According to the American Diabetes Association, about 20 million people in the United States have diabetes, a disease in which the body does not produce or properly use insulin. But while nearly 15 million have been diagnosed with diabetes, another 6 million people are unaware that they have it.
"A problem that seems minor for many people, like a fungal infection or sores on the feet, can become catastrophic in someone with diabetes or other circulatory problems," says Jonathan Wilkin, M.D., former director of the FDA's Division of Dermatologic and Dental Drug Products. Diabetes is the leading cause of non-traumatic foot amputations each year.
People with diabetes may experience neuropathy in the feet, a condition that affects the nerves and the ability to feel pain and heat or cold. "Someone without sensation in the feet can literally step on a nail and not know it," says Amir Assili, D.P.M, a podiatrist in Gaithersburg, Md. Assili says a 28-year-old man who came in complaining of a loss of sensation in both feet was diagnosed with diabetes soon after.
Another major foot problem linked to diabetes is poor blood circulation. High levels of blood sugar damage the blood vessels, making them less able to supply the skin and other parts of the body with blood. Poor circulation interferes with the ability to heal and raises the risk of infection. Minor cuts or even cracks from dry skin can turn into ulcers, small red sores that can become deep and infected. Foot amputations may be necessary when an infection reaches bone and spreads beyond a manageable extent. Doctors normally treat diabetic foot ulcers by cleaning them and applying wound dressings, or with surgical debridement, which removes contaminated tissue from a wound to prevent infection. In severe cases, reconstructive procedures that reshape the foot may be needed to prevent undue pressure on the foot.
During the past few years, the FDA has approved new products to treat chronic foot ulcers that are not responding to standard methods.
Examples are Apligraf, made by Organogenesis Inc. of Canton, Mass., and Dermagraft, made by Smith and Nephew in La Jolla, Calif.
"The optimal approach," Assili says, "is to prevent ulcers from occurring through tight blood sugar control and regular visits to an endocrinologist." People with diabetes should also see a podiatric physician at least once a year and practice the basics of good foot care that apply to everyone--wearing comfortable socks and shoes and maintaining foot hygiene. Those who have been diagnosed with decreased circulation or neuropathy with loss of protective sensation should be seen by their podiatric physician more frequently.
Feet should also be checked daily by the patient or family members for any cuts and sores. "Early detection is important because a problem can quickly turn serious," Assili says. People with diabetes and other circulatory problems should never try to treat their own feet, because of the risk of infection.