DIABETIC FOOT: PAINFUL WOUNDS & ULCERS IN THE FEET AND TOES

Diabetes is a fairly common condition, characterized by an overall elevated level of blood sugar in the body.

There are significant risks of long term increased levels of blood sugar. One such complication is called the diabetic foot or diabetic foot syndrome (DFS).

Patients suffering from this secondary diabetes complication develop painful wounds and ulcers in the feet and toes. These wounds can potentially serve as entry points for a range of infections and pathogens.

In chronic cases, as the disease progresses there are real risks of gangrene. A patient’s mobility is severely restricted and is at risk of sepsis.

In the worst-case scenario amputation of the limb might become necessary. Immediate medical attention to avoid long term progression is highly recommended.

CAUSES OF DIABETIC FOOT

Long term diabetes often comes with complications that arise from the permanently disturbed metabolism. A range of factors often lead to the development of diabetic foot. Some of the most commonly known causes include:

• Narrowing of the blood vessels- Diabetic Angiopathy.
• Nerve damage due to elevated sugar levels- Diabetic Polyneuropathy.
• Circulatory disorders, PAD – Peripheral arterial disease. Hypertension and smoking can further exacerbate the risk of a PAD.
• Poor proprioception and poor quality footwear (too tight or abrasive).
• Reduced blood flow and metabolic diseases that lead to longer healing times.
• Being overweight or obese and a general lack of exercise.
• High blood pressure.

DIABETIC FOOT SYNDROME SYMPTOMS

Diabetic foot syndrome has a wide range of symptoms depending on the progression of the condition. Some of the most commonly known symptoms include:

• Itching and tingling sensation in the feet.
• Numbness and a loss of sensation in the foot. Patient’s describe this as “Fallen asleep feet”.
• Aching legs and painful wounds at the bottom of the feet. Patients tend to restrict their mobility significantly to avoid painful ulcers and can have a debilitating impact on the patient’s quality of life.

As the condition progresses, the symptoms get severe and can lead to serious complications with permanent consequences.

• Chronic wounds that can worsen into gangrene in the long term.
• Widespread infection caused by potential pathogens and bacteria entering the wounds.
• Infection of the surrounding tissue including the bony structure and, in some cases, blood poisoning. 
• Massive deformations (Charcot foot).
• In advanced patients, amputation becomes the only course of action because of the widespread gangrene.

PAIN AND CARE FOR DIABETIC FOOT

Since people with diabetes have a lifelong risk of developing diabetic foot, the correct treatment of the disease is crucial. Every person affected should complete courses in diabetic training that provide the necessary basic knowledge. 

A good guideline to follow for regular care and monitoring of the feet include:

• Check the feet daily for visible changes (increased cornea formation, cracks under or between the toes, redness) or small wounds.
• Regular use of a pH-neutral, moisturizing soap in foot care.
• Short foot baths (approx. three minutes) to avoid softening the skin, preferable using lukewarm water (check with bath thermometer).
• Carefully drying your feet with a soft towel, especially between your toes.
• Regular removal of calluses or corns from trained podiatrists – many health insurance companies reimburse the costs for medical pedicure.
• Careful foot hygiene with daily change of stockings.
• File back the toenails instead of cutting them, rounding off the corners of the nails to prevent in growth.
• Daily creaming of the feet with high-fat, unscented skin creams to prevent drying out and cracking (products suitable for diabetics are often marked accordingly).
• Avoid walking barefoot to prevent injury.
• Skin injuries, even minor ones should be shown to a doctor immediately. Avoid self-treatment at all costs.

TREATMENT OF DIABETIC FOOT

• REGULAR EXERCISE

Frequent short walks or leg and foot exercises helps boost blood circulation in the legs and facilitate healing. This reduces the likelihood of small wounds and also accelerates the healing of existing wounds. 

• LIFESTYLE CHANGES

Reducing weight and obesity and avoiding bad habits like drinking and smoking can have a huge impact on the prognosis of diabetic foot syndrome. It is highly advised that patients look to suitable footwear that do not squeeze, rub or constrict the feet. 

• CUSTOM ORTHOPEDIC FOOTWEAR

Shoes designed specifically for diabetic patients called diabetic bespoke shoes alongside soft insole pads can greatly reduce the likelihood of injury and subsequent risk of infection. 

• REGULAR INSULIN INTAKE

Controlling the root cause of the foot syndrome, i.e. the progression of diabetes is a crucial aspect of treating diabetic foot. Preventing the progression into chronic diabetes with a prolonged duration of elevated blood sugar levels can help reduce the risks of damage and injury to the soft tissues. 

