When is a Diabetic Foot Problem an Emergency? | DOC

When is a Diabetic Foot Problem an Emergency?

Diabetes is the leading cause of non-traumatic amputations in the United States and the San Francisco Bay Area. Although the number of diabetic foot amputations continues to rise, you can take steps to make sure it doesn’t happen to you.

The fact is that most diabetes related amputations begin as a small problem. Usually a little blister or callus on the bottom of the foot is ignored because it doesn’t hurt. Or an ingrown toenail goes unnoticed. Or maybe you step on a splinter or tiny sliver of glass that has been stuck in the carpet for years.

I have actually personally performed amputations on diabetics in each of these cases. And in every case, the amputation could have been prevented with earlier treatment.

As a diabetic foot surgeon, I do something that most doctors don’t do anymore. I give diabetic patients my cell phone number. I tell my patients to call me anytime they think they have a diabetic foot problem.

The reason I do this is very simple. Early treatment of diabetic foot sores and infections is always best and easier than if it is delayed. The longer the foot problem is left untreated the more likely it becomes that hospitalization or amputation will be necessary.

But even in spite of this, many of my patients have often still waited too long. “It was Thanksgiving.” “I had family in town that week.” “I didn’t want to wake you in the middle of the night.” “I didn’t want to bother you on the weekend.” There’s always an excuse for not calling. But never a good one.

So I think if you can understand the more common “minor” problems that turn into an infected diabetic foot that needs surgery, you will be more likely to seek help earlier. So here they are…

“Minor” Diabetic Foot Emergencies that Need Immediate Treatment:

Ingrown Toenail

The grooves along the sides of the toenails are filled with bacteria. If a toenail becomes ingrown, bacteria can easily cause an infection. Ingrown toenails are easily treated by a podiatrist when they first begin. If the are left untreated for a day or two, they can cause a diabetic foot amputation. If the bone becomes infected, the toe has to be amputated.

Calluses on the Feet

In people with diabetes, calluses form to protect the foot from friction and irritation. Unfortunately the calluses can get so thick that a diabetic foot sore (called a diabetic foot ulcer) forms under the callus. You can’t see the sore unless you remove the callus. Many amputations result from infected calluses that don’t show any outward sign of infection until it is too late. Your podiatrist can safely remove calluses before the skin underneath breaks down and forms an open sore.

Blisters on the Feet

A blister is a fluid filled bubble of skin usually caused by rubbing inside a shoe. Because diabetes causes decreased blood flow to the foot (as well as problems with the cells that fight infection) the fluid can become the perfect place for bacteria to grow. Any blister on the foot is a diabetic foot emergency. Most of the time, a podiatrist will remove the top of the blister and prevent an infection from beginning. In some cases, antibiotics may be necessary.

Redness on the Foot

Redness is the most common outward sign of infection in the diabetic foot. If you see a red area on your foot, you must assume it is infection until your podiatrist can determine otherwise. A difference of a few hours can mean the difference between taking some antibiotics at home, or spending weeks in the hospital and operating room.

Stepping on Sharp Objects

This is probably the most preventable cause of amputation. Just wear shoes. But even if you are careful, you may eventually step on something that injures the bottom of the foot. The reason puncture wounds are so bad is that bacteria can enter and get trapped under the thick skin on the sole of the foot. This is how a diabetic foot abscess begins. These can lead to major infections that require surgical drainage of the infection or amputation of the leg. Always seek immediate treatment with even the smallest wound from stepping on something sharp.

Check Your Feet!

If you (or your spouse) will check your feet in the morning and evening every day, your chances of getting a diabetic foot problem that ends up as an amputation will be dramatically reduced. If you don’t check your feet every day, a small problem can go unnoticed until it becomes a limb or life threatening emergency.

Get Help FAST!

If you notice any of the problems mentioned above, get help…NOW. Don’t wait for a week or even a couple of days to get an appointment. Call someone who will see you right away or go to the emergency room. Diabetic foot problems that lead to amputation can often be prevented with early treatment. So don’t wait.

Dr. Christopher Segler is a Bay Area Podiatrist who has received an award from the American Podiatric Medical Association for his research on the accurate early diagnosis of bone infections related to amputations. He makes house calls in San Francisco 24 hours a day, 7 days a week. You can reach him any time of day or night at (415)-308-0833.