People with diabetes are prone to foot problems that develop due to prolonged periods of high blood sugar levels. Diabetic neuropathy and peripheral vascular disease are the two main foot problems that occur, and both can have serious complications.

Diabetes is a disease that causes faulty or insufficient insulin production or low sensitivity to insulin. Insulin is an essential hormone that is responsible for helping cells absorb sugar from the blood to use for energy.

When this process does not work correctly, sugar remains circulating in the blood, causing health problems.

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

Diabetes is responsible for over 50 percent of all foot amputations in the United States.

In this article, we look at the foot problems that can occur in people with unmanaged or poorly managed diabetes and how to manage these effects.

The two main foot problems that occur in people with diabetes are:

Diabetic neuropathy

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Diabetic neuropathy can numb the feet, reducing awareness of wounds, infections, and tight shoes.

Over time, diabetes can cause nerve damage that leads to numbness in the feet. This can make it hard for people with diabetes to feel sensation in their extremities.

The condition also makes it difficult for a person with diabetes to feel irritation, soreness, or infection on the feet. They may not notice when their shoes are rubbing. This lack of sensation can lead to an increased risk of cuts, sores, and blisters.

If a person does not receive treatment for an infection, ulcers and even gangrene can develop. If a person develops gangrene, they may require an amputation. TO If aperson develops gangrene, a doctor might suggest amputation.

Peripheral vascular disease

Diabetes leads to changes in the blood vessels, including arteries. In peripheral vascular disease, fatty deposits block vessels beyond the brain and heart.

It tends to affect blood vessels leading to and from the extremities, such as the hands and feet, reducing blood flow to both.

Reduced blood flow can lead to pain, infection, and wounds that heal slowly. If a person develops a severe infection, a doctor may recommend amputation.

Foot symptoms of diabetes vary from person to person and may depend on the specific issues a person is experiencing at the time.

However, symptoms might include:

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

If an infection develops, a person may also experience some of the following:

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

Any person with diabetes who experiences symptoms of an infection, especially on the feet, should seek emergency treatment.

Complications

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If gangrene develops due to an unnoticed wound, a doctor may suggest amputation.

Diabetic neuropathy and peripheral vascular disease are serious conditions that a doctor must monitor closely.

Both cause complications that can have serious, on-going 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, which alters the shape of the feet as bones in the foot and toe shift or break

Sometimes, doctors can reverse complications, such as infections. However, others, including gangrene, may lead to permanent physical changes.

A doctor may recommend amputation if a person develops gangrene

Read more about gangrene here.

When to see a doctor

People who have diabetes should see a doctor regularly as part of their care.

However, anyone who notices any of the following changes should seek immediate medical attention:

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

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

Nonsurgical treatment

A doctor will first attempt to treat diabetic foot problems without using surgery. Some methods include:

  • keeping wounds clean and dressed
  • wearing immobilization devices, such as a cast boot or total contact cast
  • closely observing any gangrene on the toes until self-amputation occurs, which is when the toes fall off due to lack of blood flow

Surgical treatment

When nonsurgical treatment does not successfully heal diabetic foot problems, the doctor might consider surgery. Surgical options include:

  • the removal of decaying or dead tissue
  • amputation, ranging from single toes or sections of foot to amputation of the leg below or even above the knee
  • surgical stabilization of Charcot's Foot
  • an arterial bypass for peripheral vascular disease, which assists blood flow to the area
  • endovascular surgery with placement of stents, which uses small devices to keep blood vessels open

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A person should try to wash the feet every day.

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

  • Check the feet each day: Examine the feet daily, or ask someone to check for any changes or injuries.
  • Wash the feet daily: Keep the feet clean to prevent infections.
  • Wear supportive shoes and socks: Protect the feet in socks and shoes at all times. A podiatrist may recommend special shoes to help prevent deformities. Do not apply socks so tightly that they restrict blood flow.
  • Promote blood flow to the feet: Put the feet up when sitting, wiggle the toes periodically, and get enough exercise. These actions help promote healthy blood flow to the feet.
  • Trim nails carefully: Trim toenails straight across and keep them short. Rounded nails can grow inward, leading to infection.
  • Care for corns and bunions: Treat corns and bunions carefully. Never shave corns, as this increases the risk of infection.
  • Protect feet from extreme temperatures: Exposure to extreme hot and cold can damage the feet of people with diabetes.
  • Receive regular examinations on the feet: Regular examinations by a doctor are key to preventing infections, amputations, and severe deformities.
  • Control blood sugar: Uncontrolled blood sugars increase the risk of podiatric complications from diabetes.
  • Avoid smoking: Smoking adversely affects blood flow to the tissues, which can make foot problems worse in people with diabetes.

Learn more about whether people with diabetes can soak their feet in salts here.

Prevention

Diabetes can cause serious foot problems that can result in feet or limb loss, deformity, and infections. However, it is possible for a person to prevent or minimize many of these problems.

While controlling blood sugar by following the recommended diabetes treatment plans is the best way to prevent these serious problems, self-care and regular check-ups with a doctor can also help prevent problems from developing.

Foot problems in diabetes can occur due to restricted blood flow and unnoticed cuts and infections that develop due to numbness in the area.

A person with diabetes needs regular podiatric checks to ensure that any foot problems do not develop into complications.

A doctor will try to treat the feet using sterilization, observation, and, possibly, immobilization devices, such as a cast boot. If these are not effective, they might recommend surgery to remove infected tissue that has the potential to spread.

This might require amputation above or below the knee.

People with diabetes need to keep their feet clean, undergo regular monitoring, and put on supportive footwear to minimize complications and foot issues.

Q:

What other areas does diabetes affect in the body?

A:

When diabetes is not well controlled, long-term complications can develop and affect many different areas of the body.

Uncontrolled blood sugars can cause blood vessel injury that can lead to cardiovascular disease, kidney damage, nerve injury in the extremities, and eye problems. Diabetes can also make a person more susceptible to skin infections.

Elaine K. Luo, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.