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June 29, 2001

Complications

Question from Claremore, Oklahoma, USA:

I am trying to help a friend who has degenerative foot disease related to his diabetes, and I need to understand what exactly is involved here and what treatment, if any, is possible. What can you tell me about foot diseases associated with diabetes?

Answer:

When foot disease associated with bone deterioration begins to develop, you usually have a patient with long-standing diabetes. Multiple issues come in to play.

First, there is likely to be diabetic neuropathy in which the nerves do not work well, and the patients do not have good sensation, even to tissue damaging injuries. With further use, the bone continues to deteriorate, even though the patient does not feel it. In addition, the healing process is compromised by poor local blood flow. This would also compromise antibiotic delivery to an infected site.

Finally, good blood sugar control is required for the body’s immune system to work well. By the time bone disease is present, patients may require more dramatic treatments to improve their situation. It may not be possible to completely heal the bones back to normal. First, the patient should have the foot unloaded. This means staying off the foot for weeks to months.This is very hard to do, but is very often necessary. Second, special shoes and orthotic devices are needed to distribute weight more evenly and avoid areas of pressure over areas where skin is breaking down. Finally, the nerve function usually does not recover once it is gone. This means patients have to be more conscious of conditions, activities, shoes that can cause problems. Infection needs to be avoided by obtaining good blood sugar control and aggressive treatment of minor skin abrasions. This means looking at the feet every day for the rest of the patient’s life.

JTL