Diabetic foot problems are a major complication of diabetes that can lead to severe consequences like amputation if not properly managed. The feet are especially vulnerable to nerve damage and poor circulation in people with diabetes. This results in a loss of protective sensations and makes it easy to get foot injuries or infections without realizing it. Moreover, high blood sugar levels impair wound healing and make it harder to fight off infections. However, with diligent foot care and blood glucose control, it may be possible to reverse some diabetic foot problems.
What are the common foot problems in diabetics?
Some of the most common diabetic foot problems include:
Peripheral neuropathy
This nerve damage in the feet causes loss of feeling. The feet become numb and insensitive to touch, pain, heat or cold. Patients may not feel a pebble in their shoe or a blister forming and this leads to wounds.
Peripheral vascular disease
Poor circulation or blood flow to the feet makes it harder for sores or cuts to heal. Blood vessels narrow and restrict oxygen supply.
Foot ulcers
Ulcers are open sores that form due to nerve damage and circulation issues. They can get infected easily.
Charcot foot
This condition weakens the bones due to neuropathy and causes deformities in foot shape. The joints collapse and feet become misaligned.
Hammertoes and bunions
Imbalance in foot muscles and tendons causes toes to curl abnormally and push against each other or the shoe. This leads to painful deformities.
Infections
Bacteria thrive in high blood sugar environments. Ingrown toenails, fungal infections, etc. are common.
Gangrene
Due to severely restricted blood flow and unnoticed wounds, the skin and tissue in the feet dies and turns black. Amputation may be required.
What factors cause these foot problems?
Uncontrolled blood sugar
Consistently high blood glucose levels damage the nerves and arteries in the feet. Keeping sugar levels close to normal can prevent nerve and vessel impairment.
Smoking
Smoking constricts blood vessels including those in the feet. This compounds the circulation problems caused by diabetes.
Nerve injury
Unnoticed repetitive trauma to feet, abnormal foot mechanics, and injuries that go unnoticed due to numbness can damage foot nerves.
Calluses
Thickened dead skin that builds up due to excessive pressure can lead to ulcers underneath by blocking blood supply.
Foot deformities
Bunions, hammertoes, etc. cause abnormal pressure points that make ulcer formation more likely.
Poor foot hygiene
Not washing and drying feet well, moist environments favor bacterial and fungal growth.
Ill-fitting shoes
Tight, rigid, or worn out shoes put excess pressure on feet and cause blisters or calluses.
Can these diabetic foot problems be reversed?
The short answer is yes, it is possible to reverse some diabetic foot complications through diligent foot care and controlling risk factors. However, severe nerve damage or deformities may be irreversible. Here’s a more detailed look:
Peripheral neuropathy
The nerve damage and loss of sensation associated with this condition is often irreversible. However, keeping blood sugar tightly controlled can halt progression and prevent further nerve damage. Reducing additional risk factors helps too.
Peripheral vascular disease
While the arterial narrowing and plaque buildup isn’t reversible, lifestyle changes and medications can help improve blood circulation to the feet. Quitting smoking is a must. Exercise, diet, and medications to lower cholesterol and blood pressure are key.
Foot ulcers and infections
These can be cured and reversed with prompt treatment like wound debridement, antibiotics, using special boots to offload pressure from the wound, etc. Preventing recurrence is important.
Charcot foot
The foot deformities caused are permanent but progression of damage can be slowed or stopped through protective footwear, activity modification, and keeping weight off. Surgery may repair some deformities.
Hammertoes and bunions
Splints, toe spacers, and appropriate footwear can help realign toes and relieve pain. Custom orthotics improve biomechanics. Surgery can correct deformity.
Gangrene
Caught early, it can be treated with antibiotics, wound care, and revascularization procedures. However, severe gangrene necessitates amputation.
What diabetes foot care tips can help reverse problems?
Here are some proactive daily foot care habits to prevent and reverse diabetic foot complications:
Check feet daily
Inspect for cuts, blisters, redness or swelling which signal problems. Use a mirror if unable to visualize undersides. Feel for changes in temperature or new pains.
Wash & moisturize
Cleanse daily with mild soap and warm water. Dry carefully including between the toes. Apply moisturizer to prevent cracking.
Proper nail care
Trim toenails straight across to avoid ingrown nails. Use an emery board to gently file edges. Seek professional help if necessary.
Always wear shoes
Don’t go barefoot to avoid injury. Wear clean dry socks to wick moisture and use slippers indoors.
Choose proper footwear
Well-fitted shoes with adequate toe room support foot health. Get professionally fitted orthotics if needed.
Stay active
Regular non-impact exercise boosts circulation. But check feet for blisters/irritation and avoid high impact activities.
No hot packs/heating pads
Use lukewarm water only. Check water temperature with elbow first since injured feet may not sense heat properly leading to burns.
Elevate legs
Rest feet above heart level when sitting to aid blood flow. Avoid crossing legs.
Don’t self-treat corns/calluses
Seek professional help for removal to avoid wounds. Use prescribed orthotics/shoe inserts.
Quit smoking
Smoking restricts circulation and delays wound healing. Speak to your doctor about aids to quit smoking.
What medications can help?
Your doctor may prescribe certain medications to eliminate foot problems and avoid recurrence:
Antibiotics
To clear infection causing foot ulcers/wounds. Topical antibiotics may also be used.
Pain relievers
Oral NSAIDs or topical diclofenac gel can provide relief from diabetic nerve pain. Narcotics are avoided.
Antifungal/antiviral drugs
Medications to eliminate fungal, yeast or viral infections causing itchy rashes or nail problems.
