Diabetes Can Cause Major Problems With Your Lower Limbs
By Leslie Boyd
posted 11/11/02

ASHEVILLE - As a waiter, George Walker spends a lot of time on his feet. He didn't realize when he was diagnosed with type 2 diabetes 20 years ago that his feet, and thereby his livelihood, could be in jeopardy.

Then, two years ago, Walker got an ulcerated sore on his foot.

"It healed OK, and they were pretty surprised by that," says Walker, 77. "Now I know I have to take very good care of my feet."

In fact, few people with diabetes realize how the disease can devastate their feet. But diabetes is the number one cause of lower limb amputations in the United States, and among people who do have an amputation, only 30 to 40 percent are still alive after five years, says Dr. David Humphry of the Mission St. Joseph's Wound Care Clinic.

Diabetes causes high levels of glucose in the blood, which can damage just about any organ in the body. It affects the nerves in the feet, a condition called peripheral neuropathy, so patients lose sensation. It also causes vascular changes, hardening and clogging the arteries so the feet don't get enough oxygenated blood.

That means patients might not feel an irritation until it breaks the skin, allowing bacteria to enter the wound. Because the blood supply is poor, the body has a diminished capacity to fight the infection, so the wounds don't heal.

Walker's sore didn't hurt. In fact, he was able to continue working while it healed. But he did know enough to get help as soon as he noticed the sore so it never became infected. Who is at risk?

About 15 percent of people with diabetes will get a foot ulcer, said Humphry. Once that has happened, patients are more likely to get another foot ulcer, and are 15 to 40 times more likely to need an amputation, depending on their race and economic status.

Hispanics, African Americans and American Indians are up to twice as likely to have an amputation as whites, said Humphry. That's because they're often sicker when they seek care, so the damage to nerves and arteries has happened already. They're also less likely to have good health insurance so they may not be able to control their diabetes as well as someone who has ready access to quality care.

Of course, the best way to prevent foot wounds and amputations is to prevent diabetes, said Humphry.

"Once you're in that tunnel, it's one-way," he says. "You can't go back."

Once the nerves are damaged, they don't send the message to the brain to make feet sweat, so the skin becomes dry and cracked. Cracks in the skin create the perfect opportunity for bacterial and fungal infections to enter, and when the feet are numb, the patient may not realize there's an injury until infection has set in.

The changes to the nerves and blood vessels also affect the muscles and bones in the feet. The muscles may contract and cause hammer toes, and other bone deformities. If the patient doesn't buy specially fitted shoes, the skin around these bone deformities can break down from constant rubbing and become infected.

Even cutting the toenails can be dangerous. A small nick can develop into a big infection. Walker has a podiatrist cut his toenails.

But people who have the disease can prevent, or at least delay, the onset of foot problems, says Jennifer Gribbin, a physical therapist and wound care specialist at the Haywood Regional Medical Center Wound Care Clinic.

"If you have diabetes, you need tight control of your glucose levels," she says. "It's the glucose that causes the problems, so controlling it will lessen the chance of all complications."

Many of her patients don't even know they're at higher risk for non-healing wounds, says Gribbin. Too often, patients think they can take their medications, avoid eating sugary foods and they'll be fine. Foot fitness

Walker strives to control his glucose levels and he reads everything he can find about diabetes. The more involved he is in his care, he says, the more likely he'll be able to maintain his health and enjoy his family - he's a great- great grandfather.

But, says Humphry, most people with diabetes will develop complications eventually, even those who follow a plan of care religiously.

"It's a progressive disease," he says. "It eventually takes its toll."

Peripheral neuropathy and vascular disease are two of the more common complications, and once they occur, foot sores are almost inevitable, he says.

"People who can't feel their feet will think their shoes are too loose so they go down a size," he says. "That can cause the skin to break down. They can't feel a pebble in their shoes or a blister on their toe."

One of the most effective ways to prevent foot injury is to wear shoes that fit properly. Have your feet measured and buy the appropriate size shoe.

"That's one of two things I tell people right away," says Gribbin. "Wear good shoes and don't ever go barefoot. Never, ever go without shoes."

Another important piece of advice, says Humphry, is to inspect the feet every day. Check the tops and bottoms and between the toes and see the doctor if there's even a small problem.

Have your feet checked by a health care professional at lease once a year, or up to four times a year if you've had problems, says Gribbin.

Source:  Citizen-Times.Com.

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