While "One Foot, Two Foot, Red Foot, Blue Foot" may be the opening line of a humorous children's book by Dr. Seuss, foot complications are no laughing matter to the 20 million Americans with diabetes. According to the American Orthopaedic Foot & Ankle Society (AOFAS), ulceration, infection, and gangrene are the most common foot and ankle problems of the diabetic patient. Approximately 60,000 lower extremity amputations are performed annually, in the US alone, in patients with diabetes. However, with ongoing, diligent and proper foot care, many of these amputations are preventable.
The AOFAS recommends diabetic individuals check their feet daily by inspecting all sides including the bottom; any changes in shape or color, sense of feeling/sensation, painful areas or skin integrity need to be evaluated by an orthopaedic foot and ankle surgeon. There are two major causes of foot complications in diabetic patients: nerve damage (neuropathy) and loss of circulation (ischemia). Neuropathy or loss of feeling in feet affects 60-70% of diabetics. With a diabetic foot, a wound as small as a blister from wearing a shoe that is too tight can lead to a major emergency if undetected. Many diabetics experience a decrease in blood flow; therefore injuries are often slow to heal. If a blister is not healing it's at risk for infection. As a diabetic, an infection may spread quickly with little warning.
AOFAS member Michael S. Pinzur, MD, Professor, Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL, former chair of the AOFAS Diabetes Committee, and assistant editor of the FootForum which appears monthly in the Society's scientific journal, "Foot & Ankle International (FAI)," provides the following advice: "It is imperative that diabetics inspect their feet daily, as foot infection is the leading cause of hospitalization for diabetic individuals in the US. Foot ulcers, blisters and infections are often difficult for diabetic individuals to discover, as many have impaired vision or limited ability to examine the bottoms of their feet. Often a spouse or caregiver needs to participate in the daily evaluation. Mirrors and magnifying glasses are helpful aids in inspecting difficult to access areas of the feet. This becomes crucial, as many diabetics have impaired immune systems and have a lowered resistance to infection. The ability to spike a fever or develop an elevated white blood cell count is often impaired. Often times, the first signs of a developing infection are a rising blood sugar level or a need for increased doses of insulin."
The AOFAS suggests the following daily foot care routine and infection prevention tips for individuals with diabetes: