Diabetic Foot Infections & Podiatry


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One of the major roles podiatrists play in the developed world is in the management of diabetes, a condition involving a deregulation of blood sugar levels. Diabetes has a number of serious medical consequences, including changes in the structure and anatomy of the foot that can be painful and even life threatening. In this article we look at one of the aspects of the condition known as ‘diabetic foot’, infection.

What does diabetes have to do with feet?

Diabetes is a disease that is more directly a consequence of changes in how our body regulates blood sugar through the hormone insulin. Type 1 diabetics simply don’t produce enough of this hormone, while type 2 diabetics are resistant to the effects of the hormone. Either way, the disease doesn’t seem to have much to do with the foot at first glance, however foot complications are one of the major medical concerns stemming from diabetes.

The management of diabetes relies on a combination of medication and lifestyle changes, the latter referring to diet and exercise regimes that work to keep blood sugar levels from changing too much. When these management efforts prove unsuccessful for whatever reason, complications tend to arise, and these include serious conditions affecting the heart and kidneys amongst others. This is because at its roots diabetes is a metabolic condition, and if left unchecked it begins to affect many different basic bodily functions, often with dire consequences.

One of these effects is a set of conditions collectively referred to as ‘diabetic foot’. This is a condition which affects the feet of diabetes as management of the disease goes awry and metabolic changes begin to take their toll on the skin, blood vessels, and joints of the foot.

What are diabetic foot infections?

There are three distinct elements to diabetic foot that all contribute to worsen one another and result in the overall condition. The first is a process called ulceration, during which changes in the structure and function of skin cells, blood vessels, and muscle cause a progressive deterioration which ultimately leaves the foot extremely vulnerable to injury and infection. The most common symptoms are usually pain and swelling of the foot, although these can sometimes pass unnoticed because of the second distinct element to diabetic foot.

Alongside the many changes wrought by ulceration, diabetics also suffer a gradual loss of nerve function in their feet, which means that their ability to sense pain and injury from the lower limb deteriorates as the condition progresses. This change also results in a loss of what is called ‘fine motor control’, which basically describes the foot’s ability to move in a concise and controlled fashion in response to signals from the brain.

A combination of both ulceration and the loss of nerve function in the periphery leaves diabetics in particular danger of injury to the foot. Even something as small as an ill-fitted shoe or rough seam in a sock can injure the foot and leave it extremely vulnerable to infection.

Infections can vary from cellulitis to gas gangrene, each presenting with different symptoms and severities but ultimately posing a serious threat to a diabetic because of how difficult they can be to treat. As mentioned above, the diabetic foot features poor circulation because of the ulceration process. This means that the foot as a whole suffers from inefficient protection from the body’s defences (defensive cells are found in the blood), and that any medication administered by a doctor won’t be well distributed around the foot.

In an unfortunately high number of cases infections of the diabetic foot can become serious enough to pose a serious risk to a patient’s life, and when this happens doctors often have no choice but to amputate the lower limb.

Podiatry and diabetic foot infections

Thus far this article has detailed the dangers to the overall health of the foot posed by infections of the lower limb. As specialists dealing in the care and management of the foot, podiatrists are an important part of diabetic healthcare.

Diabetics are advised to schedule regular appointments with podiatrists, either through the NHS or through private practice, to ensure that their feet are appropriately cared for. Because of the neuropathy involved in diabetic foot, many patients won’t notice injuries and infections of the foot during their early stages.

Podiatrists can provide general advice on the health and maintenance of the foot during appointments, and this is an excellent preventative measure that can stymy the progress of diabetic foot. They can also inspect the foot for any tell-tale signs of infection or the swelling of foot ulceration. If detected early, these conditions can be addressed more effectively, preserving the foot, and hence quality of life and mobility, as much as possible.

Podiatrists are also qualified to provide treatments for diabetic foot, although their scope of practice is dependent on what qualifications they possess. Some podiatrists will be able to prescribe medication to help with an infection, while others can perform some surgical procedures.

Modern diabetic care closely involves podiatrists in the care and management of diabetic patients, and as these practices continue to improve so will the treatment and outcomes of diabetic foot.


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