• SOFT-PAD INSOLES

High-quality soft cushion insoles, such as the ErgoPad soft diabetes, distributes the pressure evenly over the tread so that there is no increased stress on individual foot areas. Places under the protrusions such as the heel bone or the base joint of the big toe are particularly at risk. 

The ErgoPad soft diabetes cushion insert is made of a multi-layer soft cushion that absorbs and distributes pressure as soon as it occurs. It also relieves the sensitive region in the rear foot with an additional heel pad, which protects the soft tissue and skin zone under the heel bone when walking.

It is particularly suitable for patients for whom an individual orthopedic adjustment of the insert is not available and also provides effective relief in the case of foot deformities (articulated, flat or spreading feet).

The breathable and skin-friendly material makes it perfect for everyday use. Patients have reported significant improvement in quality of life and relief from symptoms with regular use of the ErgoPad Soft insole.

Additionally, we recommend wearing the ViscoPed Foot Orthosis. This shoe insole is able to fit in most shoes without modification,

The ViscoPed has long soles, meaning they cushion the entire sole of the foot. The forefront and heel also have pressure relief zones which redistribute typical pressure peaks across the wider surface of the foot for relief.

The viscoelastic material is shock-absorbing, allowing your knee, hip and spine joints to be protected.

TYPE 1 DIABETES: ALSO KNOWN AS JUVENILE DIABETES

Diabetes mellitus, or simply known as diabetes, is a common condition which affects many and can be detected at a young age.

Patients suffering from type 1 Diabetes have little to no insulin produced by the pancreas unlike type 2 diabetes where there is enough insulin. 

This lack of insulin reduces the body’s ability to absorb enough sugar, leading to severe consequences.

If the condition worsens over one’s lifetime, there are significant risks to major organs of the body including the heart, eyes, kidneys, nerves and blood vessels. 

CAUSES OF TYPE 1 DIABETES

In Type-1 diabetes, the body’s own antibodies attack the insulin-forming cells of the pancreas and effectively destroy them. This results in little to no insulin being produced in the body. Type-1 diabetes is yet to be definitely linked to a causal factor. However, scientists suspect some of them might include:

• Hereditary and congenital factors – which could explain the auto-immune response
• Certain environmental influences – which are suspected to play a role in developing diabetes, however, the link is yet to be clearly demonstrated
• Viral infections in mothers during the course of pregnancy
• Vitamin D deficiency in childhood

TYPE 1 DIABETES SYMPTOMS

Typical symptoms of type 1 diabetes can be:

• Fatigue
• Abnormal weight loss
• Strong feeling of thirst accompanied by frequent urination 
• Abdominal pain, nausea and vomiting with no apparent cause 
• Dry or itchy skin 
• Exhaled air with a chemical scent (acetone smell)

If blood sugar levels aren’t regulated frequently overtime, using localised injections of insulin, there are significant risks of developing chronic symptoms including:

• Damage to tissues and internal organs
• Damage to nerves and blood vessels
• Significant risks of developing associated diabetic diseases including:
  • Diabetic Nephropathy (damage to the kidneys)
• Diabetic Angiopathy (damage to the arteries) The increased sugar levels can erode arteries and soft tissue. The body responds by depositing proteins that calcify. As time progresses, these calcifications thicken and can lead to narrowing of the affected artery. This can damage the arteries and organs they supply in the long term.
• Diabetic Foot Syndrome: Diabetic foot syndrome is a serious complication that can be life-threatening. The condition is caused due to increasing neuropathy. Dry skin and a waning sensibility often result in undetected wounds, which in turn are exacerbated due to the circulatory disorder from diabetes. Further, the wounds can serve as an entry point for pathogens and infections and can result in sepsis.
• Reticulopathy (damage to the retina of the eye) 
• Risk of stroke and heart attacks
• Developing dementia (vascular dementia).

DIAGNOSIS OF TYPE 1 DIABETES

A complete patient’s history is crucial to determine pre-existing risk factors of developing Type-1 Diabetes. Type 1 is relatively rare and occurs in only 5% of the population (as compared to type 2). 

Doctors typically run a blood sugar test using a drop of blood to confirm elevated blood sugar levels as well as the low levels (or absence) of insulin. Doctors can also request a urine sample to test for glucose or chemicals produced in the body as by-products, due to the lack of insulin.

