The Diabetic Foot

By Marcos Otero, Gulf Coast Immediate Care Center, Fort Walton Beach

Diabetic Foot – Diabetes causes many complications. Diabetes damages every cell in the body and can manifest in many ways. Poorly controlled diabetes can damage the heart, brain, kidneys, and skin, but today we will focus on the damage it can cause to a diabetics’ foot.

MCC came to our clinic complaining that he had a cold left foot for several weeks, and now the foot hurts to even walk on it. Many things can cause foot pain, including heel spurs, bunions, fractures, etc. MCC’s problems were his circulation problems caused by his diabetes.

MCC is a 62-year-old Hispanic male who has had diabetes for over thirty years. His health has become extremely poor in the last years, and his daughter even says that he has aged in those two years well beyond his stated age. He also had not been consistent with treatment being on and off medications depending on how he felt. Now he has excruciating foot pain, with the left being much worse. His daughter says. “Three weeks ago, he began having more foot pain, and the foot became ice cold to touch.”

When I met him, he indeed did look much older than his stated age. He could barely walk. The foot was cyanotic (blue color indicating poor oxygenation). His left is much more so than the right. Both lower legs and feet had evidence of ischemic lesions. The left foot was ICE COLD to touch with barely perceptible pulses. The lower legs showed evidence of hair loss with shiny thin scaling skin. The nails were brittle and thickened. 

All these findings are evidence of severe peripheral vascular disease. Most likely caused by long-standing diabetes. After all the years of on and off diabetic treatment, MCC is now suffering complications and the consequences. There is a possibility he may need amputation of his toes or, worse, his foot. Avoiding these problems may have been possible with appropriate care early on.

HOW DOES DIABETES-RELATED POOR CIRCULATION HAPPEN?

• Elevated blood sugars deposit fat inside the blood vessels. These deposits narrow and harden the vessel wall affecting flow. 
• Peripheral artery disease (PAD) also narrows the blood vessels, mainly in your legs and feet, with fat deposits. 

This reduced circulation may lead to amputations. 

Signs of poor circulation

Are you getting muscle cramps? Is there a stinging feeling in your legs or arms? Do you have cold or numb hands – feet? People with diabetes with poor blood circulation or inadequate blood flow can have serious health problems. Symptoms of poor circulation include:

• The pale blue color on the affected areas
• Pain when walking, particularly in calves, thighs, and buttocks
• Cold hands and feet
• Tingling or numbness in hands or feet
• Dry cracked skin, especially on the lower extremities
• Hair loss on legs or feet
• Brittle toenails
• Infections in your feet 
• Varicose veins 
• Slow-healing wounds
• Ulcers on the legs and feet
• Erectile dysfunction

Improve your circulation by making small changes can significantly improve your circulation. The following helps immensely:

Exercise – Take quick, frequent exercise breaks and exercise to benefit problem areas

Eat for heart health – A healthy heart diet should include:

• Omega-3 fatty acids (high in salmon and flax seeds) help lower blood pressure and improve circulation. 
• High-fiber foods (such as oatmeal and apples) reduce cholesterol and limit the narrowing and hardening of your arteries. Iron (found in red meats and spinach) helps create red blood vessels.

Wear diabetic compression socks – Diabetic socks put pressure on calves and feet and like a massage increase blood flow. For diabetes, the compression keeps veins straight, improving blood flow to the feet and keeping feet warm. Also, socks can also reduce swelling and help to prevent blood clots.

Maintain controlled blood sugar at goal levels – Managing blood sugar levels reduces the build-up of fatty deposits in blood vessels. The diabetic goal is to keep glucose between 80–120 mg/dL before a meal and less than 180 mg/dL after the meal.

Check your feet daily for any injuries.

Lose weight.

Take Your Medications as Prescribed! Always take them as directed.

Stop smoking

Control your blood pressure and cholesterol levels.

Remember that although you may feel well uncontrolled diabetes will affect you in some way in the future.