Damage To The Feet And Legs - Long Term Complications: Diabetes
Content provided by the Faculty of the Harvard Medical School
Damage to the feet and legs
Diabetes is responsible for most lower limb amputations not caused by trauma. The underlying problem is a combination of peripheral neuropathy and diminished blood flow from the buildup of plaques that block the large and medium-size arteries feeding the leg. When these conditions coincide and are compounded by changes in small blood vessels, a simple cut on the bottom of the foot or even an ingrown nail can become so severely infected that a toe or foot must be amputated.
How does this happen? Because peripheral neuropathy impairs pain sensation, a foot injury can go unnoticed, worsen, and become a feeding ground for invasive bacteria. Poor circulation exacerbates the problem by impeding the body's infection fighters. The white blood cells, antibodies, and other defenders can't easily reach the infected area, and ulcers develop. Foot ulcers are dangerous and require immediate attention. If not treated, they can penetrate deep below the skin and spread infection into bone.
Toes are most vulnerable to infection. People with severe peripheral neuropathy are also more prone to Charcot's foot, a condition in which joint destruction and deformity interfere with walking. Charcot's foot develops when minor trauma to a joint or bone due to daily wear and tear goes unnoticed. Because no changes are made in the individual's stride, footwear, or exercise program, the foot joints are destroyed.
Putting your best foot forwardThe adage "An ounce of prevention is worth a pound of cure" applies to many diabetes complications, and foot and leg damage is no exception. The best way to avoid these problems is to keep your blood sugar levels tightly controlled and to practice good foot care:
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Detection and treatment
Because people with peripheral neuropathy can't rely on symptoms to tell them something is wrong, they must carefully check their feet and toes every day for a possible injury. Footwear must be carefully fitted.
Your doctor may prescribe oral or intravenous antibiotics for a foot ulcer or sore that's infected, but healing can take anywhere from weeks to months and may require bed rest.
When circulatory problems inhibit healing, vascular procedures, such as a bypass, may be necessary. If the infection penetrates to the bone or gangrene sets in, part of the foot or leg may need to be amputated. Usually a prosthesis can be fitted afterward to make walking possible.
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 Wash your feet every day, and dry them carefully. |
| Last updated: | January 23, 2007 |
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Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
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