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Circulatory Problems (blood flow)
Arterial - arterial problems can be subdivided into large, medium, and small vessel disease and involves impedance of nutrient and oxygen rich blood from the heart to the extremity. Severe arterial problems are the cause of "dry" gangrene.
Venous - venous (vein) problems involve poor or improper return of "spent" blood back to the heart which can result in chronic ulcers (non-healing wounds).
Edema - a collection of fluid outside of the vessels seen beneath the skin which can be another source of chronic ulcers or non-healing wounds. This condition can be caused by problems with the heart, lungs, kidneys, liver or by medications.
Neurological Problems (nerve problems) termed "neuropathy"
The high blood sugar levels present in diabetics can cause damage to the nerves that serve the feet. These nerves can be divided in 3 categories:
1) Motor - damage to these fibers can cause muscle imbalances leading to deformaties such as hammertoes and bunions.
2) Sensory - damage to these nerves can render a person unable to feel something that should hurt (ie. stepping on a piece of broken glass could go unnoticed and lead to a major limb-threatening infection).
3) Autonomic - these nerve fibers regulate unconsious parameters such as skin temperature and sweating. Damage could cause such problems as xerosis (a dry skin condition common in diabetics).
Preventive Care
Dr. Kneebone participates in the Medicare Therapeutic (not diabetic) Shoe Program. For example, all new patients are screened thoroughly for problems in these four organ systems:
1) Musculoskeletal - assessing for deformaties such as bunions and hammertoes.
2) Neurological - described above.
3) Circulatory - described above.
4) Integument (skin, nails and hair) - here we are screening for such problems as corns, calluses, athlete's foot, nail problems.
Dr. Kneebone participates in the Medicare Diabetic Shoe Program - he is a shoe fit specialists.
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