For people with diabetes, foot complications such as neuropathy and circulation problems can make it difficult for wounds to heal. Serious problems can arise from common skin issues such as:
Diabetes that is not well controlled can lead to slower healing. 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, which can lead 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, the medical term for numbness and loss of sensation due to damage to the nerves that serve the feet and hands. People with diabetic neuropathy cannot feel various sensations, such as pressure or touch, as intensely as those without damage to their nerves. On the other hand, peripheral neuropathy is often very painful, causing burning, tingling, or other painful feelings in the feet.
If a wound is not felt right away, it can go unchecked. Poor circulation can make it difficult for the body to heal these wounds. Infection can then set in and become so serious that amputation becomes necessary.
Checking the feet for abnormalities is a very important part of diabetes care. Abnormalities may include:
- callouses or corns
- red or swollen spots on the feet
- hot spots, or areas that are warm to the touch
- changes in skin color
- ingrown or overgrown toenails
- dry or cracked skin
If you notice any of these symptoms, be sure to go to your doctor right away. Another important part of preventive care is for your doctor to check your feet every visit and test them 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. These measures will help prevent complications before they occur.
In addition to keeping your blood sugar level within its target range, 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 shoes or sneakers that are:
Exercising also reduces hypertension and keeps weight down, which is crucial.
To keep your feet healthy, follow these tips:
- Check your feet daily, including between the toes. If you cannot see your feet, use a mirror to help.
- Visit a doctor if you notice any wounds or abnormalities on your feet.
- 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, such as cotton or wool. Do not wear new shoes for more than an hour at a time. Check your feet carefully after removing shoes. 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. 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.”
If you have diabetes, it is possible to avoid foot complications if you are diligent and maintain healthy blood sugar levels. Daily inspection of your feet is also essential.