Common Disorders
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Did you know the foot has 28 bones, 37 joints, 107 ligaments, 19 muscles, and numerous tendons? These parts all work together to allow the foot to move in a variety of ways while balancing your weight and propelling you forward or backward on even or uneven surfaces. It is no wonder that most Americans will experience a foot problem that will require the care of a specialist at one point or another in their lifetime.

Corns and calluses are areas of thick skin that result form excessive pressure or friction over a boney prominence. When these areas develop on the bottom of the foot they are called calluses. When they occur on the top of the toes they are called corns. They can also occur between the toes, the back of the heels and the top of the foot. The thickening of the skin is a normal body response to pressure or friction. Often times they are associated with a projection of bone called a bone spur. Not all areas of thickened skin are corns or calluses. Planter warts, inclusion cysts and porokeratoses also cause a discreet thickening of the skin that resembles corns and calluses.

Calluses

The most common area for the formation of calluses on the bottom of the foot is in the area of the ball of the foot. This is a weight bearing area where the long bones behind the toes called metatarsals, bear the greatest amount of weight and pressure. If one or more of these long bones (metatarsals) is out of alignment then excessive pressure is generated in the area producing a callous. The callused area can be very discreet and have a "core" or they can be more dispersed covering a larger area. These areas can become quite painful as the skin thickens. People who have diabetes are at risk of these areas breaking down producing sores or ulcerations that can become infected.People with diabetes should not try home remedies and should see a doctor for the treatment.

Blisters

Blisters form as a result of heat, moisture and friction. Blisters can also form as a result of fungal infections of the skin, allergic reactions or burns. If a patient has diabetes, they should be evaluated by a doctor in a timely fashion. Generally, a person will recognize a burn by association with a specific painful event. People with diabetes may not be able recognize the painful event due to a condition called neuropathy. A doctor should attend to burns. Blisters are due to fungal infection of the skin or to allergic reactions, which will generally occur in clusters and be smaller than blisters caused by friction. They will also often occur in areas of the foot, which are free from friction forces.

Athlete's foot is caused by a fungal infection of the skin on the foot. The majority of these infections are caused by one of three fungal agents called dermatophytes. Athlete's foot is by far the most common fungal infection of the skin. The infection can be either acute or chronic. The recurrent form of the disease is often associated with fungal-infected toenails. The acute form of the infection most often presents with moist, scaling between the toes with occasional small blisters and/or fissures. As the blistering breaks, the infection spreads and can involve large areas of the skin on the foot. The burning and itching that accompany the blisters may cause great discomfort that can be relieved by opening and draining the blisters or applying cool water compresses. The infection can also occur as isolated circular lesions on the bottom or top of the foot. As the skin breaks down from the fungal infection, a secondary bacterial infection can ensue.

Malignant Melanoma

Pigmented lesions should always be inspected and observed. Most pigmented areas are nothing but freckles and moles. However a potentially deadly pigmented lesion that can occur on the foot and lower extremity is Malignant MelanomaA physician should evaluate any pigmented lesion that suddenly occurs or a pigmented lesion that starts to change its appearance. These changes are usually subtle and may consist of increased size and depth of color, onset of bleeding, seepage of clear fluid, tumor formation, ulceration and formation of satellite pigmented lesions. The color is usually not uniform but is likely to be scattered irregularity, being brown, bluish black or black. An increase in pigmentation may precede enlargement of the lesion by several months. Although any part of the body may be affected, the most frequent site is the foot, then in order of frequency, the remainder of the lower extremity, head and neck, abdomen, arms and back. Malignant melanoma may also form under the nails of the feet and hands. The thumb and big toe are more commonly affected than the other nails. Quite often the adjacent skin to the nail is ulcerated. Usually a fungal infection is suspected and antifungal treatment may be administered for months before the true nature of the lesion is discovered. A black malignant melanoma of the toe can also be mistaken for  Overall, the incidence of malignant melanoma is quite low.

