peripheral arterial disease and the diabetic foot
/ PAD /
The same furring-up of arteries that causes heart attacks also clogs the vessels feeding the legs. In peripheral arterial disease (PAD), narrowed leg arteries starve the muscles of blood, so walking brings on a cramping calf pain that forces the person to stop and rest — a pattern called intermittent claudication. When the same large-vessel disease combines with diabetes, the result can be devastating to the foot, because diabetes adds nerve damage and impaired healing to poor circulation.
The diabetic foot is the dangerous meeting of three problems. Numbness from neuropathy means an injury — a blister from a tight shoe, a pebble, a small cut — is not felt; poor blood flow from PAD means it heals badly; and high blood sugar invites infection. A trivial wound can become a deep, non-healing ulcer, then spreading infection, then, too often, amputation. Rehabilitation's role is both to keep people walking and to save the foot: for PAD, supervised walking-to-the-point-of-pain exercise programs reliably increase pain-free walking distance, and they work as well as or better than many procedures. For the foot, the team focuses on prevention — daily foot inspection of insensate feet, protective and properly fitted footwear, offloading pressure from ulcers with special shoes or casts, meticulous skin and nail care, and prompt treatment of any wound.
The honest, sobering point is that prevention and early action are everything: a large share of diabetic amputations are preventable, and most are preceded by a foot ulcer that began with an unnoticed minor injury. Rehabilitation cannot reopen blocked arteries or regrow nerves, but daily foot care, good footwear, and supervised exercise prevent catastrophe and preserve walking — the cheapest and most effective interventions are also the least dramatic.
A man with diabetes cannot feel his feet and walks on a small stone for a day without knowing; it leaves an ulcer. Meanwhile his calf cramps after 100 metres from PAD. Rehab offloads the ulcer with a special shoe, teaches daily foot checks, and starts a supervised walking program that doubles his pain-free distance.
Supervised walking helps PAD; daily foot care and good footwear prevent most diabetic amputations.
Most diabetic amputations are preventable and usually start from an unnoticed minor foot injury. Supervised walking is first-line for claudication and rivals procedures; rehab cannot reopen arteries or regrow nerves, so prevention and daily foot care are everything.