Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Write down the patient's symptoms and be prepared to talk about them on the phone with
a doctor. Following is a list of common reasons to call a doctor if a person
with diabetes has a diabetic foot or leg problem. For most of these problems, a doctor visit within about 72 hours is appropriate.
Any significant trauma to the feet or legs, no matter how minor, needs medical attention. Even minor injuries can result in serious infections.
Persistent mild-to-moderate pain in the feet or legs is a signal that something is wrong. Constant pain is never normal.
Any new blister, wound, or ulcer less than 1 inch across can become a more serious problem.
The patient will need to develop a plan with a doctor on how to treat these wounds.
Any new areas of warmth, redness, or swelling on the feet or legs are frequently early signs of infection or inflammation. Addressing them early may prevent more serious problems.
Pain, redness, or swelling around a toenail could mean the patient has an ingrown toenail
- a leading cause of diabetic foot infections and amputations. Prompt and early treatment is essential.
New or constant numbness in the feet or legs can be a sign of diabetic nerve damage (neuropathy) or of impaired circulation in
the legs. Both conditions put the patient at risk for serious problems such as infections and amputations.
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.
Constant itching in the feet can be a sign of fungal infection or dry skin, both of which can lead to infection.
Calluses or corns developing on the feet should be professionally removed. Home removal is not recommended.
Fever, defined as a temperature over 98.6°F (37°C), in association with any other symptoms or even fever alone should prompt
a call to a doctor's office. The degree of fever does not always correlate with the seriousness of infection.
The patient 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 the patient's condition permits, write down the patient's symptoms, a list of medications, allergies to medicines, and
the 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
the patient's problem.
Following are some common reasons to seek immediate medical attention for diabetic foot and leg problems.
Severe pain in the 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).
Any cut to the feet or legs that bleeds significantly and goes all the way through the skin needs proper cleaning and repair to aid healing.
Any significant puncture wounds to the feet (for example, stepping on a nail or being bitten by a dog or cat) carry a high risk of becoming infected.
Wounds or ulcers that are more than about 1 inch across on the feet or legs are frequently associated with limb-threatening infections.
Redness or red streaks spreading away from a wound or ulcer on the feet or legs are a sign of infection spreading through the tissues.
Fever higher than 101.5°F (38.6°C) in association with redness, swelling, warmth, or any wound or ulcer on the legs may be a sign of a limb-threatening or life-threatening infection. If you are a person with diabetes and you simply have a fever more than 101.5°F (38.6°C), and no other symptoms, seek immediate care to determine the source of the fever and to initiate a plan of care. 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 than101.5°F (38.6°C)] very seriously and seek medical attention.
The patient's doctor may or may not prescribe antibiotics, since fevers are
often due to viral infections, which typically do not require antibiotics.
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.
Confusion may also be a sign of either very high or very low blood sugars, which are more common when infection