Diabetic foot color change after non healing ulcer

by D.C.

Dear Doctor

My History
I am a type 1 diabetic for 50+ years
test 10 times a day and HA1c runs 5.6-6.1 Intensive therapy...
with diabetic nueropathy, gastroparesis , hyperlipidemia ( under control with ldl of 86 and hdl of 83 ) & atherosclerosis ( treated with stents 4 years ago also previously had a femoral/ popliteal bypass 20 years ago .
I had an ulcer on the top of my 3rd digit just under the nail
It started out as a small scratch (3 months earlier in Nov.) and turned into a non healing ulcer ..
We got it healed in Feb. with the use of Augmentin for 1 week & Duoderm dressings for 3 weeks .
2 days later Feb. 18th (after the skin had closed) the toe showed signs of infection and I was put on Keflex for 2 weeks.
Follow up visit Dr. ordered xray & changed to Cipro for 2 weeks ( which will be finished Monday morning ).

lost 2 toenails ... they lifted up after the doctor had in soaking in epsom salt and had to be trimmed back because they were just flapping and could have gotten torn off if not clipped off...
Tried to attach pics but wont allow after several attempts

My question for you is my foot keeps turning bright red ... my healthy foot does not do this... the redness comes and goes (within minutes sometimes ) it is not constantly red and it varies in degree of color change . Another thing is it is cooler than the normal foot to the touch...
It started out as it just being red in the injured toe... then in a few toes then all toes and now my whole foot changing colors .
My feet were always the same color before this and sometimes still are ... but more often than not when I look at my feet The one that had the problem is constantly and dramatically changing differing colors of red to white...

Do you have any idea why this is happening or what it possibly could be and also what type of doctor should I be seeing at this point ?


Thank you so much for any advice

RESPONSE

Hi D.C.

In spite of how well you seem at controlling your blood sugars, unfortunately, after so many years there are going to be issues that you will have to deal with that may be a result of type 1 Diabetes.
In your narrative you mention that you had femoral-popliteal bypass surgery twenty years ago, which tells me you had circulation issues in your foot and leg way back then. (I am assuming it was on the same foot in question, but probably does not matter if it were the other foot).

Next, you developed an ulcer on your toe that had some degree of difficulty in closing but it eventually closed. People develop ulcers on their feet primarily due to poor circulation. If there had been adequate circulation going into the toe, the scratch you sustained in November would have healed uneventfully.

The redness you are experiencing in your feet in most cases is also due to poor circulation. When not enough blood is coming into the foot, the superficial arterioles (the small blood vessels close to the skin), dilate or open up and give the foot its red appearance. Others who have poor circulation will see their foot appear very pale. Either situation is a sign of poor blood flow into the foot.


Lastly, you state that your affected foot is colder than the other foot. This too, is a sign of poor circulation. It is warm blood coming into the foot that gives it its warm feeling. Lack of blood=cold foot.

So, all the symptoms you write about are consistent with poor circulation going into the foot where you had the ulcer. This is a potentially dangerous situation and requires the need to see a vascular specialist immediately to determine the cause of the problem.

Please do not put this off as this is how diabetics get themselves into trouble.

Marc Mitnick DPM
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