In people with diabetes, foot complications from neuropathy (nerve damage) and/or circulation difficulties can make healing from sores, cuts, and ulcers difficult. These slow-to-heal wounds can lead to infections. Other foot issues, such as calluses, are also common in people with diabetes. While calluses may not seem worrisome, if left untrimmed they can turn into ulcers or open sores. People with diabetes are also at risk for Charcot joint, a condition in which a weight-bearing joint progressively degenerates, leading to bone loss and deformity.
Because of nerve damage, people with diabetes may not immediately notice that there are problems with their feet. Over time, people with diabetic neuropathy can develop foot problems that cannot be healed, and this leads to amputations.
Diabetes is one of the leading causes of lower-extremity amputations in the United States.
Uncontrolled high blood sugar levels in people with poorly controlled diabetes can cause peripheral neuropathy, or numbness and loss of sensation due to nerve damage. People with diabetic neuropathy simply cannot feel pain as intensely as someone without damage to his or her nerves.
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.
Checking the feet for callouses, sores, cuts, and so on is a very important part of diabetes care. However, according to a 2011 article in Diabetic Medicine, “a number of surveys and studies have reported that 23 to 63 percent [of people with diabetes] check their feet rarely or not at all.” Another important part of preventive care is for your doctor to check your feet every visit, and test your feet for touch sensation once per year.
All people with diabetes need to be proactive. Ask questions. Work with your doctor to develop guidelines for foot care, to help prevent complications before they occur.
In addition to following a diet that controls blood sugar, there are several steps that people with diabetes can take to prevent foot complications. To improve blood flow to the lower extremities, people with diabetes should walk as regularly as possible in sturdy, comfortable, closed-toe shoes or sneakers. Exercising also reduces hypertension and keeps weight down, which is crucial.
Routinely examine your feet for any changes, including the presence of cuts, sores, or ulcerated skin. Any wounds, cuts, or sores on the feet must be reported to a physician immediately. To keep your feet healthy, follow these tips:
- Check your feet daily, including between the toes.
- Visit a doctor if you notice cuts, sores, wounds, ulcers, redness, swelling, hot areas, or deformities.
- Do not walk barefooted, even around the house. Small sores can turn into big problems. Walking on hot pavement without shoes can cause damage that you might not feel.
- Do not smoke, as it narrows blood vessels and contributes to poor circulation.
- Keep your feet clean and dry—do not soak them. Pat feet dry; don’t rub.
- Moisturize after cleaning, but not between the toes.
- Avoid hot water; check tub water temperature with your hand, not your foot.
- Trim toenails after bathing. Cut straight across and then smooth with a soft nail file. Check for sharp edges and never cut cuticles.
- Use a pumice stone to keep calluses in check. Never cut calluses or corns yourself or use over-the-counter chemicals on them.
- Visit a podiatrist for additional nail and callus care.
- Wear properly fitting footwear and natural-fiber socks (for example, cotton or wool). Do not wear new shoes for more than an hour at a time, and check your feet carefully after removing them. Check inside your shoes for raised areas or objects before you put them on.
- Avoid high heels and shoes with pointed toes.
- If your feet are cold, warm them 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, people with diabetes should see a vascular specialist, an endocrinologist, and a podiatrist.”
It is possible for people with diabetes to avoid foot complications if they are diligent and maintain healthy blood sugar levels. But daily inspection of the feet is also essential.