Diabetic Foot Disease

What is diabetic foot disease?

Foot problems are one of the most common complications of diabetes. They account for more hospital admissions than any other problem in patients with diabetes. The main issues patients with diabetes have with their feet include reduced sensation or alternatively pain (neuropathy) and foot deformity. Diabetics may have poor blood flow to the foot due to atherosclerosis and blocked vessels (peripheral artery disease). They are prone to ulceration and infection including the bone due to reduced immunity and poor wound healing. Diabetes related ulceration and infection is the most common cause of amputation of the leg. Appropriate foot care and wearing appropriate footwear can prevent these complications from occurring.

What should I do to prevent foot complications if I have diabetes?

Patients with diabetes should check their feet daily for dryness, cracking and tinea. Feet should be cleaned, dried and kept well moisturised. Properly fitted comfortable shoes should always be worn including inside the house to protect the feet from injury. Regular podiatry is needed for at-risk patients with diabetes. Callus (a thickened and hardened part of the skin) needs to be debrided (removed) regularly as callus can sometimes hide ulceration which will only be revealed when the callus is removed and without removal of callus infection is more likely.

What should I do if I develop an ulcer?

The development of an ulcer mandates input from several different healthcare professionals. These include your primary care GP, endocrinologist, podiatrist, specialist nurse and a vascular surgeon. All patients with diabetes presenting with a foot ulcer need a full examination of the foot including an assessment of sensation (neuropathy), the circulation (peripheral arterial disease) and the extent of any infection. Understanding the impact of reduced sensation, poor blood flow and infection will dictate the treatment required to heal the ulcer.

How are ulcers treated in patients with diabetes and neuropathy?

The key to management of neuropathic ulcers is relieving the pressure from the area in order to allow it to heal. Pressure relief may be achieved using special footwear or pressure-relieving boots. Some patients may require bed rest potentially in hospital. Regular removal of callus and infected tissue may also be required. Regular appropriate dressings, including those containing antibacterial treatments are also important. Some patients with large ulcers benefit from special suction dressings.

How are ulcers treated in patients with diabetes and peripheral arterial disease?

Ulcers related to poor blood flow may be painful and typically require immediate vascular assessment to identify the most appropriate treatment to restore the blood flow. Improving the flow may be achieved either with open surgical bypass or minimally invasive endovascular surgery as with other patients with peripheral arterial disease. Gangrene and amputation are among the most feared complications of diabetes although it usually only occurs when significant peripheral arterial disease is present.

How are ulcers treated in patients with diabetes and infection?

Infection in diabetic foot ulcers can vary from superficial infection to deeper infection of the tissues and bones. Treatment includes antibiotics and in cases of deep infection surgery to remove the infected tissue (debridement). Infection into the bone can be particularly problematic and often requires surgery and prolonged treatment with antibiotics. It is a common reason for toe amputation in patients with diabetes. In patients with diabetic foot infection attention must also be paid to controlling blood sugars and addressing any other medical conditions.

Sydney Vascular Ultrasound provides specialised vascular and venous diagnostic imaging in Burwood, Bankstown and Liverpool.