Diabetic Foot Health
Diabetes affects nearly 30 million Americans with another 84 million Americans living with pre-diabetes per the CDC.
Diabetes is the body’s inability to properly use insulin and reduces the body’s ability to convert sugars, starches, and other foods into energy. This inability to use insulin correctly may lead to changes in many body systems including skin, nerves, blood vessels, bones and hormones.
Many times diabetes affects the foot and ankle.
Changes in skin color, numbness, pain, increased swelling, and open sores or dry cracks can all develop to the foot and ankle. A podiatrist is a crucial part of the diabetes healthcare team. Podiatrists are specially trained to assess and treat the damage diabetes can cause in your feet, identify risks to the lower extremities , and best prevent future medical events to the lower extremities. Dr. Castelein performs an annual exam on diabetic patients to assess risk for peripheral vascular disease (PVD), Peripheral neuropathy (numbness/tingling in feet and toes), and foot deformities while checking skin health condition. During this exam, Dr. Castelein will discuss any areas of concern he diagnoses and work with you to develop a specific treatment plan to best promote foot health while managing diabetes. If problems develop, Dr. Castelein is able to make a comprehensive plan to best heal the area of concern and avoid future complications.
Schedule an appointment today with Dr. Bryant Castelein, DPM – Podiatry Specialist
Peripheral Neuropathy
Peripheral neuropathy is a condition to the smaller nerves outside the brain and spinal cord.
These smaller nerves are typically sensory nerves involved in protecting the body from the outside world. Common symptoms include an abnormal feeling in the foot and ankle of pins-and-needles, burning, tingling, pain or a numbness sensation. Uncontrolled diabetes is the most common cause of peripheral neuropathy. Other main causes of peripheral neuropathy include autoimmune diseases, infection, cancer treatments, prolonged alcoholism, vascular diseases or peripheral neuropathy can occasionally have no source . People with diabetes typically develop neuropathy from nerve damage due to prolonged increases in blood glucose levels. The onset of neuropathy is usually slow but can progress more centrally within the body, leading to reduced organ function (such as gastroparesis). Symptoms typically worsen as peripheral neuropathy advances.
Peripheral neuropathy can become debilitating with severe consequences if left untreated. It is also largely irreversible. The best treatment is early diagnosis and reducing risk factors to slow or stop the progression of symptoms. Dr. Castelein first looks to treat the underlying cause of neuropathy. To help determine the cause of neuropathy, he may use advanced testing such as epidermal nerve fiber density testing (ENFD), electromyography (EMG) or nerve conduction velocity (NCV) test. These tests are very useful in confirming diagnosis as well as objectively quantifying the degree of neuropathy. After addressing the cause, Dr. Castelein aims to correct the symptoms of neuropathy. Typically, vitamins found to supplement nerve function, foot braces and accommodating shoes are discussed depending on patient preference and severity of the neuropathy. He can also recommend therapies to help lessen symptoms and promote muscle health and coordination.
Ulcer Care
A diabetic foot ulcer is an open wound or sore that can appear on the foot, toes, ankle, or leg. Ulcers can be serious and seeking treatment as soon as the wound is noticed is vital. Diabetic ulcers will not go away on their own and require medical attention.
Individuals with diabetes, peripheral neuropathy, poor circulation, or foot deformities are at higher risk for developing an ulcer. When a patient has loss of protective sensation from peripheral neuropathy, the ulcer may not cause pain leading it to go unnoticed and increasing the risk of infection and amputation.
Not all wounds heal in the same way. Dr. Castelein looks to provide quick and effective treatments. These treatments are tailored to the wound based on the wound’s needs and the needs of the patient. He uses a combination of techniques when treating ulcers including:
- Offload pressure from the area
- Removing dead skin and tissue from the affected area
- Apply cutting-edge wound graft technology on the affected area
- Prescribe antibiotics as needed to resolve infection
- Evaluating systemic factors such as peripheral vascular disease and diabetes
After the ulcer is healed, Dr. Castelein offers regular foot examinations to help prevent the development of additional diabetic ulcers. Discussion of individualized prevention methods such as footwear/padding, advanced shoes or braces, maintaining healthy blood glucose levels, and controlling other systemic health considerations will aid in further prevention of foot and ankle ulcers.
Charcot Foot
Charcot Foot is a rare foot deformity that affects diabetic patients with advanced neuropathy (numbness/tingling in the feet). This deformity affects the bones, joints and soft tissues of the foot and ankle which can lead to difficulty walking, bone loss and in some cases, amputation. Common symptoms include prolonged pain/discomfort, redness, swelling and warmth in the affected foot. In advanced stages of Charcot the bones in the foot shift. This causes changes to the structure of the foot and ankle. Many times the bone structure changes alter the function of the foot and can lead to ulcerations or instability.
Dr. Castelein uses x-rays and a physical examination to determine the presence of Charcot. Treatment targets halting current bone change and minimizing further deformity while allowing the bones to heal. Dr. Castelein may recommend immobilization to limit movement and weight-bearing activities during the initial healing period. He also uses bone stimulators to help return the bone to its normal state. Once the foot is no longer at risk for further deformity, protective footwear including splints, braces, orthotics or special offloading devices depending on severity and progression. These medical equipment devices are needed to best reduce the risk of future ulcerations, and arthritis while maintaining the best level of movement.
Diabetic Shoes
Taking great care of diabetic feet is a top priority at Brighton Foot and Ankle. Diabetic shoes decrease the risk of complications including ulcers, calluses, and skin concerns. These specific shoes have protective properties to ensure diabetic patients are comfortable and safe in footwear. They provide support and protection to reduce pressure points, accommodate changes in toe and foot structure, and have specific inserts. Dr. Castelein assesses the need for ordering diabetic shoes, measures your foot carefully and lets you choose from over 100 styles of shoe.
Diabetic shoes are:
- Wider in the toe box, allowing room to move without developing cuts or blisters
- Stabilizing which can decrease the amount of scrapes and falls
- Protective to prevent diabetic foot ulcers
The best and easiest way to protect your feet as a diabetic patient is to wear shoes at all times! Dr. Castelein recommends checking your feet daily and always keeping up on your annual exams.
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