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DIABETIC FOOT CARE

When to Seek Medical Care

Write down your symptoms and be prepared to talk about them on the phone with your doctor. Following is a list of common reasons to call your doctor if you have a diabetic foot or leg problem. For most of these problems, a doctor visit within about 72 hours is appropriate.

    A.   Any significant trauma to your feet or legs, no matter how minor, needs medical attention. Even minor injuries can result in serious infections.

    B.   Persistent mild-to-moderate pain in your feet or legs is a signal that something is wrong. Constant pain is never normal.

    C.   Any new blister, wound, or ulcer less than 1 inch across can become a more serious problem. You will need to develop a plan with your doctor on how to treat these wounds.

    D.   Any new areas of warmth, redness, or swelling on your feet or legs are frequently early signs of infection or inflammation. Addressing them early may prevent more serious problems.

    E.   Pain, redness, or swelling around a toenail could mean you have an ingrown toenail—a leading cause of diabetic foot infections and amputations. Prompt and early treatment is essential.

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    F.   New or constant numbness in your feet or legs can be a sign of diabetic nerve damage (neuropathy) or of impaired circulation in your legs. Both conditions put you at risk for serious problems such as infections and amputations.

    G.   Difficulty walking can result from diabetic arthritis (Charcot's joints), often a sign of abnormal strain or pressure on the foot or of poorly fitting shoes. Early intervention is key to preventing more serious problems including falls as well as lower extremity skin breakdown and infections.

    H.   Constant itching in the feet can be a sign of fungal infection or dry skin, both of which can lead to infection.

    I.   Calluses or corns developing on the feet should be professionally removed. Home removal is not recommended.

    J.   Fever, defined as a temperature greater than 98.6°F, in association with any other symptoms or even fever alone should prompt an immediate call to your doctor. The degree of fever does not always correlate with the seriousness of infection. You could have no fever or a very low fever and still have a serious infection. People with diabetes need to be especially cautious of fever.

    If time and your condition permit, write down your symptoms, a list of your medications, allergies to medicines, and your doctor's name and phone number prior to coming to the hospital's emergency department. This information will greatly assist the emergency physician in the evaluation and treatment of your problem.

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Following are some common reasons to seek immediate medical attention for diabetic foot and leg problems.

    A.   Severe pain in your feet or legs is often a sign of acute loss of circulation to the leg, serious infection, or may be due to severe nerve damage (neuropathy).

    B.   Any cut to your feet or legs that bleeds significantly and goes all the way through the skin needs proper cleaning and repair to aid healing.

    C.   Any significant puncture wounds to your feet (for example, stepping on a nail or being bitten by a dog or cat) carry a high risk of becoming infected.

    D.   Wounds or ulcers that are more than about 1 inch across on your feet or legs are frequently associated with limb-threatening infections.

    E.   Redness or red streaks spreading away from a wound or ulcer on your feet or legs are a sign of infection spreading through the tissues.

    F.   Fever higher than 101.5°F in association with redness, swelling, warmth, or any wound or ulcer on your legs may be a sign of a limb or life-threatening infection. If you have diabetes and you simply have a fever more than 101.5° F, and no other symptoms, seek immediate emergency care to determine a source and treatment plan. Because the degree of fever does not always correlate with the seriousness of the illness, people with diabetes should take even low-grade fevers (less than 101.5°F) very seriously and seek medical attention.

    G.   Alteration in mental status (confusion) may be a sign of life-threatening infection that could lead to loss of a leg or foot, when associated with a leg wound or foot ulcer. It may also be a sign of either very high or very low blood sugars, which are more common when there is infection present.

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