TREATMENT FOR TYPE 1 DIABETES (JUVENILE DIABETES)

Unfortunately, type 1 diabetes is not curable. However, there are effective ways to manage the condition. Treatment primarily revolves around maintaining proper levels of insulin to balance the elevated sugar levels in the body. A good guideline to follow includes:

• KNOWING YOUR BODY

It is important that patients measure their insulin levels regularly to gather as much information as to how activities and certain foods affect their blood sugar and insulin levels. The more information patients have, the better and more informed choices they can make to regulate the condition.

• REGULAR INSULIN INJECTIONS

In type-1 diabetes, the body produces insufficient or no insulin, hence it is imperative that patients maintain healthy insulin levels by relying on external localised injections of insulin. Typically, doctors start patients out on two injections a day. The amount might vary on a case by case basis. 

• REGULATED EXERCISE

Exercise is very important in treating type 1 diabetes as physical activity can help regulate the blood sugar levels. Patients who regularly exercise and maintain a healthy insulin level (through the prescribed insulin injections) can effectively reduce the risk of developing secondary diabetic diseases.

• SOFT-PAD INSOLES

Type 1 diabetes is often associated with sensitive feet and various foot deformities, which lead to increases in pressure. 

SOFT PAD INSOLES: PREVENT DIABETIC FOOT SYNDROME

High-quality soft cushion insoles such as the ErgoPad soft diabetes help prevent diabetic foot syndrome by relieving the feet at critical points. The multi-layered structure absorbs excess pressure and distributes them evenly over the entire tread when walking. This effectively relieves pressure points on the heel and on the big toe joint, which are exposed to particularly high loads of stress when walking. 

Regular use of the ErgoPad Soft provides comfort and relief to sensitive feet and can help minimise the chances of injury and by extension infections and diabetic foot syndrome. It is highly recommended patient’s use soft pad insoles for a healthy prognosis. 

TYPE 2 DIABETES: ALSO KNOWN AS ADULT ONSET DIABETES

Diabetes mellitus or simply diabetes is a relatively common condition affecting many and usually is detected at a young age. Patients suffering from this condition have a permanently elevated blood sugar level.

In the case of Type-2 Diabetes, the body produces enough insulin, however, the body fails to respond to the insulin and develops a resistance to insulin. This results in accumulation of blood sugar in the body.

As the condition progresses there are significant risks to major organs of the body including the heart, eyes, kidneys, nerves and blood vessels.

CAUSES OF TYPE 2 DIABETES

Type-2 Diabetes is a disease affecting patients of all ages. There are a few well-known factors that contribute to the development of the condition, they include:

• Hereditary and congenital factors. Diabetes can be passed down within the family and is probably the leading cause of the condition.
• Lack of exercise and being overweight or obese can significantly increase the risk.
• Adipose tissue or fat, in some cases, produces substances that can promote insulin resistance. This may be a direct result of a fat metabolism disorder.
• High blood pressure
• Unhealthy diet including alcohol consumption and smoking.
• Stress

TYPE 2 DIABETES SYMPTOMS

• Fatigue and blurry vision
• Loss in weight
• Strong feeling of thirst accompanied by frequent urination
• Abdominal pain, nausea and vomiting with no apparent cause
• Delayed healing of wounds
• Dry or itchy skin
• Chemical smelling exhaled air (acetone smell)
• Dark rashes around the neck or armpits (called acanthosis nigricans) and is often a sign of insulin resistance.

As time progresses and if blood sugar levels aren’t regulated regularly using localized injections of insulin, there are significant risks of developing chronic symptoms including:

• Damage to tissues and internal organs
• Damage to nerves and blood vessels
• Significant risks of developing associated diabetic diseases including:
  • Diabetic Nephropathy (damage to the kidneys)
• Diabetic Angiopathy (damage to the arteries) The increased sugar levels can erode arteries and soft tissue. The body responds by depositing proteins that calcify. As time progresses, these calcifications thicken and can lead to narrowing of the affected artery. and damage the arteries and organs they supply in the long term.
• Diabetic Foot Syndrome: Diabetic foot syndrome is a serious complication that can be life-threatening. The condition is caused due to increasing neuropathy. Dry skin and a waning sensibility often result in undetected wounds, which in turn are exacerbated due to the circulatory disorder from diabetes. Further, the wounds can serve as an entry point for pathogens and infections and can result in sepsis.
• Reticulopathy (damage to the retina of the eye)
• Malfunctions of the cardiovascular system, the digestive system and the musculoskeletal system.
• Peripheral Circulatory Disorders (PAD)
• Risk of stroke and heart attacks
• Developing dementia (Vascular dementia)

DIAGNOSIS OF TYPE 2 DIABETES

A professional medical practitioner begins with a complete patient history to understand any family history of the disease. Following which the doctor can conduct one of the following tests:

• A1C test: A simple blood glucose test to measure sugar levels.
• Fasting Plasma Glucose test: requires a patient to fast before the test to measure sugar levels on an empty stomach.
• Oral Glucose tolerance test (OGTT): This test requires a patient to drink something sweet. It allows the doctor to measure how the body handles the intake of sugar and can provide valuable information for an effective treatment path.

