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Why do diabetics present problems in their feet

Diabetis is a chronic illness , it means that it lasts lifelong having metabolic components, vascular and neuropathic problems. Along the years, without a proper control, alterations in blood circulation, absence or lack of sensibility of the inferior extremities will appear, as well as injuries that cicatrize with difficulty, problems of blood sugar (glycemia) that lessen the foot’s answer and its components when infected or don’t answer to stimulus, etc. Therefore discipline is necessary and it must be understand that there exists a great risk factor when no proper control of glycemia is taken. The hygiene of feet is vital and self care of possible injuries will avoid future lamentations. It is necessary to avoid exposing them to heat , to walk barefoot and the use of large footwear made of natural material is unavoidable. The consultation with the podiatrist is very important .

Extract of the work presented in the first workshop about the diabetic foot and vascular ulcer for Primary Attention, Town Council clinics, Antofagasta, Chile, November 2000.
Pod. Luis Tapia L.

Diabetes supposes a major health problem being a chronic illness with a prevalence of the problem of a 5% to 8% and increasing along the years ,because this condition may be developed at any age.

The diabetic foot may endanger the leg and even life, and it will also affect the family, social and work activities, supposing a high cost for the family as well as for the sick person and the health system.
That’s the reason why it is necessary to build multidisciplinary acting protocols in the diabetic foot’s units in the different physiopathological steps because it has been proved that the percentage of amputations has diminished in 50% and the cicatrization of the ulcers in more than 40% , and the backsliding in 80%.

The more usual problems of the diabetic foot.

VALGUS FLATFOOT The feet show ulcers in the inner border of the first metatarsal head and the distal part of the toes.
It’s necessary to value the vibration sensibility, its alterations appearing as one of its most precocious clinical signs with neuropathic compromise.

The lack of sensibility, plus the analgesia of the bone, of the capsule and articular ligaments leave the foot unprotected in front of repeated injuries due to walking. They may give origin to fractures, and pathologic luxations , causing deformities of the normal structure of the tarsal and metatarsal regions, known as neuropathic arthropaty or Charcot arthropaty: the foot gets flat, short and enlarges.


Injuries

Heel fissures, slow cicatrizing injuries, haematoma, oedema. When we observe the nails of a possible diabetic, we will find: ungual dystrophy, lamellar desquamation, laminar fragility, onychomycosis. But faced with it, we must have the capacity of analysis to realize when an onychodystrophia is only caused by bad shoewear, or when the desquamation is due to psoriasis, to systemic injuries, or to a preexistent structural alteration of the foot, or an oedema is produced by a cardiopathy or a renal pathology, and therefore ,not related to diabetis.

Another sign of recognizing the problem are the bacterial or mychotic infections provoking folliculitis, cellulitis, furuncles. They colonize infected ulcers., Candida and dermatophytes located in the interdigital folds extending themselves to the foot plant. Another common dermatophytosis is Tinea Pedis. Whether there are ischemic, neuropathic or venous, ulcers always get infected

The diabetic patient is more prone to infections than the not diabetic, due to vascular and neuropathic alterations.

Conclusions

Prevention means directed processes with results in the short term, but many diabetics can’t wait, have suffered and developed recurrent injuries, lessening their capacity to work.

The condition of the diabetic foot is directly related to the foot’s capacity to adapt itself to the changing processes which will accompany it through life.
The necessity of creating multidisciplinary equipments for Primary Assistance using assistance protocols in which the podiatrist’s vital prophylactic measures will avoid the risks of amputations or intermediate injuries in a significant percentage. Podiatry offers nowadays various alternatives to minimize the pain , being the patient’s well-being its goal. The challenge is traced, and now it’s up to you to answer in the best of manners.

 

 

 
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Dirección

Edificio El Ancla
Calle Copiapo 739 Depto. 203
Fono: 55- 226922
Antofagasta - Chile