Complications of Diabetes

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Why You Really Hurt
It All Starts in the foot

by Dr. Burton S. Shuler

There are three major

problems, which all must

come together at the same

time, for the development of

foot complications in the

diabetic. They are

ischemia, (poor circulation)
neuropathy, (nerve disease)
infection, (precipitation factor)

These three are known as the

DIABETIC FOOT TRIAD.

All three normally must be

present in order for the

possibility of an ulcer to

occur (skin break down)

which then can lead, to an

infection (gangrene) which

then can lead to an

amputation. I say

possible, because beside

the TRIAD having to be

present, the patient must

also sustain some type of

ongoing trauma or insult

(precipitation factor) to

their feet, to help trigger

the infection phase.

Because a person is

a diabetic they are more

prone to get the TRIAD,

and then develop foot

complications.

1. Ischemia

Ischaemia, which is a

lack of blood, is a

symptom of

Peripheral Vascular Disease,

in the foot, caused by an

abnormally high Glucose

level; which can then

lead to skin break downs

(ULCERS). If the blood

supply to the foot is

reduced sufficiently,

minor wounds may not

heal and the patient may

have pain at rest due to

the lack of oxygen to the

foot.

Ischemia can also be

caused by CALCIFICATION

of THE ARTERIES, which

can be due to long term

non-controlled diabetes,

where the large blood vessels

have an abnormal buildup of

materials that blocks the

flow of blood to the

foot.

Microangiopathies,

which occur in the

smaller blood vessels,

known as the arterioles

and capillaries is another

cause of ischemia, and

is prone to any blockage

caused by diabetes.

Because of these blockages

the blood vessels can not

transport enough blood to

respond to any injury of the

foot and or toes.

Hence causing the start of

various complications.

2. Neuropathy

In the normal foot

that has a normal glucose

level and has normal

feeling, small wounds

or infections are

distinguish by the

amount of discomfort

they present and are

treated according. They

almost always heal quickly

without complications.

In the long standing diabetic

foot that has lost its

feeling, a tiny cut may

turn into a major problem

because the patient can't

feel the problem.

Nerve paralysis of the

tiniest of the muscles

(intrinsic) of the

feet causes a muscle

imbalance which

results in the metatarsal

heads of the foot being

pushed down abnormally,

and with a Hammering of the Toes

taking place.

These imbalances can

become one of

the precipitation factors

that can start the

break down of the

skin.

3. Infection

If the precipitating

factors

are not controlled,

infection can occur.

In diabetic patients

who have Circulation Disease

and/or Nerve Damage, the presence

of these precipitating

factors can be the

"smoking gun"

that leads to infection,

gangrene, amputation,

or worst. The good news

is that if you do get

control of the

precipitating/aggravating

factor, this nightmare

can be avoided. By

determined treatment of

any sign of any infection

and by getting rid of

the basis of any type of

trauma to the foot, you

have a much better

chance of avoiding a

foot infection.

Precipitating Factors

To have a full blown

infection which can lead

to amputation you must

have an on going insult to

the foot.

Some of them are

repeated trauma caused

by abnormal pressure in

the foot, like from

the metatarsal heads

constantly pushing down

or Ingrown Toenails

constantly digging into the

flesh; abnormal shoe

pressure irritating,

or burns caused by

over-the-counter

corn medication, or

heating pads.

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