Q: I’ve had diabetes for a few years, and lately I’ve been hearing a lot about people losing their toes or feet because of it. That really worries me. How can diabetes cause so much trouble with your feet, and what can I do to keep that from happening?
A: That is a great question. It is scary to think about losing a toe or leg. Diabetes is a challenging disease, because it causes a lot of changes to the body. It’s important to understand these changes, so that you can prevent complications like amputations.
First, diabetes can cause atherosclerosis, which is hardening of the arteries from cholesterol-filled plaque. When patients get blockages in their arteries, they are predisposed to getting spontaneous wounds and have trouble healing wounds. To prevent this, you need to work on blood sugar control and need to talk to your doctor about whether blood pressure and cholesterol medications are right for you. If you use tobacco, ask for help quitting, since tobacco use can clog arteries too. If you and your doctor don’t feel a pulse in your foot, you might benefit from seeing a vascular surgeon like me. Fortunately, patients are often able to avoid surgery.
Next, diabetes can cause nerve problems. With neuropathy, you might not be able to feel a rock in your shoe or notice cuts or blisters like you normally wound. This could lead to a delay in recognizing problems. Some patients even develop a foot deformity called Charcot foot. With that, they can put pressure on abnormal places on the foot and ankle that ultimately result in wounds. Proper foot care, including self-examinations and podiatric evaluation, is imperative. Foot doctors can recognize even subtle problems and can recommend shoes, inserts, braces, medicines and surgeries to keep the problems from worsening.
Additionally, diabetes suppresses the immune system. The high blood sugars make patients more likely to get infections, even without trauma. If you have a hard time getting your blood sugars controlled or see that your hemoglobin A1c is high, ask your doctor whether you would benefit from seeing an endocrinologist, a specialist in diabetes.
The good news is that you don’t have to do this alone. The nutritionists, physical therapists, primary care doctors, endocrinologists and podiatrists work together to prevent these problems, and vascular surgeons like me can often work with them to fix problems that arise to keep you on your feet for years to come.
Dr. Sachin Phade is a vascular surgeon with Galen Surgery-Vascular and is a member of the Chattanooga-Hamilton County Medical Society.