Piabetic foot ulcers

Diabetes is a complex condition which ultimately stems from a deregulation of blood sugar levels through insulin. While the disease itself does not have its origins in the lower limb, one of its long term complications is diabetic foot, an umbrella term which refers to a number of major pathologies of the foot which can affect a person’s mobility and livelihood. The care of diabetic foot is partly the responsibility of trained podiatrists, specialists in the field of foot care able to deliver high quality treatments when necessary to prevent or treat diabetic foot.

What is diabetic foot ulceration?

Foot ulceration is a major complication of diabetes which can severely impact a patient’s mobility. This condition comes under the broader term ‘diabetic foot’, affecting about 15% of diabetics. Ulceration is directly responsible for at least 84% of diabetic foot amputations, making it a major medical obstacle.

While diabetes is a metabolic disorder with its origins in the pancreas, its effects over time are wide ranging. One of these is a the disruption of vasculature at the extremities, particularly the foot and lower limb. Healthy blood flow is vital to maintaining function anywhere in the body, and the foot is no exception.  Ultimately ‘ulceration’ refers to dramatic changes in the tissues of the foot discussed below.

The changes in metabolism observed during diabetes are thought to cause the release of AGEs (advanced glycation end products), by-products of disrupted cell functions caused by diabetes. AGEs affect an important structural component of the skin and other tissues called the ECM (extracellular matrix), which in turn results in a number of distinct changes in the foot and ankle that cause diabetic foot ulceration.

The most prominent of these has already been mentioned, the disruption of blood flow in the lower limb, and other changes include changes in the texture and structure of skin, primarily a loss of elasticity, which renders it vulnerable to injury. The accumulation of AGEs also affects tendons, ligaments, and cartilage, all important components of joints, and the stiffening of joints is part of the ulceration process.

These changes ultimately affect the actual structure of the foot, causing distinct deformities which can impair a person’s ability to walk without pain. 

Foot ulceration is compounded by another aspect of diabetic foot, the progressive loss of nerve function in the lower limb referred to as neuropathy. Neuropathy has two important implications which contribute to ulceration. The first is that the transmission of signals to the muscles of the lower limb are disrupted, meaning that these muscles don’t relax or contract as they should, causing them to loose strength and eventually the ability to function properly at all.

The second is a loss of pain sensitivity in the lower limb. When added to the already increased vulnerability to damage from injury discussed above, this creates a situation where a foot is exceptionally vulnerable to wounds.

Podiatry and diabetic ulceration

Diabetics are advised to attend at least one yearly session with a podiatrist to examine the foot for any signs of stress and injury. During the early stages of the disease, this is largely a monitoring process that looks for any signs of diabetic foot. Your podiatrist will also probably make recommendations about how to avoid injury and look after your feet, particularly through appropriate footwear.

If diabetic foot does develop, a podiatrist can administer treatment to alleviate pain and minimise the chances of injury and damage to the foot. Podiatrists with the appropriate training and experience can prescribe medication or perform minor foot surgeries to treat diabetic foot. They can also assess risk factors which can cause the condition to worsen, and advise you on the best course of action for the preservation of your feet. Ultimately the podiatry service aims to provide diabetics with as much support as possible to prevent the onset of diabetic foot, and if the condition does set in, to manage and treat the condition.

Podiatric services are available through the NHS and private providers.

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