Diabetic neuropathy

If you are a diabetic, then you are run the risk of serious foot problems if not careful and, which if ignored, can result in amputation of toe, foot or leg.

The lack of sensation to cold, heat or pain due to nerve damage in feet is called peripheral neuropathy. Diabetes damages nerve fibers especially the small nerve endings in the limbs (hands & legs).

What are the problems associated with Diabetic neuropathy?

Generally, it causes loss of ability to feel pain and other sensations leading to neuropathic ulceration.

Due to loss of sensation, people tend to exert a lot of pressure on one area of the foot while walking. This builds a callus (thickened skin due to repeated friction) at that site. If the pressure is increased, it may lead to breakdown of tissues and ulceration.

Symptoms like pain, burning, feeling of pins and needles pricks or numbness are associated with this condition.

Causes

Foot problems in diabetes may occur due to the following conditions:

Peripheral artery diseases(decreases delivery of oxygen to feet and legs): poor blood flow to the feet slows down the wound healing process. This can increase the risk of infection.

Peripheral neuropathy(damage to peripheral nerves): loss of sensation in the feet resulting in injuries. If it is unnoticed, this leads to ulceration.

Foot deformity:The reduced blood supply progressively weakens the bones in the legs. And this bone loss combined with traumatic injuries can change the shape of the foot leading to severe deformity (known as Charcot Foot)

Diabetic Neuropathy Symptoms

  • Calluses may develop due to abnormal alignment of feet

  • Fungal infections of nail

  • Athlete’s foot- fungal infection of the skin

  • Bent toes due to muscle weakness

  • Ingrown toe nails

  • Cracking of the skin of the feet due to dry skin

How diabetes affects your skin and feet?

Diabetes has an adverse effect on the texture of your skin in the legs, elbow, feet and other regions. People with long standing or poorly controlled diabetes are at risk of damage to nerves in their feet. This is also known as Peripheral Neuropathy.

Frequent urination is one of the common symptoms of diabetes. This heavy loss of fluid makes your skin more prone to dryness.

Dry skin is often itchy causing sores which are vulnerable to infection. Dry skin tends to crack, allowing germs to enter and spread infection. Dryness of the skin is also caused by nerves damage that reduces the amount of sweat. Without sweat the skin loses its moisture content and becomes dehydrated and dry.

Tests for diagnosing foot problems are done based on your complaints, medical history, and visual / physical examination. These help in deciding the best diabetic neuropathy treatment for you. Tests may include

Visual examination: Physician examines your leg muscles, muscle tone and strength, tendon flexes and sensitivity to touch, heat, cold and vibration.

The doctor also checks for any sores, cuts, bruises, blisters or injury.

Foot print anlaysis: This test is done to know the irregular movements of walk.

Filament test: This test is used to check sense of touch in your legs by placing a nylon filament on your feet.

If you are not able to feel the presence of nylon filament on your feet, it implies that you have lost sensation in legs.

Nerve conduction study: This uses mild electrical waves to calculate how rapidly your nerve is able to conduct these electrical signals.

Electromyography:It measures the amount of electrical signal produced in your muscles. This is done along with Nerve conduction test.

Quantitative sensory testing:Used to analyze how your nerve reacts to vibration and temperature change.

Autonomic testing:This calculates your blood pressure at different points and evaluates your ability to sweat.

What are the common foot problems in diabetics?

Corn and callus:These are thick layers of skin. These are caused by too much rubbing or pressure on the same spot.

Blisters:These are areas of skin that are raised and filled with fluid. Wearing very tight shoes without socks may cause blisters.

Ingrown toenails:The edges of the toe nails grow into the skin. This can happen when there are cuts into the corners of your toe nails when you trim them.

Bunion:A bunion is a bump at the outside edge of big toe. As the bump gets worse, it can get filled with extra bone and fluid. High heels, pointed shoes or tight, narrow shoes may cause a bunion.

Plantar warts:These are small, flesh colored growths on the bottom of your feet. Sometimes they turn into tiny and black warts.

Hammertoe:These are toes that curl under your feet. These can form when one or both joints of the small toes bend from weakness in your foot.

Dry and cracked skin:this skin would be rough, scaly and flaking. Your skin may turn gray, if you have dark complexion. Symptoms could be redness and itching. This condition is caused by high blood glucose, nerve damage or poor blood circulation.

Athlete’s foot:It is a fungus that causes itching, burning, redness and cracking of your skin. The fungus grows on the soles of your feet and in between your toes.

Charcot’s foot:It is a problem in which the joints and soft tissue in your feet are destroyed. In the early stages, the joints become stiff and collect fluid. The problem can quickly worsen making the foot deform and sometimes bone loss at the site can be seen.

Fungal infections:Of toe nails makes them thick, hard to cut and appear yellow, green, brown or black. A nail may also fall off.

If you are facing any of these problems consult your doctor at once.

It is possible to reduce the risk and incidence of amputation of limb in diabetic patients with Careful monitoring, regular checks, preventing injuries, controlling infection and good foot care in a diabetic patient.

Once you are diagnosed with diabetes it is very important that special care is given to your feet to avoid infection and amputation. Clinically it is recommended that foot test should be done at every visit to your doctor. Below described are few points that will help you take care of your feet

  • Maintain your blood glucose, blood pressure and cholesterol level.

  • Keep your feet clean by washing it with warm water, then dry it well and wipe gently in between the toes.

  • Check your feet every day for cuts, bruises and sores, or any other infections. Use mirror to check the areas your eyes can’t reach.

  • In case of dry skin apply lotion. Do not apply them between toes.

  • Regularly cut your nails when it is soft after washing, do not cut them too deep.

  • Callus and corn can be softened using a pumice stone after having shower.

  • v
  • Do not walk bare foot.

  • Wear socks to avoid blisters.

  • Wear shoes that perfectly fit you and always before wearing it check for sharp edges.

  • Maintain the blood flow in the legs by placing your legs up while sitting and shaking it gently for 5 minutes. Never cross your legs for a long time.

As prevention is better than cure, always try to avoid injuries. In case, if you get injury, immediately clean with a mild antiseptic lotion and change the dressing every day. Any suspected infection, should be consulted with a physician.