Diabetic foot surgery

Two of the most common disease processes that affect the feet in people with diabetes are diabetic peripheral sensory neuropathy and peripheral arterial disease.

Peripheral arterial disease involves damage to the medium and small arteries that supply blood and oxygen to nourish foot tissue.

Peripheral sensory neuropathy affects more than half of people with diabetes. Neuropathy damages the nerves in the feet, so people experience numbness or tingling, or feel like they have a heavy stocking or mud caked on their foot. In some cases, people experience burning or shooting pains in their feet, which are often worse at night.

Sensory neuropathy also creates an environment in which people can injure their feet but not feel the injury.

For instance, people with diabetic sensory neuropathy can burn their feet with bath water that is too hot or when they walk on hot pavement barefoot during the summer.

Foot ulcers develop when the skin is exposed to repetitive pressure on the bottom of the foot, or from friction from poorly fitting shoes. Normally, people would feel pain because their shoes are rubbing against their foot, but neuropathy masks the pain.

Patients often discover their ulcers because blood leaves a stain on their stockings or on the floor – not because they feel the ulcer. Because many patients with diabetes have neuropathy, sometimes they do not notice the wound until it grows larger or becomes infected.

Foot ulcers are a leading cause of foot infections in adults. Often, the combination of ulceration, nerve damage, infection, and poor blood flow to the foot leads to toe, foot, or leg amputation in patients with diabetes.

Diabetic ulcers can become nonhealing wounds that persist for months or even years. In some cases, the ulcers heal but return in the same spot – after you’ve had one, you’re more likely to develop another. Getting specialized foot care is key to protecting your foot and your overall health. Many centers offer special shoes and insoles, diabetes education, and regular foot evaluations to reduce the risk of re-ulceration.