Diabetes is a very common problem, affecting 5 to 6 percent of the US population. Diabetics are about 25 times as likely to become blind and seven times more likely to develop gangrene. In addition, one out of five diabetics requires either a major or minor limb amputation.
Diabetics can have foot problems that may be categorized as neuropathy, ischemia, infection or any combination of these. By properly defining their problem, it becomes easy to prioritize which require the most urgent treatment. As a general rule, infection is eradicated first. The management of diabetic foot infections can be very challenging, as external signs of infection can be quite subtle. Drainage is sometimes required. Once the infection is under control, the ischemia can be treated, and eventually, the neuropathy. With good footwear, most neuropathic ulcers can be healed. However, if the ulcer is deep and involves the bone or joints, minor amputation may become necessary.
Patients with diabetic foot problems need to take excellent care of their feet, including performing daily foot inspections. If their vision is not ideal, patients should share this responsibility with someone else. In addition, diabetics with foot problems should never walk barefoot because they might step on something sharp. A laceration might not be felt in a neuropathic foot, so unknowingly, infection could enter through the wound site. Patients should also be incredibly careful about cutting their toenails. If a toenail is cut too closely, tissue may be cut as well, leaving open a potential entry site for infection. Furthermore, patients should be careful about soaking their feet in hot water because burns can heal poorly and result in a limb-threatening problem.
Physicians in Lahey's Department of Vascular Surgery are available to evaluate any type of diabetic foot problem – neuropathic, ischemic or infection. Patients who believe they may have an infection should be seen immediately. For further information, please contact the Department of Vascular Surgery at 781-744-8577.