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Diabetic Foot Problems

Fundamentals of diabetic foot problems

Foot problems are a major reason behind hospitalizations for diabetics. Diabetes can affect nerves in the foot and prevent you from feeling injuries. It can also cause reduced or altered blood flow, which can prevent injuries from healing. Because minor injuries can become major infections among diabetics, it is important to keep a diabetic foot healthy. Prevention is the key to avoiding foot problems in diabetic patients.

Common diabetic foot problems include:

  • Foot ulcers
  • Swelling
  • Cuts and sores
  • Corns
  • Ingrown toenails
  • Deep infections
  • Charcot Fractures (unrealized fractures because lack of sensation does not cause pain)

What causes diabetic foot problems?

The loss of nerve function – neuropathy – among diabetic patients in their feet and legs typically develops over time. Because patients cannot feel foot injuries as acutely as those without diabetes, they may inadvertently ignore foot problems. Therefore, pain is not an early indicator of problems in diabetic patients. Poor circulation and decreased immunity to infection can also lead to serious diabetic foot problems.

Symptoms of diabetic foot problems include pain or a tingling foot sensation in the feet at night. Ulcers, infections, and other problems may be painless. As a result, routine self-inspection of each foot is of utmost importance. Additionally, patients may experience unsteadiness in standing and walking due to the loss of sensation. Finally, the foot may have swelling, redness, ulcers, and bleeding, all of which should alert the patient to call a physician.

What are the benefits of treatment?

If you are diabetic and have a foot problem, you should contact your doctor for evaluation and treatment. To take care of the foot, you should do the following:

  • Wear shoes that fit properly.
  • Inspect each foot daily for blisters, cuts, sores, and other problems. 
  • Avoid going barefoot.
  • Avoid exposure to temperature extremes.
  • Do not self-treat corns, calluses, or ingrown toenails.
  • Instead, see a physician for treatment.
  • Have regular foot examinations.
  • Keep your feet warm.
  • Control your diabetes by monitoring your blood sugar levels and taking prescribed medications.
  • Do not ignore minor problems, as they can become severe very quickly in diabetics.

Serious foot problems that have resisted conservative treatment methods may require surgery. Surgery may be aimed at removing a foot infection, realigning bony deformities, or an amputation to prevent further problems.

What are the risks of treatment?

Risks of foot surgery include nerve injury and infection. As you still have diabetes, problems can recur in the future.

How do I prepare for surgery?

  • Complete any pre-operative tests or lab work prescribed by your doctor.
  • Arrange to have someone drive you home from the hospital.
  • Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
  • Call the appropriate surgery center to verify your appointment time. If your surgery is being done at Cleveland Clinic, call:
    • Main Campus: 216.444.0281
    • Beachwood: 216.839.3500
    • Strongsville: 440.878.3400
    • Marymount: 216.518.3200
  • Refrain from eating or drinking anything after midnight the night before surgery.

Are there foot exercises I can start now prior to surgery?

In preparation of any foot/ankle surgery, upper body strengthening is encouraged in order to prepare for crutch/walker use after surgery.

What do I need to do the day of surgery?

  • If you currently take any medications, take them the day of your surgery with just a sip of water.
  • Refrain from taking diabetic pills or insulin on the morning of surgery.
  • Do not wear any jewelry, body piercings, makeup, nail polish, hairpins or contacts.
  • Leave valuables and money at home.
  • Wear loose-fitting, comfortable clothing.

What happens during surgery?

Your foot will be initialized in the preoperative area by someone from the surgical team. In the operating room, you will be met by a nursing team and the anesthesia team. You have several anesthetic options:

  • General: Completely asleep and breathing through a tube
  • Epidural/Spinal: Numb from the waist down, or
  • Local: Numbing medicine just above the surgical site

Epidural/Spinal and Local are usually combined with sedative medication so you can rest comfortably during the procedure. Once you are anesthetized, the surgery is initiated.

What happens after surgery?

It is not unusual to experience numbness, tingling, and burning sensations in your foot. You should elevate your foot above your heart for 48 hours after the procedure, in order to relieve pain and these sensations. If this does not resolve the problems, your cast or surgical dressing may be too tight, and you may need to call your doctor. Avoid prolonged sitting or standing, and refrain from putting weight on the operative site unless given permission by your doctor.

Your doctor will give you pain medication, which may cause nausea or constipation. Eat lightly on the day of surgery.

If you are wearing a cast, do not put anything in the cast and keep the cast clean and dry. If you are itching beneath the cast, take Benadryl and blow cool air down the cast with a hair dryer.

Ask your surgeon for complete post-operative instructions.

How long is the recovery period after surgery?

Based upon the extent of your surgery, it will take approximately 6 weeks to 3 months to recover. As a general rule, the recovery for diabetic patients is twice as long when compared to individuals non-diabetic individuals.

What is the rehab after surgery?

Rehabilitation can be done at home, or, may require formal physical therapy.

How can I manage at home during recovery?

After the first 48 hours of foot elevation, you can usually gradually return to most activities. However, the use of crutches or a walker will be required. At some point, your physician will allow you to wean off the crutches/walker to more "normal" activities. Typically, the dressing placed at the time of surgery is left intact until your first postoperative visit. The surgical dressing cannot get wet. Therefore, baths are encouraged. If one chooses to shower, then an "over-the-cast" bag is necessary.

How frequently should I schedule follow up appointments with my doctor following surgery?

Follow-up visits are scheduled by your surgeon.

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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