AF&A Blog

As the leading cause of non-traumatic, lower-limb amputations, diabetes is reaching epidemic proportions, now more than ever.  It can have a devastating impact on the body, affecting numerous parts of the body including the eyes, mouth and feet.  In fact, the feet, often overlooked at routine checkups, can reveal the first signs and symptoms of the disease.  All too often, patients forget to take off their shoes and socks and ask their health care providers to inspect their feet.  Close to 24 million people in the United States have diabetes and nearly 6 million people have it and do not even know it.  That’s why it’s important to elect to save your feet whether you have the disease or not. Know the signs and symptoms of diabetes and have your feet checked every time you visit the doctor.

1. Why should I ask my doctor to take off my shoes and socks?

The feet, said to be mirrors of our general health, can reveal diabetes warning signs such numbness, redness, swelling or non-healing wounds.  Taking off your shoes and socks at every doctor’s visit is critical to the prevention and treatment of systemic diseases such as diabetes.

2. Who is at risk for diabetes?

While many Americans are predisposed to have the disease based on family history, Hispanics, African Americans, American Indians, Asian Americans and Pacific Islanders are more at risk.  People with type 2 diabetes can do a great deal to lower their chances of getting the disease such as exercising regularly, reducing fat and calorie intake and losing weight.

3. What can happen if diabetes is not detected in its early stages?

Many people do not find out they have the disease until they develop serious complications such as foot ulcers. In fact, six million Americans with diabetes have not been diagnosed.  The good news is that diabetes, although serious, can be managed.  However, if left undiagnosed or untreated, it can damage the body and result in long-term complications such as lower-limb amputations, cardiovascular disease, stroke, blindness and kidney disorders.

4. I have been diagnosed with diabetes. What type of foot complications could I possibly experience?

You may experience the following symptoms:

·          a loss of feeling in your feet.

·          a change in the shape of your feet.

·          foot ulcers or sores that do not heal.

Keeping your blood glucose (sugar) in good control and taking care of your feet every day can help you avoid serious foot problems.

5. Should I see a podiatrist if I have diabetes?

Treating diabetes requires a team approach. A podiatrist is an integral part of the treatment team.  Your primary care doctor may refer you to a dietician, nurse educator, dentist, eye doctor and an exercise physiologist to help you manage the disease.

Risk Factors
The buildup of plaque on the artery walls is called atherosclerosis, or hardening of the arteries. It causes the arteries to narrow or become blocked, which can reduce or block blood flow. When atherosclerosis affects the arteries of the heart, it is called coronary artery disease (CAD). CAD can cause a heart attack. If atherosclerosis is in the limbs, it is called peripheral arterial disease (PAD). It most commonly affects blood flow to the legs.  If PAD is present, it also is likely to be in the coronary arteries. Smoking, high cholesterol, obesity, diabetes and high blood pressure are all PAD risk factors.

Blocked blood flow can cause pain and numbness. It also can increase a person’s chance of getting an infection, and it can make it difficult for the person’s body to fight the infection. If severe enough, blocked blood flow can cause tissue death known as gangrene. PAD and diabetes are the leading cause of non-traumatic, lower-limb amputations.

Prevalence              

PAD is a disease that affects millions of Americans over age 50. PAD affects 8 to 12 million Americans, and one in every five people over the age of 70 has the disease. It is a common, yet serious disease. Men are more likely to have symptoms of PAD, but both men and women can develop the disease. PAD can impair physical health and diminish the ability to walk.

Complications
In the advanced stages of PAD, blood flow to one or both legs can be completely or mostly blocked. This is known as critical limb ischemia (CLI). A very severe blockage in the legs and feet means that the legs do not receive the oxygen or nutrition needed for cellular or tissue growth and repair. CLI may lead to painful leg or foot sores, and it could eventually lead to gangrene. If this condition is left untreated, the foot or leg may need to be amputated.

PAD Warning Signs

• Fatigue, tiredness, cramping or pain in your legs, thighs or buttocks that always occurs when you walk but that goes away when you rest. This is called claudication.

• Foot or toe pain while idle that often disturbs your sleep.

• Skin wounds or ulcers on your feet or toes that are slow to heal (or that

do not heal for 8 to 12 weeks).

Many individuals with PAD do not experience typical leg symptoms, such as cramping, pain, or fatigue, so those at risk should undergo screening for PAD.

Diagnosis
Your podiatric physician can do a simple test to determine if you have PAD.

The test is called ankle-brachial index (ABI). It compares the

blood pressure in your ankles with the blood pressure in your arm. If your ABI is

abnormal, your podiatric physician may order other tests to determine the extent of your PAD.