December 14, 2012

Diabetic Foot Treatment

Neuropathic ulcer in a diabetic foot

Significant neuropathic ulceration under the 1st MTP joint in a diabetic foot

Diabetic foot complications are a major area of special interest for our practice. We have extensive experience and knowledge in this area. Of all of the foot problems our patients can present with, there is little that is more serious to life or limb than a foot complication due to diabetes.

Diabetes causes two main problems to the foot:

Peripheral Neuropathy   – a degeneration of the nerves within the foot that can cause pain or loss of feeling

Peripheral Arterial Disease   – narrowing or blockages of the arteries which carry blood from the heart down to the foot

People with diabetes are at risk of developing ulcerations and infections within their feet, which have the potential to require an amputation of the foot or leg. In fact, the most common reason a person with diabetes will require hospitalisation is for a foot complication. Even trivial or minor injuries to the foot have the potential to become very serious and threaten a limb.

Pedal ischaemic due to peripheral arterial disease in a diabetic foot to be treated by Brisbane podiatrists.
Podiatry Practice Brisbane treat diabetes foot problems

A painless ulcer developing under the big toe joint due to peripheral neuropathy

Diabetes related ailment to be treated by Brisbane Podiatrists.
A high risk foot with poor blood supply Neuropathic ulcer A neuropathic ulcer due to a Charcot deformity

Health Professionals recommend an Annual Foot Check-up for all People with Diabetes

Our podiatrists are very experienced in the care of people with diabetes, and Anthony Short is a consultant podiatrist to the Queensland Diabetes Centre at the Mater Hospital in Brisbane. We have also been involved in Diabetes Programs with the Divisions of General Practice, and training programs for doctors involved in the Royal Australian College of General Practitioners, along with community education seminars with Diabetes Australia (QLD).

 

Foot Care Tips for People with Diabetes

  • Always inspect your feet on a daily basis for injuries or problems
  • See your podiatrist or doctor immediately if you suspect a problem
  • Have a foot check-up with your podiatrist annually
  • Keep your diabetes under good control – it lessens the chance of complications
  • Never walk outdoors without shoes – prevention is the best cure!
  • Don’t try and treat foot problems like ingrown toenails or corns yourself, this can lead to serious consequences
  • Buy well fitting shoes with plenty of room – running shoes are generally the best for people with diabetes

Charcot Joint or Charcot Foot

One of the lesser known, but most devastating, complications of diabetes is known as a Charcot neuroarthropathy (or a Charcot joint). The name is derived from a French physician, Dr Jean-Martin Charcot, who first identified this condition in patients with peripheral neuropathy (in this case, due to syphilis) whilst working in Paris in the 1800’s.

Charcot neuroarthopathy is a situation where one or more joints within the foot can ‘collapse’ and cause serious deformity and instability, often after a seemingly trivial or inconsequential injury. The foot can change appearance quite dramatically over the course of a few months, and it is difficult to diagnose at first – as it is often confused with infection or gout. Long term, patients with a Charcot joint can be left with a severely deformed foot and high risk of ulceration or amputation.

Foot ulcers

Foot ulcers are an undesirable complication of either peripheral neuropathy and/or peripheral arterial disease. These wounds can be difficult to heal unless a good understanding of the cause of the problem is taken into consideration.

Most typically, neuropathic foot ulcers are painless wounds under the joints of the front of the foot, or around the toes. They are primarily caused by unremitting pressure over bony prominences, altered biomechanics, and the lack of ability to feel pain. If blood flow is still good, they are usually relatively easy to heal once suitable pressure offloading is done with either special footwear, orthotics, bracing or casts. There is usually a preponderance of hyperkeratotic tissue (hard skin callus) around the wound, along with non-viable tissue that needs removal by surgical debridement. This is thankfully painless and promotes much more rapid healing.

The use of special dressings to heal these wounds is typically not of great importance, and simple sterile dressings are usually sufficient because the focus is on removing pressure from these areas.

Our podiatrists will need to see the wound regularly for wound debridements, and to evaluate the effectiveness of pressure offloading approaches.

Neuropathic wound under the 2nd metatarsal head following amputation of the great toe

Neuropathic transfer ulcer under the 2nd metatarsal head following previous amputation of the great toe

By contrast, ischaemic ulcers are due to a lack of blood supply (caused by peripheral arterial disease) reaching the foot, and necrosis of the skin following often trivial injury. They are far more difficult to heal unless restoration of blood flow to the foot can be achieved. We will often work with your GP and vascular surgeon to look for ways to get better blood flow back into the foot, in order for these to heal. It may be important to use protective footwear or bracing during this period to protect these fragile tissues from any further pressure or injury.

FAQ