Diabetes and the Feet

By Gary F. Gregasavitch, DPM

All of us are likely to have problems with our feet, but diabetics may develop serious problems more quickly and have more complications, especially when circulation or nerves are impaired. When circulation is poor, the tissue is less able to fight infection. When nerves are impaired, an injury can occur without pain and as a result, may go unnoticed.

The key for the diabetic is to view all foot problems as potentially dangerous and to prevent them and seek podiatric care as soon as they occur. Except for blindness, the complication most heard about in diabetics is loss of a leg. This widespread concern is realistic.

Poor circulation often happens in diabetics, which can lead to serious complications. Symptoms such as numbness, tingling, cold or blue feet, and swelling that will not go down indicate poor circulation. Cramping may occur at night, during rest, or while walking a short distance. Smoking and stress usually increase the severity of the symptoms. Examination by a podiatrist will reveal any circulatory deficiencies.

Diabetic Neuropathy can cause insensitivity or a loss in ability to feel pain, heat or cold. If precautions are not taken, a hot bath can be a potential for a burn. Position sense is often lost in neuropathy, so the feet scrape objects in their path. Diabetic neuropathy can also affect the muscles of the feet causing deformity such as hammertoes.

When insensitivity is present, serious problems, such as ulcers and gangrene, can occur without pain. The infection may go unnoticed and appropriate care may be delayed until it is too late. By the time the trouble is discovered, amputation may be necessary to save the person's life. Daily observation of the feet is necessary by a diabetic or a responsible family member or other party.

Ulcers can be caused by lack of blood circulating to the foot, lack of soft tissue protection, excessive callus tissue, infection, or pressure points caused by deformities. If the circulatory response is adequate, most diabetic ulcers can be healed if diagnosed and treated early.

Skin changes in the foot can be caused by diabetes. Dehydration is common since the diabetic has less natural lubrication than the non-diabetic. Scratching can cause breaks in the skin that may become infected. Dryness can be helped by using a good skin cream daily on every part of the foot except between the toes.

Cuts, Scrapes, Blisters, and Puncture Wounds can cause serious problems. If foreign bodies, such as splinters, become lodged in the foot, or if an infection or puncture wound occurs, the diabetic should be treated promptly by a professional.

Ingrown Toenails can cause infections, which tend to be especially severe in diabetics. To treat the problem, the podiatrist may drain the infection to relieve the pressure, prescribe an antibiotic, and recommend special home care to help the infection heal.

Athlete's Foot is a fungal infection common in diabetics. If it or other skin rashes are not promptly treated, secondary bacterial infections that require vigorous treatment with antibiotics may develop.