Podiatry

How can diabetes affect the feet?

People with diabetes are prone to foot problems caused by prolonged periods of high blood sugar. There are two main foot problems, each of which can have serious complications.

Diabetes is a disease where the body cannot produce insulin or cannot use it effectively. Insulin is the hormone that is responsible for helping the cells takes in sugar to use for energy. When this does not happen properly, the levels of sugar in the blood can become too high.

Prolonged periods of high sugar levels in the blood can wreak havoc on many areas of the body, including the feet.

Diabetic foot problems

Over time, diabetes may cause neuropathy in the feet, which may result in a loss of feeling. The two main foot problems that affect people with diabetes are:

Diabetic neuropathy

Over time, diabetes can cause nerve damage that makes it hard for people with diabetes to feel sensation in their extremities. The condition also makes it difficult for a person to feel an irritation on their foot or notice when their shoes are rubbing. This lack of sensation and awareness leads to an increase in the risk of cuts, sores, and blisters developing.

Peripheral vascular disease

Diabetes leads to changes in the blood vessels, including arteries. In peripheral vascular disease, fatty deposits block these vessels beyond the brain and heart. It tends to affect the blood vessels leading to and from the extremities, reducing blood flow to the hands and feet. Reduced blood flow can lead to pain, infection, and slow healing wounds. Severe infections may lead to amputation.

Symptoms

Symptoms may vary from person to person and may depend on what issues a person is experiencing at the time. Symptoms of diabetic foot problems can include the following:

• loss of feeling
• numbness or tingling sensation
• blisters or other wounds without painful
• skin discoloration
• skin temperature changes
• red streaks
• wounds with or without drainage
• painful tingling
• staining on socks
• deformed foot appearance

If an infection is present in a foot or foot ulcer, a person may also experience some of the following:

• fever
• chills
• uncontrollable blood sugar
• shaking
• shock
• redness

Anyone who experiences any of the symptoms of an infection should seek emergency treatment.

Complications

Diabetic neuropathy and peripheral vascular disease are serious conditions that must be monitored closely. Both cause complications that can have serious negative effects. These complications may include:

• foot ulcers, or wounds, that do not heal
• infections, including skin infections, bone infections, and abscesses
• gangrene, when an infection causes tissue death
• foot deformity
• Charcot's Foot (fractures or dislocations in the foot that may cause deformities)

When to see a doctor

Immediate medical attention should be sought if there are changes to the feet such as skin color, persistent sores, tingling, and swelling of the foot or ankle. People who have diabetes should see a doctor regularly as part of their care. However, they should seek immediate medical attention if they notice any of the following:

• changes in foot skin color
• swelling in the foot or ankle
• temperature changes in the feet
• persistent sores on the feet
• pain or tingling in the feet or ankles
• ingrown toenails
• athlete's foot or other foot fungal infections
• dry and cracked skin on the heels
• signs of infection

Treatment

Treatment for diabetic foot problems varies according to the severity of the condition. A range of surgical and nonsurgical options is available.

Nonsurgical treatment

Nonsurgical options are normally the first method of treatment for diabetic foot problems. Some of these include:

• keeping wounds clean and dressed
• immobilization devices, such as a cast boot or total contact cast
• close observation of gangrene toes until self-amputation occurs, when the toes fall off due to lack of blood flow

Surgical treatment

When nonsurgical treatment fails to heal diabetic foot problems, surgery may be considered. Surgical treatment options include:

• removal of decaying or dead tissue
• amputation, varying from toe or part of the foot to amputation of the leg below the knee, or above the knee in some cases
• surgical stabilization of Charcot's Foot
• arterial bypass for peripheral vascular disease, or endovascular surgery with placement of stents

Diabetic foot care

Examining the feet daily and keeping them clean is recommended to prevent diabetic foot problems.

Preventing diabetic foot problems is essential for people who have diabetes. Keeping feet healthy is important, and a person should be vigilant about foot hygiene. They can take the following steps:

• Check feet each day: Examine the feet daily, or ask someone to check for any changes or injuries.
• Wash feet daily: Keeping feet clean helps to prevent infections.
• Wear supportive shoes and socks: It is important to keep feet protected in socks and shoes at all times. A podiatrist may recommend shoes to help prevent deformities. Socks should not be too tight so as to restrict blood flow.
• Promote blood flow to the feet: Putting feet up when sitting, wiggling toes periodically, and getting enough exercise helps promote healthy blood flow to the feet.
• Trim nails carefully: Trim toenails straight across and keep them short. Rounded nails can cause ingrown toenails, which can lead to infection.
• Care for corns and bunions: Treat corns and bunions carefully. Corns should never be shaved as this increases the risk of infection.
• Protect feet from extreme temperatures: Exposure to hot and cold can damage diabetic feet.
• Get feet checked regularly: Regular examinations by a doctor are key to preventing infections, amputations, and serious deformities.
• Control blood sugar: Uncontrolled blood sugar raises the likelihood of podiatric complications from diabetes,
• Avoid smoking: Smoking adversely affects the blood flow to the tissues.

Preventing diabetic foot problems

Diabetes can cause serious foot problems that can result in loss of the feet or limbs, deformity, and infections. However, many of these problems can be prevented or minimized.

While controlling blood sugar by following the recommended treatment plans is the best way to prevent these serious problems, self care and regular checkups with a doctor can prevent diabetic foot problems as well