Diabetic Foot Complications
At the Ledbrook Clinic we are always trying to educate our patients and raise awareness about diabetes foot complications. Simple education has been proven to significantly reduce the incidence of ulcer or foot and leg amputation in patients with diabetes.
Did you know:
- 30% all all people with diabetes will have a foot problem due to diabetes
- Approximately 15% of all people with diabetes will be affected by a foot ulcer during their lifetime
- Globally, up to 70% of all leg amputations happen to people with diabetes
- 49-85% of all diabetic foot related problems are preventable with correct management
Diabetes can lead to poor circulation and reduced feeling in the feet, therefore it is important to understand how foot problems develop and how they can be prevented or detected early so that they can be treated successfully.
If foot circulation or sensation worsens or a patient develops ulcerations, significant deformities, or other serious issues, an Orthotist may need to prescribe therapeutic shoes, or protective footwear and inserts.
For example, some patients require “depth shoes” combined with custom-moulded inserts to redistribute pressures on the foot. Most ulcerations that occur on the foot are pressure-related.
“Depth shoes” derive their name from the extra depth to accommodate orthotics. Please click on the link below to view a full range of orthopaedic shoes:
Patients with extreme foot deformities need custom-moulded shoes, in which the entire shoe is molded from a cast of the patient’s foot. These are for individuals with very severe foot deformities that can’t possibly be accommodated in any other shoes.
Diabetes patients who are prescribed any types of medical shoes must wear them religiously. Without correct footwear, the diabetic patient patients can end up with bone breakdown, a chronic wound, and bone infection that eventually led to amputation of his foot.
This doesn’t have to happen if the patient continue to follow directions to wear the correct footwear. Diabetes patients can’t take that risk once they have that loss of sensation.
To enhance diabetic foot health, we recommend these tips for buying new shoes:
- Buy shoes made of soft, stretchable leather.
- When possible, choose laced shoes over loafers because they fit better and offer more support.
- For better shock absorption, look for a cushioned sole instead of a thin leather sole.
- Shop for shoes later in the day because feet swell as the day progresses.
- The distance between your longest toe and the shoe tip should be half of your thumb’s width.
- To ensure proper fit, try on shoes while wearing the socks that you’ll be using.
Wear new shoes for 1-2 hours for the first time, then check feet for cuts or blisters. The next day, wear them 3-4 hours and gradually build up time to make sure they aren’t injuring your feet.
Replace old shoes when:
- The heel begins to collapse to one side
- The bottom of the heel is worn down
- The inner lining of the shoe is torn.
Studies have been carried out involving 100 people who had diabetes and an average age of 62 years old. The researchers compared the length and width of the patients’ feet to the length and width of their shoes while standing and sitting. In this study, the definition of a poor-fitting shoe was if the shoe was a 1/2 size too short or too long and more than 1 width size different than the person’s foot. The researchers found that only 24% of the people had proper-fitting shoes while sitting and that number dropped to only 20% while standing — the feet tend to spread out more when standing. They concluded that a majority of their diabetes patients were wearing poor-fitting shoes and that mostly the shoes were too narrow.
Wearing shoes that fit is not as easy as it may sound. These research studies are a small sample, but all three found that about 75% of the people they studied were not wearing shoes that fit. It is especially important for people with diabetes and neuropathy (loss of feeling) to be wearing shoes that fit. If you are not sure if your shoes fit properly, go to a shoe store with trained shoe-fitting professionals. It is recommended that you measure your feet once or twice per year. In fact, it would be ideal if you had your feet measured every time you bought new shoes.
It is vital that correct professional is sought if you have diabetes and that you wear the correct footwear and most importantly that you are CORRECTLY MEASURED for the footwear and the Orthotics which go inside the footwear and cushion the feet. This needs to be carried out by an Orthotist who is experienced in seeing the Diabetic patient.
Peripheral neuropathy is one of the most serious conditions for the at risk Diabetic patient. Peripheral neuropathy, in the lower extremities, leads to plantar foot ulceration. Secondary infection of these ulcers is by far the leading cause of major amputations of feet and legs. Proper preventative care will dramatically reduce ulcer formation and costs related to this complication.
Patients with neuropathic conditions may develop plantar bony deformities through neuropathic collapse, frequently placing the skin and soft tissues at risk. Orthoses have been used to accommodate and distribute plantar pressures over a large surface area, thereby minimizing peak loading pressures in small regions and reducing the risk of ulceration.