Diabetes and Foot Care – What No One Tells You…
Approximately 12 percent of those with diabetes will develop plantar ulcers and they’re responsible for approximately 85 percent of amputations of the lower extremities in diabetic patients. Physical therapy is beneficial in maintaining circulation, devising customized orthotic devices to relieve pressure, and for rehabilitation in the event that an amputation must be performed.
A plantar ulcer typically forms where footwear rubs or places pressure on the foot. Diabetics often spend more time in their footwear to avoid injuries, but it results in more pressure on the feet. Ulceration is the most common complication of diabetes and those with poorly controlled glucose levels are at the highest risk. Poor circulation and neuropathy combine to help disguise the ulceration until severe infection has set in.
Plantar ulcerations can become so severe that they expose tendons and joints. A diabetic’s reduced ability to fight infection allows bacteria to spread more quickly than it would in other patients and progress to gangrene and amputation.
A daily foot check is the best way to identify plantar ulcers in the earliest stage, but it’s a precaution that many diabetics fail to do. Forty-five percent of all amputations are performed on diabetic patients and obesity exacerbates the situation.
A variety of factors come into play with diabetic plantar ulcers and patients may sustain multiple episodes. Footwear and the biomechanics of the foot can complicate the problem. Drying of the skin is common in diabetics, particularly in the feet, making them prone to cracking and infections. Reduced circulation to the legs and feet increase the risk of ulceration.
A callus can easily become the site of an ulceration should it become too thick. When pain is present, diabetic patients typically try to compensate and develop awkward gaits that create more dysfunction and the potential for ulcers to occur in other locations on the foot. Planter ulcers generally occur on the side of the body that’s favored due to deformity or pain.
When a particular part of the foot is favored, it’s moved less and circulation suffers. It becomes unable to absorb the shock of movement and motion, leading patients to favor it more and inadvertently causing more dysfunction and impaired sensitivity.
Treatment and Prevention
Our physical therapists at Activbody Physical Therapy in Orange, CA are trained in identifying the early signs of ulcerations and instructing patients on all facets of care and prevention. We provide therapeutic massage, dry needling and exercise techniques to improve circulation and mitigate the formation of ulcers.
If an ulcer already exists, we can provide casting to immobilize the foot and redistribute pressure. It allows the foot to heal, prevents further trauma and damage, and supports surrounding soft tissues.
Custom orthotic devices and cutout footwear can be prescribed to relieve pressure, prevent ulcer formation, and protect at-risk areas of the feet. A gait assessment may be employed to locate areas of particular concern and identify even the smallest variations in gait that can ultimately lead to the creation of an ulcer.
Our physical therapy techniques at Activbody Physical Therapy in Orange, CA assist patients when an amputation is performed, providing gentle clinical Pilates and yoga to build strength, balance and stability. Assistance with mobility aids, ergonomic assessments and environmental accommodations help prevent further injuries.
A foot ulcer is never a trivial matter and self-care is an essential element in identifying their formation and performing appropriate wound care. Our physical therapists assist patients with care and prevention, rehabilitation following amputation, and ways to maintain mobility and preserve lifestyles.