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foot problems in diabetes
People suffering from diabetes are prone to many other health problems. One of them is a foot problem. If the blood sugar level is high for prolonged periods, it can wreak havoc on many body parts including the feet. The two main conditions that are responsible for foot problems are Peripheral vascular disease (PVD) and Peripheral neuropathy (PN). Let us look at PVD in detail here.

What is PVD?

It is a disorder of blood circulation that leads to narrowing of blood vessels outside of your heart and brain. As the blood vessels become narrow, the blood flow to the body parts decreases. According to research, PVD is 20 times more prevalent in people with diabetes than in non-diabetic people. In diabetic people, prolonged high blood sugar level raises the risk of developing PVD. Longstanding high blood sugar can damage blood vessels, decreasing blood flow to the foot. This poor circulation can weaken the skin, contribute to the formation of ulcers, and impair wound healing. Other risk factors that may cause PVD are smoking, obesity, inactivity and high cholesterol levels.

What are the symptoms of foot problems in diabetes?

One of the first symptoms of the PVD is cramping leg pain during walking. Most commonly this affects your calf muscles. However it can occur in the thigh or hip muscles too.
As the disease progresses, leg or feet pain occurs even when you are not walking. This is known as “Rest pain” and is a symptom of critical limb ischaemia.
Another symptom of PVD is that the small cuts or abrasions on the feet that do not heel easily.

PVD can eventually become a very serious problem if not treated timely. It can lead to the development of foot ulcers and gangrene and may require amputation of the leg.

How is PVD diagnosed?

Diagnostic tests can include:

  • Ankle Brachial Pressure Index (ABPI): This method evaluates the blood supply to your feet by comparing it with the blood pressure in your both arms.
  • Treadmill Exercise Test: This test combines the ABPI with a treadmill test. The ABPI is done before and after you walk on a treadmill.
  • Duplex Ultrasound: It is a non-invasive investigation that uses a probe and jelly on the skin to look inside your leg and give a picture of your blood vessels.
  • Angiography: In this test, a dye is injected into the blood vessels and then x-rays are taken to see the blood flow through the blood vessels. Other imaging techniques can also be used like Magnetic resonance angiography or CT Scan.

What is the treatment for PVD?

Treatment and management of PVD may include:

  • Increasing physical activities like exercising and walking
  • Postural corrections while standing, sitting and sleeping
  • Managing risk factors, including smoking, high blood pressure, and diabetes
  • Cholesterol-lowering medications
  • Diabetic medications to lower the blood sugar level
  • Anti-platelet medication (prevents forming blood clots inside the blood vessels)
  • Peripheral vasodilators (relaxes/expands the blood vessels and increases the blood flow)

Invasive therapy:

For some people with severe vascular disease, invasive therapy such as balloon angioplasty or stent insertion may be considered. Bypass graft would also be an option.

About The Author

Dr. Sanjay Sharma MS – General Surgery, (FAGE), FICA, FIPA, RxDx.

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