Solving Diabetes Foot Deformities Problems
Common Health Issues

Solving Diabetes Foot Deformities Problems

Your feet are triply cursed when it comes to diabetes. They can be affected by poor circulation and neuropathy and they are susceptible to infection. To make matters worse, these problems can feed on each other. If you have nerve damage to your feet, you can’t feel pain and you may not realize that something is irritating your feet. This can lead to ulceration, or the formation of an open sore. A foot ulcer can easily become infected, and without proper circulation, the infection can be slow to heal. Some people with diabetes develop foot infections that can ultimately lead to amputation.

 

More than 50,000 people with diabetes lose a limb to diabetes each year. This can be disturbing news if you have diabetes, and particularly if you have any symptoms of neuropathy or circulatory problems. But the good news is that most of these problems can be prevented or minimized. By keeping your blood glucose levels under control, taking care of your feet with daily foot inspections, visiting your doctor and podiatrist regularly, wearing properly fitting shoes, being alert to early warning signs of neuropathy or circulation problems, and treating any problems that arise, you can prevent ulcers and infection from occurring.

 

If you have sensorimotor neuropathy, you can’t feel pain or sensation in your feet and legs the way someone without neuropathy would. You could develop a blister or step on a pin and not even realize it. Even a minor irritation, if left untreated, can develop into something major. If you have a small sore or abrasion and you continue walking on it and don’t treat it, you can injure it further. Eventually, an ulcer can develop and that can become easily infected. Neuropathy can cause further problems, because it can result in muscle weakness and the loss of muscle tone. When this happens, your feet and legs can become easily deformed and more prone to trauma and injury.

 

Once a lesion develops, your body calls on its immune system to prevent and combat any infection that develops. But your immune system needs a good circulatory system in order to do its job. Unfortunately, if you have diabetes, you are likely to have impairments in your circulation, particularly in the legs. This means that any lesion that develops can be slow to heal and may be easily infected.

 

This post will deal with factors that contribute to foot deformities. For more information about how neuropathy can lead to formation of ulcers on your feet, go here. To learn more about circulatory problems, such as peripheral vascular disease, and how they can contribute to infection, go here

 

DIABETES FOOT DEFORMITIES

Foot deformities are not unique to people with diabetes. Hammertoes, bunions, and metatarsal disorders are not uncommon in the general population, especially among older citizens. But foot deformities can have more serious consequences if you have diabetes. If you have a problem in the way your foot is structured, it can cause pressure on certain points of the foot just from walking, especially when you wear poorly fitting shoes. If you have neuropathy, any calluses, corn, blisters and/or ulcers that develop can go unnoticed. They can worsen or be slow to heal if your circulation is poor. If left untreated, these lesions can develop into serious infections. The key to dealing with foot deformities is to have your shoes properly fitted and to inspect your feet daily for signs of irritation or abrasion. This can prevent serious lesions and infections from developing.

There are several common types of foot deformities among people with diabetes: hammertoes, claw toes, prominent metatarsal heads, bunions, limited joint mobility, partial foot amputations, and Charcot’s joints. 

 

Diabetes Hammertoes

Hammertoes are caused by a buckling of the toes, such that the structure of the toe resembles the neck of a swan. Hammertoes are often caused by a weakness of the small muscles of the foot. These muscles can’t stabilize the toes on the ground. This causes the toe to bend back and sit up on the metatarsal head. If you have hammertoes, you place extra pressure on the ball of your foot. This position causes irritation at the tip and top of the toes. If you have hammertoes, you probably have a difficult time getting shoes to fit properly. If your shoes don’t fit right, you may find that your foot rubs at the top of the toe and can easily develop an ulcer.

 

Diabetes Claw Toes

Claw toes are similar to hammer toes. However, there is more buckling and the toes are more deformed. The toe is bent quite a bit at the first and second joint. If you have claw toes, your toes sit on top of their metatarsal heads and push down on the ball of the foot. You are more likely to have claw toes if you have high arches. Like hammertoes, claw toes are difficult to fit properly. You will need to find a shoe with a large toe box.

 

Diabetes Prominent Metatarsal Heads

Prominent metatarsal head can occur if you have one metatarsal bone that is longer or lower than its neighboring bones. The metatarsal bones are the five long bones located in the mid- and forefoot, just behind the toes. The metatarsal heads are similar to the knuckles of the hand. They are found in the ball of the foot and support your body’s weight. Normally your weight is distributed evenly across these heads. Sometimes, one metatarsal head can carry a disproportionate amount of weight. This can cause pain, callus formation and ulceration of the foot.

