November is National Diabetes Awareness Month. Diabetic foot and leg care is a condition American Foot and Leg Specialists take very seriously. Diabetes is a metabolic disease where the body is unable to produce enough insulin, or effectively utilize insulin, which causes elevated levels of glucose in the blood. Nerves in legs and feet can be damaged when blood glucose levels are elevated, resulting in diminished sensitivity to pain, touch and injury. Scrapes, blisters, cuts and other types of wounds on the feet are often not even detected, and as a result these conditions may degenerate and become infected. Because diabetes also impacts one’s ability to heal due to poor circulation, an insufficient amount of white blood cells are able to access the wound to fight the infection. In short – you can’t feel the sore, and your body can’t adequately fight infection. In many cases, foot ulcers develop.

Ulcers on the foot can result in serious complications for diabetics. Pro-active monitoring of your feet and legs for open sores or wounds that don’t heal, or that recur after treatment is important. There are three general kinds of ulcers, each appearing on different parts of the leg or foot and having different characteristics:

Venous stasis ulcers: occur below the knee and usually on the inner leg.  They are irregularly shaped, swollen, warm, and often discolored.

Neurotrophic ulcers: typically, although not always, found at pressure points on the foot.  They vary in size and are pink/red or brown/black in color.

Arterial ulcers: usually located on the heels or tips of the toes. They can be yellow, brown, black, or grey in color and do not bleed.

Foot ulcers are particularly susceptible to infection. If left untreated, the following complications may develop:

♦   An abscess, or pus-filled pocket;

♦   A spreading infection of the skin and underlying fat;

♦   A bone infection;

♦   Gangrene, an area of dead, darkened body tissue.

The healing process needs a functional blood supply to provide energy to the cells in order to repair, as white blood cells to fight infection. This is achieved with stringent management of blood glucose levels to foster circulation. Under this diabetic wound care scenario, the ulcers may be treated by removal of the diseased tissue and adjacent callused skin, supported by antibiotics to fight infection. However, when foot ulcers do not respond to simple debridement, surgery may be necessary.  This might entail correction of blood flow impediments in the leg arteries. When an ulcer has progressed to gangrene or recurrent infections and degeneration of the flesh and bone, amputation of the diseased area, or all of the foot may be the only solution.