Diabetes and Foot Complications
Diabetes presents a serious risk of limb loss and amputation due to two major foot complications:
- Peripheral Neuropathy (nerve damage leading to sensation loss or chronic pain)
- Peripheral Arterial Disease (PAD) (narrowed or blocked arteries reducing blood flow)
Even minor or seemingly trivial injuries can sometimes rapidly become serious and limb-threatening, making foot complications the leading cause of hospital admission worldwide for people with diabetes.
If a person with diabetes develops a foot infection, these can sometimes be very severe and may affect deep tissues such as bones and joints. These infections can difficult to treat effectively, and may require a coordinated team of health professionals to help manage. There is established research that people with diabetes who are affected by a major amputation have markedly reduced long term survival.
Assessing and Preventing Complications
Health professionals recommend everyone with diabetes to have an annual diabetic foot check-up.
Daily foot inspection, immediate consultation with a podiatrist or GP for suspected problems, and strictly managing blood glucose levels are crucial for prevention.
Never walk barefoot or attempt to treat simple issues like corns, calluses or ingrown toenails yourself, and always wear spacious, well-fitting footwear. Look out for areas of colour change affecting the foot, such as red or darkened skin.
Doppler arterial examination to assess the quality of blood flow to the foot.
Charcot Neuroarthropathy
A lesser-known but destructive complication is Charcot neuroarthropathy (or Charcot joint). This condition involves the collapse of foot joints, often after a seemingly minor injury, causing severe deformity and instability.
Charcot joints can be very difficult to diagnose initially, and are sometimes mistaken for conditions like infection or gout. Undiagnosed Charcot joint conditions can result in a highly deformed foot with extreme risk of future ulceration or even amputation if left untreated.
A deformed 'rocker bottom' foot caused by Charcot joint disease, creating a neuropathic ulcer under the cuboid bone of the foot.
Neuropathic Foot Ulcers
Foot ulcers in diabetes arise from either nerve damage (neuropathic) or poor blood supply (ischaemic).
Neuropathic ulcers are typically painless wounds, often under the forefoot joints, caused by unremitting pressure and lack of sensation. These usually heal easily with effective pressure offloading (special footwear, orthotics, or casts) and regular surgical debridement to remove hard, non-viable tissue.
Ischaemic Ulcers and PAD
By contrast, ischaemic ulcers are caused by a reduced blood supply from arteries leading down to the foot, called peripheral arterial disease (PAD).
Ischaemic are very much harder to heal and will often require restoring blood flow to the foot, often in collaboration with procedures provided by vascular surgeon such as a stent or bypass procedure.
Gangrene affecting the big toe in a patient with diabetes and peripheral arterial disease (PAD).
Expert Diabetic Foot Care
Our Brisbane Podiatrists are highly experienced in diagnosing and treating all diabetic foot complications, offering a comprehensive assessment and a personalized foot care plan.