Today’s article is a continuation of last week’s, which focused on factors that increase the risk of developing foot problems, and symptoms. The other areas of focus are when to seek medical care, and the diagnostics required. The 3^rd part of the article series, would be on home and medical treatments, and follow up. Meanwhile, Happy World Diabetes Day to all!

When to Seek Medical Care

You ought to be checking your feet daily, or if you can’t see, asking someone to assist you. The following is a list of common reasons to check the doctor/ podiatrist if you have a diabetic foot or leg problem. For most of these, a visit to your health professional should occur within 72 hours.

• Any significant trauma to the feet or legs, no matter how minor, needs medical attention. Even minor injuries can result in serious infections.
• Persistent mild-to-moderate pain in the feet or legs is a signal that something is wrong. Constant pain is never normal.
• Any new blister, wound, or ulcer less than 1 inch across can become a more serious problem. The patient will need to develop a plan with a doctor/ podiatrist on how to treat these wounds.
• Any new areas of warmth, redness, or swelling on the feet or legs are frequently early signs of infection or inflammation. Addressing them early may prevent more serious problems.
• Pain, redness, or swelling around a toenail could mean the patient has an ingrown toenail– a leading cause of diabetic foot infections and amputations. Prompt and early treatment is essential.
• New or constant numbness in the feet or legs can be a sign of diabetic nerve damage (neuropathy), or impaired circulation in the legs. Both conditions put the patient at risk for serious problems such as infections and amputations.
• Difficulty walking can result from diabetic arthritis (Charcot’s joints). It’s often a sign of abnormal strain or pressure on the foot, or of poorly fitting shoes, as well as the inability to perceive pain. Early intervention is key to preventing more serious problems, including falls, as well as lower extremity skin breakdown and infections.
• Constant itching in the feet can be a sign of fungal infection or dry skin, both of which can lead to infection.
• Calluses or corns developing on the feet should be professionally removed. Home removal is not recommended.

Issues Requiring Immediate Medical Attention

• Severe pain in the feet or legs is often a sign of acute loss of circulation to the leg, serious infection, or may be due to severe nerve damage (neuropathy).
• Any cut to the feet or legs that bleeds significantly, and goes all the way through the skin, needs proper cleaning and repair to aid healing.
• Any significant puncture woundsto the feet (for example, stepping on a nail or being bitten by a dog or cat), carry a high risk of becoming infected.
• Wounds or ulcers that are more than about 1 inch across on the feet or legs, are frequently associated with limb-threatening infections.
• Redness or red streaks, spreading away from a wound or ulcer on the feet or legs, are a sign of infection spreading through the tissues.
• Alteration in mental status (confusion), may be a sign of life-threatening infection. This could lead to loss of a leg or foot, when associated with a leg wound or foot ulcer. Confusion may also be a sign of either very high or very low blood sugars, which are more common when infection is present.

Exams and Tests

Medical evaluation should include a thorough history and physical examination. It may also include laboratory tests, x-ray studies of circulation in the legs, and consultation with specialists.

• History and physical examination: First, the doctor/ podiatrist will ask the patient questions about their symptoms and will examine them. For a lower extremity wound or ulcer, this may involve probing the wound with a blunt probe to determine its depth. Minor surgical debridement of the wound (cleaning or cutting away of tissue), may be necessary to determine the seriousness of the wound.
• Laboratory tests: The doctor may decide to order a complete blood cell count, which will assist in determining the presence and severity of infection. A very high or very low white blood cell count suggests serious infection. The doctor may also check the patient’s blood glucose. Depending on the severity of the problem, the doctor may also order kidney function tests, liver enzyme tests, and heart enzyme tests, to assess whether other body systems are working properly, in the face of serious infection.
• X-rays: The doctor/ podiatrist may order x-raysstudies of the feet or legs to assess for signs of damage to the bones, or arthritis; damage from infection; or foreign bodies in the soft tissues. Gas in the soft tissues, indicates gangrene – a very serious, potentially life or limb-threatening infection.
• Ultrasound:The doctor/ podiatrist may order Doppler ultrasound to see the blood flow through the arteries and veins in the lower extremities.
• Consultation:The doctor/ podiatrist may refer to a vascular surgeon, orthopaedic surgeon, or both, to examine the patient. These specialists are skilled in dealing with diabetic lower extremity infections, bone problems, or circulatory problems.
• Angiogram:If the vascular surgeon determines that the patient has poor circulation in the lower extremities, an angiogram may be performed, in preparation for surgery to improve circulation.

Your feet mirror your general health . . . cherish them!