The early symptoms of a diabetic foot include pain, discoloration, loss of sensation, poor balance, and a “pins and needles” feeling.
As the disease advances, there is an ever-increasing vulnerability to soft-tissue wounds that develop into nonhealing ulcers and infections.
At their worst, chronic infections like these can lead to gangrene and amputations. Concurrent to the soft tissue vulnerability is a very high rate of notably severe foot deformities such as hallux valgus, bunions, corns and calluses, and hammer toes.
The central issue is the progressive loss of the oxygenation that is necessary for tissues to heal.
Over time, the diabetic foot follows the sequence of venous stasis, poor circulation, capillary breakdown, and, ultimately, soft tissue necrosis.
What causes a diabetic foot?
All of these issues are worsened by maladapted foot function.
Lower leg muscle function, which is essential for venous blood return, is poor to absent in maladapted feet. Healthy lower leg muscles normally act as muscular ‘pumps’ for venous blood return.
Maladapted foot function also exhibits an inefficient and unstable arch system. Instability increases excessive foot movement in a shoe, which imposes inappropriate pressure at localized points along with rubbing and friction to generate “hot spots” that are the precursor to the formation of ulcers.
When maladapted neuromuscular function is present, especially concurrent with the metabolic vulnerabilities of diabetes, the serious consequences of deformity and soft tissue necrosis are almost inevitable.