inside it with your hand.

  • Don't lace your shoes too tightly or loosely.

 

Sequelae of Diabetic Amputations:

Poor glycemic control can lead to peripheral neuropathy and peripheral arterial disease. Peripheral neuropathy is a progressive disease described by patients as numbness, burning, tingling and eventually leads to complete loss of feeling in the lower extremity. Peripheral arterial disease is the buildup of plaque and loss of proper function of the blood vessels supplying nutrients and oxygen via blood to the lower extremity. One or a combination of these can lead to the development of ulcerations on the feet and legs of diabetic patients. Chronic non-healing wounds on diabetics is extremely common because high blood sugars also lead to decreased wound healing, causing the wound to remain open in an inflammatory state. Open wounds eventually lead to infection because the skin normally acts as a barrier to microorganisms of the environment. Once a wound becomes infected, wound healing potential decreases and the chance of bone infection increases. Once the bone becomes infected, patients have a choice of long term IV antibiotics or amputation. There are many other complications in the poorly controlled diabetic but this is an example of why proper pedal care and tight glycemic control can be the deciding factor for amputation. Patient are fitted for custom diabetic shoes after partial foot or toe amputations and many patients are able to return to daily activities after surgery.