 

Diabetes Bunions

Bunions are caused by an enlargement of bone at the base of the big toe joint. They are often blamed on tight-fitting shoes, but more often than not, bunions are inherited. If you have a bunion, then your big toe point towards the second toe. When this happens, your big toe may sit over or under the second toe. If you have a bunion and wear a tight or ill-fighting shoe, especially high heels, you put pressure on the metatarsal head of your big toes. This can cause an ulcer to form. Arthritis may occur along with bunions and this can cause pain and stiffness in the joint. You can also develop a callus or ulcer under the big toe

 

Diabetes Limited Joint Mobility

Limited joint mobility of your foot and ankle can put an abnormal amount of pressure on the bottom of the foot. This can lead to skin damage and ulcer formation. Arthritis is one disorder that can limit the range of motion of many of the joints in your foot. When it affects one of your big toe joints, specifically the first metatarsal phalangeal joint, your toe can’t bend normally when you walk. To compensate, your weight shifts to the ball of your foot as your heel lifts off the ground. As a result, you have extra pressure under the big toe (called the hallux). Calluses tend to form here and lead to ulceration. This condition is called hallux limitus

 

Diabetes Partial Foot Amputation

Sometimes, in order to save the foot, doctors recommend partial foot amputation. However, if you have one or more toes removed from your foot, this creates a foot deformity and can create further problems. If you have toes missing, the pressure you exert on the bones of the foot is uneven as you walk. This can cause ulcers to form and can increase the chances of further amputation down the road. Many patients have avoided this dilemma by having a transmetatarsal amputation performed. In this procedure, all the toes up to part of the metatarsal bones are removed so that, in effect, the forefoot is amputated. This type of surgery results in greater balance, flexibility, and mobility and reduces the risk of developing pressure points, ulcerations and future amputation. If you have this operation, you will not have to wear a prosthesis, but you will need extra padding in your shoes.

 

Diabetes Charcot’s Joint

Charcot’s joint is a somewhat rare but debilitating foot injury that results from sensorimotor neuropathy. When the nerves of your feet are damaged, you lose the ability to sense pain. Over the years, minor injuries and fractures hurt the joints in your feet, but you probably didn’t even notice. Ultimately, the damage becomes so great that the joint is permanently destroyed. You probably won’t notice anything until your foot is discolored and swollen. Once this occurs, the joint can become completely destroyed in a matter of months. Once the middle of the foot collapses, the foot may take on a rocker-bottom configuration, which increases the pressure on the bottom of the foot. Walking can become difficult and ulcers are likely to develop.

 

DIABETES FOOT DEFORMITIES SYMPTOMS

Symptoms of foot deformities may vary depending on the exact condition. However, several signs may indicate that you have a potentially serious foot problem. Any redness, swelling, or increased skin temperature of the foot or ankle, or a change in the size or shape of the foot or ankle could mean you have a foot deformity. Any pain in your legs while at rest or while walking could initiate a circulation problem that can contribute to foot problems. Any open sores with or without drainage, no matter how small, or any nonhealing wounds, ingrown toenails, corns or calluses, or skin discoloration could be due to a foot deformity and require immediate attention. If you have Charcot’s joint, you may not feel pain in your foot, but you may notice a coarse, grating sound when you move your foot

What You Should Do

If you notice any of the symptoms associated with foot problems, contact your doctor or foot specialist right away. Although it is not an emergency situation, you should be examined as soon as possible. Foot ulcerations can be extremely slow to heal, so the earlier you seek treatment, the better. Some foot deformities, such as Charcot’s joints, can rapidly progress to a point where damage is irreversible. Any change in the shape of your foot, especially if there is any redness, swelling, or pain should be taken seriously. If you continue to use your foot, you could permanently disable it. If you notice these signs, you need to stop bearing weight on your foot immediately and see your foot care specialist at once. Any foot problems should be evaluated and treated as soon as possible.

 

DIABETES FOOT DEFORMITIES TREATMENT

Your exact treatment will depend on the nature of your problem. Certain conditions, such as Charcot’s joints, may require a specially fitted cast or splint to prevent further damage to the joint and to allow any existing fractures to heal. In some situations, and depending on your general state of health, foot surgery may be recommended to correct a deformity. For example, surgery might be advised to correct a hammertoe to relieve the pressure beneath a metatarsal head or over a prominent toe. Your doctor may also suggest surgery to treat hallux limitus, especially if it leads to ulcers under the big toe. This type of surgery increases the range of motion of the big toe and relieves the pressure on the toe to help the ulcer heal. However, surgery can only be performed if you have good circulation to the legs and feet.

