10/26/2011 03:51 pm ET | Updated Dec 26, 2011

Beware of the Diabetic Heart Attack of the Foot

Diabetes can wreak havoc on the foot, resulting in infection, leading to foot/leg amputation. While every patient with diabetes has a theoretical risk, it's the presence of more advanced diabetes that truly makes the foot susceptible to a catastrophic event.

I would like to introduce a term called the "Diabetic Heart Attack of the Foot" to illustrate the severity and seriousness of two advanced diabetic foot problems that may cause limb-threatening events:

1. Foot wound (medical term: foot ulcer)

2. Diabetic foot fracture (medical term: charcot foot).

Similar to a heart attack, a "foot attack" may occur as a relatively mild (but still serious) event that involves active management, or more severe, which can result in immediate hospitalization and limb salvage surgery/possible amputation.

Diabetes (and more so, poorly-uncontrolled diabetes) may lead to two distinct serious medical problems that interfere with normal function of the foot. They are:

  1. Peripheral Neuropathy (decreased or loss of sensation to feet): Without sensation to the foot, a person may not feel things on the bottom of the foot, or inside of the foot. This leads to stepping on objects that can puncture the skin and cause infections.

  • Peripheral Arterial Disease (decreased or loss of blood supply to the foot): Proper circulation is necessary to maintain healthy feet. When blood supply becomes diminished it can result in poor skin texture and healing difficulties -- the most dangerous is gangrene.
  • The effect of diabetes on the foot doesn't happen overnight. They occur slowly over time.

    Diabetic foot wounds

    Sores/wounds on the foot are called "ulcers" and often a strong indicator of advanced diabetes that occur when with sensory and/or circulation problems. Most commonly, these wounds occur on the bottom of the foot under pressure points (such as the ball of the foot) and on the toes. These wounds may be shallow and small or deep and wide.

    The simple presence of a wound is serious because bacteria may propagate and cause an infection. Signs of an infection are redness, swelling, malodor and/or pus (yellowish colored drainage). Infection may progress and cause tissue death and gangrene. Bone infections occur with deep wounds. Both gangrene and bone infections often require invasive surgery.

    Diabetic foot fractures

    Patients who have sensation difficulties can develop "silent" fractures in the foot, a medical term called charcot foot. Simply put, these fractures often occur from altered walking mechanics (from loss of sensation). In many circumstances, the bones heal in an incorrect position, leading to a severe disfiguration of the foot. When the foot becomes structurally deformed, pressure spots occur which can then lead to diabetic foot ulcer/wounds (explained above).

    The "Diabetic Heart Attack Of The Foot" (foot wounds and/or foot fractures) are serious events that when they occur should not be taken lightly by both patient and doctor. They indicate that the diabetes has advanced to a point where the limb becomes at risk for major problems and complications leading to foot amputation/limb loss.

    If you are diabetic, it is important that you take steps to learn how to protect your feet.

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