Diabetic Foot Conditions

If you have diabetes, contact your doctor if you have any of these symptoms:

• Changes in skin color
• Changes in skin temperature
• Swelling in the foot or ankle
• Pain in the legs
• Open sores on the feet that are slow to heal or are draining
• Ingrown toenails or toenails infected with fungus
• Corns or calluses
• Dry cracks in the skin, especially around the heel
• Foot odor that is unusual or won’t go away

The exact cause of each type of neuropathy is unknown. Researchers think that over time, uncontrolled high blood sugar damages nerves and interferes with their ability to send signals, leading to diabetic neuropathy. High blood sugar also weakens the walls of the small blood vessels that supply the nerves with oxygen and nutrients. Peripheral arterial disease happens when buildup on the walls of blood vessels causes them to narrow. It commonly affects people with type 2 diabetes, who are also prone to high cholesterol and heart disease.

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

A doctor will first attempt to treat diabetic foot problems without using surgery. Some methods include:

• Keeping wounds clean and dressed.
• Wearing immobilization devices, such as a cast boot or total contact cast.
• Closely observing any gangrene on the toes until self-amputation occurs, which is when the toes fall off due to lack of blood flow.

When nonsurgical treatment does not successfully heal diabetic foot problems, the doctor might consider surgery. Surgical options include:

• The removal of decaying or dead tissue.
• Amputation, ranging from single toes or sections of foot to amputation of the leg below or even above the knee.
• Surgical stabilization of Charcot’s Foot.
• An arterial bypass for peripheral vascular disease, which assists blood flow to the area.
• Endovascular surgery with placement of stents, which uses small devices to keep blood vessels open.

Watch this video to learn about diabetic wound care.

One way to prevent foot issues with diabetes is to keep your blood sugar within a healthy range. Other tips to prevent foot issues include:

• Stay physically active, at least 30 minutes most days of the week.
• Consult a nutritionist or certified diabetes educator (CDE) for meal planning advice.
• Quit smoking.
• Keep your blood pressure and cholesterol within a healthy range.
• Maintain a healthy weight.

Shoes for patients living with diabetes are made of special protective inserts and soft shoe materials to accommodate for conditions, such as neuropathy (numb feet), poor circulation and foot deformities (bunions, hammertoes, etc.). The shoes decrease the chance of foot sores (ulcers), which can be caused by friction and pressure. This may lead to infection, gangrene or even amputation. Most Insurance will cover 1 pair of diabetic shoes and insoles; however, not all diabetic are entitled to this benefit.

Requirements

• Completed, signed and dated statement from the certifying physician (physician managing the beneficiary’s systemic diabetes condition) specifying that the beneficiary has diabetes and:

1. Previous amputation of the other foot, or part of either foot, or
2. History of previous foot ulceration of either foot, or
3. History of pre-ulcerative calluses of either foot, or
4. Peripheral neuropathy with evidence of callus formation of either foot, or
5. Foot deformity of either foot, or
6. Poor circulation in either foot

• and is being treated under a comprehensive plan of care for his/her diabetes, and needs diabetic shoes.
• Clinical evaluation, performed by the certifying physician within six (6) months prior to delivery, that addresses the beneficiary’s diabetes management.
• Supplier in-person evaluation conducted prior to selection of items that documents an examination of the beneficiary’s feet with a description of the abnormalities that will need to be accommodated by the shoes/inserts/modification.
• In-person visit, at the time of delivery, which assesses the fit of the shoes and inserts with the beneficiary wearing them.