If you have diabetes, properly fitting footwear is essential. For many patients, a good-fitting pair of athletic shoes with plenty of cushioning may do the job. But if you any sort of recognizable foot deformity or loss of feeling in your feet, you may need therapeutic shoes. These shoes differ from normal shoes in that they are prescribed by a foot specialist and specially designed to accommodate your particular foot problem. Your therapeutic shoes should offer relief of pressure, should accommodate any deformities you have, should provide support for your foot, and should limit joint motion (if needed)

 

You should first see a podiatrist who is specially trained in the treatment of diabetic foot disorders. Your podiatrist will measure your feet and evaluate your foot structure and your particular problem. Your podiatrist can write a prescription for therapeutic shoes if you need them. You can then take the prescription to a place that sell this type of shoe. Most likely, you will visit a special therapeutic shoe store, or you may be referred to a special foot clinic or orthotic-prosthetic facility to have your shoes fitted. There, you will probably see a pedorthist, who is specially trained in fitting therapeutic shoes. You may also need to see an orthotist, who is trained to fit prostheses. It is usually necessary to make an appointment to have your shoes fitted.

 

There are several things to keep in mind in fitting any shoes, but these are especially true if you are buying therapeutic shoes. Have your feet measured for size every time you buy a new pair of shoes. The length, width, and shape of your foot may change. Also make sure to have both feet measured. Don’t be surprised if they are different sizes. Try to schedule your appointment in the afternoon or near the end of the day. Your feet have a tendency to swell as the day goes on. If you have shoes fitted in the morning, they may be too tight for you in the afternoon. By having them fitted in the afternoon, you can be assured that they will fit all day long.

 

Don’t pay attention to the size of shoe marked on the box. Sizes of shoes, even therapeutic shoes, can vary according to the manufacturer. Make your decision by how the shoe feels on your foot. When you put on the shoes, you should have 0.4 to 0.5 inch of space between your longest toe and the tip of the shoe while you are standing. Also, make sure that the ball of the foot fits well into the widest part of the shoe. Finally walk around in your shoes to make sure they feel comfortable. They should not be too tight. Don’t count on them stretching out as you wear them. Make sure they fit you at the time you buy them. Also make sure the heels don’t slip too much. If they don’t feel 100% comfortable, don’t buy them.

 

Most likely, your pedorthist will have shoes on hand that will suit your needs. About 85% of people seeking therapeutic shoes can be properly fitted with off-the-shelf shoes. However, your pedorthist may need to make adjustments in your shoes to ensure that they fit right. You may need to have the uppers stretched, you may require additional padding or lifts, or you may need to have wedges and flares added to the soles for greater stability. Rocker soles or metatarsal bars can also be added to reduce pressure on certain areas of the foot. You may also need to have special inserts called orthoics placed inside your shoes to accommodate any special foot problems. You are better off with a softer orthoic to avoid any sort of rubbing or damage to your feet. If your pedorthist cannot find a pair of shoes in stock to suit you, you may need to be fitted for a pair of custom-made shoes. These can take 3 to 6 weeks to be made and delivered.

 

DIABETES FOOT DEFORMITIES PREVENTION

Foot deformities can be difficult to prevent. Your best bet for the long term is to keep your blood glucose levels under control. This will help prevent the neuropathy that underlies diabetic foot disease. Also take steps to keep your circulatory system healthy. This means eating a balanced diet that is low in fat and stopping smoking. Foot problems can be exacerbated when your feet must support excess weight. If you are overweight, try taking steps to reduce your weight now.

 

You will also need to see a foot care specialist on a regular basis. You should have an annual exam to assess the degree of physical sensation in your feet, evaluate blood circulation to your feet, and check for any foot deformities or other problems that may put you at risk for ulcers and infections of the foot. If you have any particular foot problems, or are at risk for developing a foot problem, you should see your podiatrist more often

 

Sources and References

The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette

Diabetic foot infections: a comprehensive overview by D Pitocco, T Spanu et al 

The Diabetic Foot: The Never-Ending Challenge by Bettina Peter-Riesch

The Charcot foot: pathophysiology, diagnosis and classification by K Trieb 

Understanding Diabetic Foot Infection and its Management by Saba Noor, Rizwan Khan and Jamal Ahmad 

 

author

Rich Health Editorial Team

Health Research

Rich Health Editorial Team is made up of medical practitioners and experienced writers who provide information for dealing with health issues in a simple and easy-to-understand manner