TREATMENT FOR TYPE 2 DIABETES

• LIFESTYLE CHANGES

Switching to a healthy diet and incorporating a healthy routine including sufficient hours of sleep and exercise has proven effective in preventing the onset of diabetes type 2. Abstaining from alcohol and nicotine also greatly helps.

• KNOWING YOUR BODY
  • It is important that patients measure their insulin levels regularly to gather as much information as to how activities and certain foods affect their blood sugar and insulin levels.
• Patients should also be aware of the possibility of wounds on their feet. Regularly checking for minor wounds or injuries can help minimize the risk of infection.
• The more information patients have the better choices they can make to regulate the condition.

• REGULATED EXERCISE
  • Exercise is very important in treating type 2 diabetes. Physical activity can help regulate the metabolism of blood sugar and help with the insulin resistance.
• Patients who regularly exercise and maintain a healthy insulin level (through the prescribed insulin injections) can prevent risks of developing secondary diabetic diseases.
• REGULAR INSULIN INJECTIONS
  • In type-2 diabetes the body produces sufficient insulin, however, the body is unable to utilize it. Over time the pancreas begins to decrease the amount of insulin it produces.
• In the long term patients suffering from type-2 diabetes also need to regulate insulin levels by relying on external localized injections of insulin.
• Typically, doctors start patients out on two injections a day. The amount might vary on a case to case basis.
• Ensuring adequate levels of insulin can help shield against risks of secondary diabetic diseases like diabetic foot syndrome. 

SOFT PAD INSOLES: PREVENT DIABETIC FOOT SYNDROME

High-quality soft cushion insoles such as the ErgoPad soft diabetes help prevent diabetic foot syndrome by relieving the feet at critical points. The multi-layered structure absorbs excess pressure and distributes them evenly over the entire tread when walking. This effectively relieves pressure points on the heel and on the big toe joint, which are exposed to particularly high loads of stress when walking. 

Regular use of the ErgoPad Soft provides comfort and relief to sensitive feet and can help minimize the chances of injury and by extension infections and diabetic foot syndrome. It is highly recommended patient’s use soft pad insoles for a healthy prognosis. 

DIABETIC ANGIOPATHY: ALSO KNOWN AS DIABETIC PERIPHERAL ANGIOPATHY (DPA)

Diabetes is a serious condition where the body loses the ability to regulate blood sugar level. Patients suffering from diabetes tend to have elevated blood glucose.

Long term neglect or prolonged periods of elevated sugar levels can lead to a range of associated secondary conditions.

Diabetic angiopathy is one of the most common complications that arise from chronic diabetes. Patients suffering from diabetic angiopathy experience a narrowing in the arteries.

As a result, there is an under-supply of blood and oxygen to different organs and can lead to damage in the long term. Angiopathy is a very serious condition and has debilitating effects on quality of life. It is in the patient’s best interest to seek immediate medical attention.

CAUSES & TYPES OF DIABETIC ANGIOPATHY

The main cause of diabetic angiopathy is high blood sugar. If sugar is present in excessive amounts in the blood it can damage cells and tissues. The cells that line the arteries are damaged and the smooth layer of the cell wall called endothelium is compromised.

Rough spots arise along the endothelium and can encourage the build-up of deposits we refer to as plaque. As time progresses, these deposits calcify and become more pronounced, effectively narrowing (stenosis) the artery and hampering natural blood flow.

The bottleneck created results in under-supply of oxygen-rich blood to different organs. Patients can develop various disorders depending on the location of the stenosis and generally have an increased risk of stroke and a heart attack.

Broadly there are two forms of diabetic angiopathy, they are:

• Micro-Angiopathy: Primarily affects the small blood vessels in the kidneys, eyes or nerves. 
• Macro-Angiopathy: Primarily affects the large blood vessels in the brain or the neck as well as the coronary arteries or the large arteries of the legs.

