In people with diabetes foot complications from neuropathy (nerve damage) can appear in the form of ulcers, sores, or open cuts.
Other foot issues, like calluses, are also common. While calluses may not seem worrisome, if left untrimmed they can turn into ulcers or open sores. Again, because of nerve damage, diabetics may not immediately notice such problems. Over time, diabetics with neuropathy may also experience changes in the shape of their feet, such as buckled digits or “hammer” toes, bunions, or other deformities that may require specialized footwear.
Causes of Diabetes-Related Foot Problems
Because the prolonged elevation of sugar levels in diabetics often causes peripheral neuropathy, or numbness and loss of sensation due to nerve damage, diabetics risk repeated foot injury. Diabetics simply cannot feel pain as intensely as someone without damage to his or her nerves.
Many diabetics are unaware of the serious dangers of neuropathy in the feet. Essentially, if a wound is not felt right away, it can go unchecked, and an infection can become so serious that amputation becomes necessary.
People with diabetes can also suffer from poor blood circulation in their lower extremities, which slows the healing process when a cut or wound is present. Any wound that is slow to heal further increases the risk of infection since bacteria can easily enter open sores and cuts.
Accord to a 2011 article in Diabetic Medicine, “a number of surveys and studies have reported that 23 to 63 percent [of diabetic patients] check their feet rarely or not at all.” Other research suggested that physicians only routinely examine patients’ feet that have had past wounds.
This lack of awareness may be greater for patients in the early stages of nerve damage because they are also unaware of the risks associated with it. Therefore, diabetics need to be proactive. Ask questions. Work with your doctor to develop guidelines for foot care to help prevent the possibility of complications before they occur.
Prevention: How to Avoid Foot Problems
Research suggests that foot care is not a priority for most diabetics, which is likely due to a lack of information or understanding of the disease. In addition to following a diet that controls blood sugar, there are several steps that diabetics need to take to prevent foot complications. To improve blood flow to the lower extremities, diabetics should walk regularly in sturdy, comfortable, closed-toe shoes or sneakers. Exercising also reduces hypertension and weight, which is crucial.
All diabetics should routinely examine their feet for any changes, including the presence of cuts, sores, or ulcerated skin. Diabetics with decreased circulation, numbness, or loss of sensation in their feet should not cut their own toenails. They should instead visit a podiatrist (foot doctor) regularly. Any wounds, cuts, or sores on the feet must be reported to a physician. The following list provides further details about how to avoid foot complications:
- Check your feet daily, including between the toes.
- Visit a doctor if you notice cuts, sores, wounds, ulcers, or deformities.
- Do not walk barefooted, even around the house.
- Do not smoke, as it narrows blood vessels and contributes to poor circulation.
- Keep your feet clean and dry—do not soak them.
- Moisturize after cleaning, but not between the toes.
- Avoid hot water; check tub water temperature with your hand, not your foot.
- Trim toenails and calluses regularly.
- Wear properly fitting footwear.
- Avoid high heels and shoes with pointed toes.
- If your feet are cold, warm them only with socks.
- Wiggle your toes and pump your ankles while sitting.
- Do not cross your legs, as doing so may constrict blood flow.
- Keep off your feet and elevate your legs if you have an injury.
According to Dr. Harvey Katzeff, co-coordinator of the Comprehensive Diabetic Foot Care Center at the Vascular Institute at Long Island Jewish Medical Center, “Everyone with diabetes should learn proper foot care. Along with their personal physicians, [diabetic] patients should see a vascular specialist, an endocrinologist, and a podiatrist.”
It is possible for diabetics to avoid foot complications if they are diligent and maintain healthy blood sugar levels. But daily inspection of the feet is also essential.