Allopurinol
This prevents buildup of uric acid especially if diabetes has caused kidney damage. Reduces risk of gout-related foot pain.
Blood thinners
Improve circulation to the feet and prevent clots. But may increase bleeding risk.
Blood sugar lowering medication
Insulin or oral anti-diabetic drugs to keep glucose levels controlled and prevent further nerve/vessel damage.
When to see a podiatrist?
Consulting a foot specialist or podiatrist is advisable in the following situations:
Diabetic foot examination
Get an annual screening to identify any problems early when they are easiest to reverse. The podiatrist will check for loss of sensation, signs of poor circulation, deformities, etc.
Corn/callus/wart removal
Don’t attempt to cut or dig these out yourself. Allow the podiatrist to safely pare down built up thick skin and treat underlying wounds.
Ingrown toenail fixing
They will remove the edges of the nail digging into the skin and use chemical cauterization to prevent regrowth into the skin.
Custom orthotics
Devices made from molds of your feet help realign the foot, reduce pressure on problem areas, and fix biomechanical imbalances.
Prescribing therapeutic shoes
Special diabetic shoes with extra depth/width and custom inserts protect feet from injury. They help heal and prevent recurrence of foot ulcers.
Toenail fungus laser therapy
The podiatrist can directly target fungal infection in the nail with specialized lasers to avoid using oral antifungal medications long-term.
Surgery if needed
To repair deformities or straighten toes causing abnormal pressure and risk of ulcers. This can reverse problems before they worsen.
Can custom orthotics reverse diabetic foot complications?
Yes, custom orthotic inserts molded specifically to the shape of the feet can effectively reverse various foot deformities, ulcers, and pain caused by diabetes. Here’s how:
Redistribute pressure
By providing extra cushioning and support in areas of the feet bearing excessive pressure, orthotics prevent callus and ulcer formation.
Provide stability
They keep the foot properly aligned and joints stable preventing collapse of arch or charcot foot deformities.
Offload pressure from wounds
Special orthotic shoes/inserts with a cavity over foot ulcers avoid pressure on lesions so they can heal.
Accommodate deformities
Orthotics are customized to fit hammertoes, bunions etc. comfortably without friction and irritation.
Improve gait mechanics
They facilitate rolling of the foot, correct stride, and take pressure off sore spots to prevent further injury.
Reduce shear stress
Orthotics with a lower heel-to-toe gradient minimize shear forces on the foot during walking that can worsen ulcers.
Limit joint mobility
Restriction of foot joint motion by orthotics can prevent progression of charcot foot damage.
Offload rearfoot
Orthotics take weight off the heel which is common site for callus/ulcer formation in diabetics with peripheral neuropathy.
What surgical procedures can reverse diabetic foot problems?
Surgery is an option to reverse some effects of diabetic foot complications once conservative treatments fail. Common procedures include:
Revascularization surgery
Bypassing blocked vessels or angioplasty can improve blood supply and heal ischemic ulcers that won’t heal otherwise due to poor circulation.
Hammertoe/bunion surgery
Corrective surgery realigns the bent toes or misaligned joint thereby removing pressure points and calluses leading to ulcers. Pins/wires may hold toes straight until healing occurs.
Exostectomy
Removing protruding portions of the foot bones eliminates friction that causes pain and risk of wounds from abnormal bony prominences (due to charcot foot).
Removal of dead tissue (debridement)
Surgical cleaning of necrotic or infected dead skin and tissues around the ulcer helps healing and reverses infection.
Amputation
Partial foot or toe amputation may be needed for unsalvageable ulcers/infected wounds to preserve the remaining foot.
Charcot foot reconstruction surgery
Reshaping the deformed foot and fixing fractures can help restore foot architecture and offload pressure areas.
Achilles tendon lengthening
When tendon tightening causes foot deformity and ulceration, this surgery can eliminate pressure spots and reverse deformity.
Can diabetic peripheral neuropathy be reversed?
Unfortunately, significant peripheral nerve damage causing loss of foot sensation is often not reversible in diabetes. However, progression of neuropathy can be slowed or halted by diligently controlling blood glucose levels. Lifestyle changes to improve neuropathy symptoms include:
Tight blood sugar control
Keeping HbA1c under 6.5% prevents worsening of nerve damage. Monitoring glucose levels post-meals to limit spikes is key.
Daily foot inspection
Check for injuries daily due to loss of pain sensation. Nerve damage increases risk of wounds going unnoticed.
Smoking cessation
Smoking exacerbates nerve damage and peripheral vascular disease. Quitting can limit progression.
Dietary changes
Low GI foods (cereals, berries) help maintain steady glucose levels and prevent neuropathy flare-ups.
Vitamin supplementation
B vitamins, alpha lipoic acid, acetyl L-carnitine are vital for nerve health. Check with your doctor first.
Aerobic exercise
Walking, cycling, swimming can improve circulation to peripheral nerves and help control blood sugar too.
Stress management
Relaxation techniques, meditation, yoga, tai chi, and massage therapy may ease neuropathic pain.
Proper footwear
Well-fitting shoes, custom orthotics, metatarsal pads all minimize pressure on feet and nerve irritation.
Conclusion
In summary, diligent foot care, lifestyle changes, and seeking early treatment are key to reversing foot complications and preventing their progression in diabetics. Controlling blood sugar levels is vital to halt nerve and vessel damage. While severe neuropathy or deformities may not be reversible, it is still possible to heal foot problems and avoid recurrence with various measures discussed. Patients and doctors need to work together to protect feet and maintain mobility.