The Importance of the Diabetic Foot Exam

by admin on March 11, 2014

Diabetes type II has become one of the most common chronic diseases in America, with over 1.5 million people diagnosed in 2011 alone1.  Now, 21 million1 Americans live daily with the effects of Diabetes, and our healthcare system struggles to minimize the hardship of medical complications related to diabetes.  Feet are important enough that the American Diabetes Association recommends a foot exam at least once a year for diabetics2, but most patients I encounter have no idea what can go wrong or why they need to be checked.

Feet are a part of the body that suffers disproportionately from diabetes.  This is because high blood sugars attack nerve endings and small blood vessels, both of which are found in abundance in the feet.  Neuropathy is a form of nerve damage caused by high blood sugars that result in destruction of the nerve endings, causing phantom sensations, pain, or no feeling at all.  The last stage, complete numbness, is the most dangerous of all.  This is because pain and sensation are things we take for granted; if we rub a blister in our shoes, the discomfort forces us to put a band-aid on it.  If we step on a piece of glass, we have to immediately stop and pull it out.  For people with neuropathy, this information never makes it to the brain, and they don’t find out until they look in a mirror or worse, until after infection has set in.  Furthermore, loss of nerve endings gradually produces weakness of the muscles in the feet and leg, leading to the development of hammertoes, bunions, and flat feet.

Having high blood sugar also speeds the progress of peripheral vascular disease.  The process, which is the same as heart disease but affecting blood vessels in the rest of the body, causes blockages in the arteries that prevents the flow of blood downstream.  Having poor circulation means that cuts and scrapes and broken bones take longer to heal, or can’t heal at all.  And since antibiotics rely on the bloodstream to transport them to infected areas, they are less effective in persons with peripheral vascular disease.  In the worst cases, blood flow can become so restricted that normal body tissue cannot even survive, leading to gangrene of the digits.

In the coming issues I will discuss what foot problems can result from having diabetes, and what the warning signs are and what to do about them.  Until then, if you have Diabetes, talk to your primary care provider about your feet, and how to prevent complication.


1. Source: CDC

2. Source: ADA

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