- Diabetes Education
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by tmi
Foot problems may be warning of heart attack, stroke
By Jeffery Boberg, D.P.M
Maybe it’s because of my medical specialty — podiatry, the diagnosis and treatment of foot, ankle and lower leg disorders — but it seems everyone I talk to knows someone who has lost a toe, foot or leg to diabetes.
In reality, only a small percentage of diabetics lose part of a limb. Diabetes reduces blood circulation and causes nerve damage throughout the entire body. The foot, however, is the earliest marker — the “canary in the cage” warning — of vascular disease and nerve damage in the body.
Diabetics with peripheral arterial disease (PAD) of their foot are much more likely to suffer a heart attack or stroke — and that risk is significant! It’s an early warning that you need to have your blood pressure and cholesterol levels carefully monitored to prevent complications that can damage your heart or brain.
When no pain can be a real pain
Your blood vessels are smallest at their furthest point from the heart — in your foot. The excess sugar in a diabetic’s bloodstream results in micro-vascular injury to these small blood vessels that supply the nerves, damaging nerve fibers. We call this condition neuropathy. The body’s electrical wiring system is breaking down, causing numbness, or a burning, “shooting” or stabbing pain.
Everybody describes the symptoms of neuropathy differently. While it may sound contradictory, the neuropathy pain you feel actually reduces your foot’s ability to feel the pain that counts. After you lose natural feeling, you may not realize that your foot has been injured, and you tend to ignore it.
Take, for instance, when you know your shoes are too tight. Painful blisters form on your feet, which you immediately try to help heal.
If the diabetic doesn’t feel that pressure wound, his or her shoe will eventually rub a hole (ulcer) through the skin. This ulcer becomes the portal for infection. Bacteria now have an entry site. And remember, diabetics don’t respond as well to infection; their body’s resistance is compromised compared to non-diabetics.
The bones in the foot are right under the skin, so a skin infection can quickly lead to an infection of a bone in the foot or leg. When all else fails, when antibiotics can’t control the bone infection, the only cure becomes amputation.
Foot care programs can decrease the incidence of lower-extremity ulcers and amputations by 44 to 85 percent. Most ulcers that lead to amputation can be prevented through daily foot inspection and care, and regular visits to your physician and podiatrist.
Foot exam determines risk for other problems
Amputation prevention only partially answers why diabetics must come in for regular foot examinations.
During an exam, the podiatrist will take a soft piece of plastic film and push it up against the foot until the plastic bends from 10 grams of pressure. Patients who cannot feel the plastic have sustained “loss of preventive sensation” or LOPS.
The podiatrist will notify the patient’s primary care physician if the diagnosis is poor foot circulation — peripheral artery disease. In response, the primary care physician will often alter a diabetic’s medication.
Even though blood tests may indicate the diabetic’s cholesterol is under control, cholesterol-lowering drugs called statins will be prescribed. The patient’s blood pressure, even if not particularly high, will be treated more aggressively. These are proven to reduce the incidence of heart attack and stroke in diabetics.
An overreaction to a foot problem? Hardly. Forty percent of diabetics who develop an ulcer on their foot will die within five years — not from the ulcer, but from a heart attack or stroke. That’s a higher mortality rate than for some cancers.
Here are a few podiatric suggestions for diabetics:
• Examine your feet every day. • Wear white socks to see blood and drainage from your foot that you might not feel.
• Keep your feet moisturized; diabetics are more prone to dry skin.
• However, do not use moisturizer in between toes, which might promote athlete’s foot.
• Do not soak feet that have lost feeling. You may burn your foot in water that is too hot; diabetics with PAD can burn their feet even at slightly higher water temperatures.
• Wear a custom-designed diabetic shoe — a wide, soft shoe that most insurers cover for diabetic patients with PAD.
• If a foot is red or swollen, have it checked by a physician immediately.
In general: A diabetic with good circulation needs to see a foot care specialist at least once a year. One with poor circulation should visit a podiatrist every three to six months and if you have any deformity in your feet along with PAD you should have your feet looked at every 2-4 months. Those who have had a history of a diabetic ulcer need to be seen at least every 4 weeks, for the rest of your lives!