Diabetic Foot Disorders

Why do diabetics develop problems with their feet?

Diabetics foot disease is a complex problem. However, there are 3 main reasons why foot ulcers and wounds develop:

A) Diseased Nerves (Diabetic Neuropathy)

B) Infection

C) Poor Blood Supply (Peripheral Vascular Disease)

foot problems

A) Diseased Nerves (Diabetic Neuropathy)

Diabetic Neuropathy leads to imbalance in the actions of muscles that control the toes of the feet. This causes toes to develop deformities like claw toes or hammer toes. As a result, abnormal pressure points develop.

As a result of these abnormal pressure points, hard callosities develop that cause ulcers in the tisues beneath.

Diabetic Neuropathy can also lead to poor sensation and dry skin. The ability to feel is a natural protective mechanism that prevents our bodies from getting excessive harm. Diabetics cannot tell if they have wounds on their feet.

B) Infection

Diabetics have an impaired ability to fight infection. A diabetic patient may not feel pain, swelling or even develop any fever if he or she has in infection in the foot. It is common for a diabetic to harbour a large amount of pus in the foot as a result of an untreated wound.

Infection may progress into deeper tissues and affect the bone causing Osteomyelitis. This can be seen as bony destruction on X ray at the late stages.

C) Poor Blood Supply (Peripheral Vascular Disease)

i) What is Peripheral Vascular Disease (PVD)?

Peripheral vascular disease (PVD) is caused by artherosclerosis which is the buid-up of plaque in the arteries. This leads is the narrowing of arteries supplying various organs of the body. Diabetes is a common but not the only contributing factor in developing PVD.

The diagram below depicts and build-up of plaque in the arteries seen in PVD.

The plaque seen in artherosclerosis is rock hard as one can see in the diagram above.

As seen in the above diagram, Smokers have a 4-5 times higher risk and Diabetics a 3-4 times higher risk of developing PVD. When multiple risk factors exist eg smoking, diabetes and hypertension in the same patient, the risk is multiplied.

ii) How common is it?

PVD is more common than expected. In fact, studies done show that if you are > 70 years of age or are between 50-69 years of age and have a history of diabetes or smoking, the chance of developing PVD is 29% (i.e. nearly 1 in 3)

iv) What are the symptoms?

PVD affects the organs of the whole body. Narrowed and diseased arteries may lead to Stroke or even Heart Attacks. It is common to have these co-existing conditions. Most patients do not have any symptoms of PVD. In Diabetics with PVD , this can range from dusky toes or pain in the feet or even having cold feet. In severe cases, they develop non healing wounds and even gangrene.