DIABETIC PERIPHERAL ANGIOPATHY (DPA) SYMPTOMS

Typical angiopathy symptoms are hard to diagnose since the stenosis can occur almost anywhere in the body and often go unnoticed for a long time. Depending on the location of the narrowing (stenosis) some of the most commonly known symptoms include:

• Micro-angiopathies of the kidney. This involves excreting an unusually high concentration of a certain protein (albumin). Albumin plays an important role in keeping fluids in the bloodstream, so it doesn’t seep into other tissues. Changes in the natural level of albumin secretion can have serious consequences for the circulatory system.
• If the eye is affected, there are no immediate symptoms. In time, there are visual disturbances such as blurred vision and dark spots or veils in the visual field. These are the first signs of retinopathy, which can lead to blindness if the course is severe.
• If vessels in the brain are affected, this can be manifested by problems with concentration or thinking, memory problems, mood swings or depressive moods.
• Angiopathy in larger vessels (macro-angiopathy) can cause a weakened pulse in the early stages as well as cold feet and hands or pain when walking longer distances.

DIAGNOSIS OF DIABETIC PERIPHERAL ANGIOPATHY

• A complete patient’s history is crucial to determine pre-existing risk factors of developing diabetic angiopathy.
• Doctors typically run a blood sugar test using a drop of blood to confirm elevated levels of blood sugar as well as the low levels (or absence) of insulin in cases of Type-1 Diabetes and insulin resistance in Type-2 diabetes.
• Doctors can also request a urine sample to test for glucose or chemicals produced in the body as by-products due to the lack of insulin.
• Sophisticated imaging technology like Ultrasound can help detect blockages in the arteries caused by the calcification of plaque and can allow doctors to pinpoint the location of stenoses.

DIABETIC ANGIOPATHY PREVENTION

Optimal blood sugar control is the most important preventive option. Daily blood sugar checks, an adapted diet and a graduated drug therapy to the correct insulin administration helps to keep the blood sugar level below the critical value.

Diabetic training allows patients to deal with their illness competently and in a well-informed manner. A healthy, active lifestyle with regular physical activity is beneficial to improve blood flow, reduce blood pressure and improve the performance of the heart.

TREATMENT FOR DIABETIC PERIPHERAL ANGIOPATHY (DPA)

Treatment of angiopathy primarily aims at minimizing the risk factors and a long term goal to regulate blood sugar levels. Regulating the sugar levels can itself act as a major step towards shielding the body from further damage and disease progression. A good treatment path for Diabetic angiopathy include:

• REGULAR INSULIN INJECTIONS

In general, external intake of insulin is required to regulate and maintain healthy levels of blood sugar in the body. Patients suffering from type 1 (little to no insulin production) and type 2 (insulin resistance in the short run, leading to a decrease in the overall production of insulin in the liver) require localized injections to stay healthy.

• LIFESTYLE CHANGES

It is important to make certain lifestyle changes, especially in the case of micro-angiopathy. The blood vessels are too small to seek surgical treatment and thus, alternate methods should be explored. Typically, a healthy diet, avoiding smoking and drinking, regular exercise can help boost blood circulation and improve the supply of oxygen in the affected areas.

• SURGICAL INTERVENTION

In case of macro-angiopathy, there are a few surgical procedures that can be used to alleviate symptoms and provide relief. Some of them include:

• The removal of calcified plaques (lime peeling)
• The dilation of the narrowed vessel using a balloon catheter (balloon catheter dilatation)
• Bypass surgery
• The implantation of a tube (stent) that keeps the narrowed vessel open and thus improves blood flow.

Surgery has significant risks. However, it might be necessary to avoid life-threatening incidents like a stroke or heart attack.

SOFT PAD INSOLES: COMFORTABLE FOOTWEAR

In diabetic angiopathy, reduced blood flow to the legs and feet affects wound healing (healing takes longer). Even minor injuries to the feet can lead to chronic wounds and ulcers that do not heal – referred to as the diabetic foot syndrome. Those affected usually do not notice when sores form due to the impaired sensitivity. 

Comfortable footwear with soft inner padding and no pressing seams along with a soft pad inserts, such as that of ErgoPad soft Diabetes, prevents the formation of pressure points and wounds.

The ErgoPad soft diabetes shoe inserts particularly relieve the critical areas on the heel and the big toe joint, which are particularly stressed during movement. The insole helps prevent the development of diabetic foot syndrome.

Regular use of a soft insole can greatly improve the quality of life of a patient and can effectively shield them from further damage and risk of infection (sepsis) and is highly recommended for a healthy prognosis.

Additionally, we recommend wearing the ViscoPed Foot Orthosis. This shoe insole is able to fit in most shoes without modification,

The ViscoPed has long soles, meaning they cushion the entire sole of the foot. The forefront and heel also have pressure relief zones which redistribute typical pressure peaks across the wider surface of the foot for relief.

The viscoelastic material is shock-absorbing, allowing your knee, hip and spine joints to be protected.