Diabetes significantly increases the risk of foot complications due to two major physiological changes: nerve damage (neuropathy) and poor blood flow (peripheral artery disease). Neuropathy causes a loss of protective sensation, meaning a small cut, blister, or pressure sore may go unnoticed and progress to a severe wound without pain. Reduced circulation slows the healing process, making any injury prone to infection and difficult to treat. A podiatrist focuses on the prevention, diagnosis, and treatment of foot and ankle disorders. For individuals with diabetes, the podiatrist’s role is to mitigate these risks and prevent serious outcomes, such as ulcers, severe infection, and amputation, that result from these compounding factors.
Preventive Care and Annual Screenings
The most effective strategy in diabetic foot care is proactive prevention, centered on the annual comprehensive foot examination. During this yearly assessment, the podiatrist screens for early signs of nerve damage and vascular compromise. The neurological assessment uses the 10-gram monofilament, a non-invasive tool touched to several points on the foot. The inability to feel the pressure of this flexible fiber indicates a loss of protective sensation, which immediately places the patient into a high-risk category for ulceration.
The podiatrist also performs a vascular assessment, checking for the presence and strength of the dorsalis pedis and posterior tibial pulses. If pulses are diminished, further testing, like the Ankle-Brachial Index (ABI) or specialized Doppler studies, may be performed to assess the severity of poor circulation. This evaluation establishes a patient’s risk level, which dictates the necessary frequency of follow-up care.
Beyond screening, routine maintenance care is a cornerstone of prevention for high-risk patients. Podiatrists safely trim toenails and manage calluses or corns that can develop excessive thickness. These hardened areas can create pressure points under the skin that eventually break down into ulcers. The podiatrist also provides detailed patient education, emphasizing daily self-checks, proper foot hygiene, and the selection of appropriate, non-constricting footwear.
Managing Common Diabetic Foot Conditions
When a complication, such as a diabetic foot ulcer, does occur, the podiatrist manages the non-surgical treatment protocol to promote healing and avoid worsening the wound. A primary step in wound care is debridement, which involves the careful removal of dead, damaged, or infected tissue from the ulcer bed. This procedure reduces the bacterial load and stimulates the growth of healthy tissue.
The most important intervention for a plantar (bottom of the foot) ulcer is offloading, which means redistributing pressure away from the wound to allow it to heal. The gold standard for offloading is often the Total Contact Cast (TCC), an irremovable device that encases the foot and lower leg, distributing weight across a much larger surface area. The TCC leads to high healing rates for non-infected, neuropathic wounds.
Specialized dressings and topical treatments, including growth factors, are also used to keep the wound bed moist and protected from infection. Offloading may also be achieved with specialized boots or removable cast walkers, though non-removable devices are generally more effective because they ensure continuous adherence to the treatment plan. For severe calluses or corns that pose an immediate ulcer risk, the podiatrist performs regular conservative trimming and paring to eliminate the precursor to tissue breakdown.
Advanced Treatment and Surgical Interventions
When conservative wound care fails or a severe infection is present, the podiatrist transitions to advanced medical and surgical interventions, often working as part of a multidisciplinary team. These interventions are focused on limb salvage to prevent a major amputation. Severe, deep ulcers may require surgical debridement, which is a more aggressive removal of infected or necrotic tissue to fully cleanse the wound and expose the underlying structures.
Managing deep infection, particularly osteomyelitis (infection in the bone), involves a combination of surgical debridement and long-term systemic antibiotics. The podiatrist surgically removes the infected bone while preserving as much viable, healthy tissue as possible to maintain function. This complex process is often staged, meaning multiple procedures may be necessary to fully eradicate the infection before reconstruction begins.
The podiatrist also manages Charcot neuroarthropathy, a progressive condition where the bones and joints in the foot weaken and collapse due to severe neuropathy. In its acute phase, treatment involves immobilization, often with a cast. Severe deformity or instability may require surgical correction. Surgical procedures for Charcot foot, such as arthrodesis (fusion of the joint) or exostectomy (removal of a bony prominence), aim to realign the foot into a stable, “plantigrade” position that can tolerate walking and wearing therapeutic footwear without developing new ulcers.