The Charcot foot is a non-infective, destructive type of arthritis that affects between 1-2.5% of diabetics. The incidence of this arthritic process has increased recently due to patients with diabetes mellitus living longer. There is an equal distribution among males and females. The average age of patients developing a Charcot foot is 40 years. 30% of patients develop a Charcot foot in both feet and/or ankles. This form of arthritis can develop suddenly and without pain. In a very short period of time the bones in the foot and/or ankle can spontaneously fracture and fragment.

The final result in the development of a diabetic Charcot foot is severe foot deformity. These deformities may result in difficulty wearing standard footgear. As the deformity progresses the foot takes on the appearance of a "rocker bottom". As the arch of the foot collapses areas of pressure develop on the bottom of the foot that are prone to developing open sores or ulcerations. Loss of ankle stability may occur to such an extent that the patient may not be able to walk without the use of a brace. The vast majority of these deformities can be treated with non-operative care. New advances in technology and the development of new forms of lower extremity braces and splints have provided a wider range of treatment alternatives that are very effective in managing the Charcot foot.

There are two types of dermatitis caused by substances coming in contact with the skin: primary irritant dermatitisand allergic contact dermatitis. The primary irritant dermatitis is due to a non-allergic reaction of the skin resulting from exposure to an irritating substance. Allergic contact dermatitis is the allergic sensitization to various substances.

Primary Irritant Dermatitis

People who work in areas where their feet are exposed to repeated or prolonged contact to chemicals, oils, or wet cement can develop primary irritant dermatitis. There are certain solutions that people soak their feet in as home remedies. Some of these solutions are safe if used properly, but their improper use can cause a significant contact dermatitis. This can result in skin break down and infection. This is particularly dangerous in people with diabetes; the result can be devastating and limb threatening. A common misconception is the value of soaking in hot water. Some people believe that the hotter the water the better. Quite to the contrary, hot water can cause damage to the skin and result in first or second-degree burns. People will soak their feet in all sorts of solutions. Common solutions are bleach, vinegar, salt water and iodine-based solutions such as betadine. If used properly and under the guidance of a doctor, these solutions can be beneficial. A common mistake that is made is to create solutions that are too strong. Should this occur, irritation to the skin and the development of a rash can develop. The dermatitis that results can also become secondarily infected.

Ulcerations, infections and gangrene are the most common foot and ankle problems that the patient with diabetes must face. As a result, thousands of diabetic patients require amputations each year. Foot infections are the most common reason for hospitalization of diabetic patients. Ulcerations of the feet may take months or even years to heal. It takes 20 times more energy to heal a wound than to maintain a health foot.

There are two major causes of foot problems in diabetes:

  1. Nerve Damage (neuropathy): This causes loss of feeling in the foot, which normally protects the foot from injury. The protective sensations of sharp/dull, hot /cold, pressure and vibration become altered or lost completely. Furthermore, nerve damage causes toe deformities, collapse of the arch, and dry skin. These problems may result in foot ulcers and infections, which may progress rapidly to gangrene and amputation. However: Daily foot care and regular visits to the podiatrist can prevent ulcerations and infections.
  2. Loss of circulation (angiopathy): Poor circulation may be difficult to treat. If circulation is poor gangrene and amputation may be unavoidable. Cigarette smoking should be avoided. Smoking can significantly reduce the circulation to the feet significantly. There are certain medications available for improving circulation (Trental) and by-pass surgery may be necessary to improve circulation to the feet. Chelation therapy is an alternative form of treatment for circulatory problems that is not well recognized by the medical community at large. Daily foot care and regular visits to the podiatrist can often prevent or delay the need for amputation.

Do the Following to Protect Your Feet

This is an "Ask the Doctor Question" and the response. We felt that this question and answer was informative.

Question:

I would like to know how the cells in the body react when someone has diabetes and how is this different from someone who does not have diabetes?

Answer: