If you have diabetes, it is important to keep blood sugars in the target range as much as possible. This can help to prevent and/or delay complications from diabetes, although genetics also plays a role in their development. Having high blood sugars over a long period puts a person at increased risk of developing a range of complications, including problems with their feet.
About 50% of people with diabetes develop peripheral neuropathy, and they have a 25% greater risk of developing a foot ulcer. People with diabetes also have a 15 times higher rate of amputation than people without diabetes.
This increased risk is often due to a combination of factors that are attributed to diabetes and having chronic high blood sugars, including:
- Neuropathy: a loss of sensory, motor, and autonomic nerve damage
- Ischemia: poor blood supply to organs
- Foot deformation
Here is an overview of foot complications associated with diabetes.
People with diabetes often don’t realize they have a cut or wound on their foot because they can’t feel it (due to neuropathy) and they also often have poor blood circulation which slows healing. Over 80% of lower limb amputations occur after a foot ulcer; however, these are easily preventable if caught early.
Diabetic peripheral neuropathy (DPN)
DPN is the most common complication of diabetes and includes any disorder of the peripheral nervous system, but it occurs most often in your hands and feet.
It begins in the furthest body parts from the center of your body (e.g., toes) and then progresses inward toward your trunk. Keeping your blood sugar as close to your target range as possible has been shown to stop progression and/or improve symptoms of neuropathy.
When a person has a drop foot, there is a walking (gait) issue in which the front of the foot does not lift when walking, so the person drags their foot on the floor. The person may lift their foot with their thigh in a stomping motion to compensate when walking.
Falling can be an issue if a drop foot isn’t addressed, especially when walking up or down the stairs. Drop foot isn’t a disease, but rather the result of an underlying neurological and/or muscular issue.
Autonomic neuropathy is a type of nerve damage that affects the non-voluntary, non-sensory nervous system. When it is in the lower limbs, it can reduce sweating, cause dry skin, and cause skin cracks to develop.
Motor neuropathy that affects the muscles in the foot can cause foot deformity. The foot deformity plus sensory neuropathy can cause pressure, forming calluses.
Having a callus on the bottom (plantar area) of the foot increases the person’s risk of developing an ulcer in that area.
Fungal infections on the foot/between the toes (e.g., athlete’s foot) and nail infections (when nails have a yellow/brown/white discoloration and are thick or cracked) are also common in a person with diabetes.
Peripheral artery disease (PAD)
PAD is a cholesterol (plaque) build-up in the arteries that causes a decrease in blood flow to the legs and feet. Risk factors for PAD include diabetes, high cholesterol, high blood pressure, smoking, increased age (older than 60 years), and atherosclerosis. Atherosclerotic cardiovascular disease (ASCVD) that affects the legs and feet is thought to be due to the build-up of plaque in the blood vessels, narrowing the arteries.
This is also known as neuropathic arthropathy or Charcot neuro-osteoarthropathy and most commonly affects the foot, but the knee and wrist could also be affected. In a person who has neuropathy, bone tissue begins to be destroyed around damaged nerves, which can lead to irreversible foot deformity. Early diagnosis is the key to stopping or slowing the progression.
How to prevent and/or delay foot complications
There are things you can do now to help prevent and/or delay the progression of foot complications:
- Managing your diabetes: taking medication and/or insulin, checking your blood sugar often, eating a healthy diet, getting regular physical activity, and managing stress
- Managing blood pressure
- Managing your cholesterol
- Healthy lifestyle modifications: stop smoking, drinking alcohol in moderation, get regular sleep, and manage stress
Following preventive foot-care recommendations reduce serious foot issues and amputations by up to 80% including:
- Having an annual foot exam
- Washing and drying your feet (especially between your toes) daily (do not soak your feet)
- Checking the bottom of your feet and lower legs every day to make sure there are no sores, cuts, or any objects in your foot or issues with your toenails (if you have nerve damage you may not be able to feel it)
- Moisturizing your feet daily
- Trimming your toenails carefully (straight across) or go to a podiatrist to have it done
- Not going barefoot
- Wearing clean dry socks and shoes that fit properly
- Check-in your shoes before you put them on to make sure there are no objects that could cut or press on your foot (e.g., if you have a small rock in your shoe, you may not feel it if you have neuropathy but it can rub your foot and create a sore)
- Using specialized footwear as prescribed by your doctor to prevent further foot complications
- Call your doctor if there are any changes to your skin, any sores, or cuts so they can be treated early before they progress into more serious health issues
If you have been diagnosed with a foot complication it can affect your daily living because of the pain, limit your mobility or functioning, and affect you emotionally.
Talk to your diabetes health care provider about how you are feeling and your worries. He or she can recommend practical tips for adjusting to the foot complication as well as refer you to a mental health provider who has experience in helping patients with diabetes.
Taking care of yourself both medically and psychologically can help improve your overall quality of life.
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