Sunday, March 03, 2024
DIABETES Diabetic Foot Problems

Foot Problems From Diabetes: Causes, Symptoms & Prevention of Diabetic Foot Problems

Diabetes is a major problem in the United States. Individuals with diabetes have a 30-fold higher risk of undergoing an amputation (1). There are many different types of foot problems that can occur secondary to diabetes. 

It’s important to be aware of what can happen to your feet when you have diabetes and what you can do to better take care of your feet. This will help prevent infections and amputations. 

In this article, we’ll discuss the major foot problems that are commonly seen in people with diabetes, their symptoms, diagnosis, as well as how you can prevent these issues.

What Is Diabetes?

Diabetes is a metabolic disorder characterized by high levels of glucose in the blood. It occurs when the body either does not produce enough insulin or is unable to effectively use the insulin it produces. 

Insulin is a hormone that helps regulate blood sugar levels and allows cells to use glucose for energy. 

When diabetes is not properly managed, it can lead to various complications, including foot problems.

diabetes foot problems

What  Are the Main Causes of Diabetic Foot Problems?

Neuropathy is one of the biggest problems that can occur from diabetes. When you have elevated blood sugar levels for a prolonged period, this can cause nerve damage to occur. 

Neuropathy is said to be present to some degree in more than 50% of diabetic persons older than 60 years (2). 

You may notice subtle neuropathy symptoms start in your toes and then progress into your foot. This can happen slowly within a few months to a few years. This is a major problem, as neuropathy is often not reversible. 

If you can’t feel the bottoms of your feet, you are at higher risk for foot problems.

In someone who doesn’t have diabetes-related neuropathy, their body signals notify them when there is a problem with their feet. 

Say for instance you develop a foot infection…if you have full sensation, your body alerts you to the infected area by activating pain signals. 

People who have neuropathy, may not even feel any discomfort associated with an infection or ulceration.

Peripheral vascular disease is often seen in people who have diabetes. Peripheral vascular disease is when there is narrowing or blockage of arteries that supply your feet. 

Diabetics who have peripheral vascular disease need to be aware of the risks associated with this. Say for instance you have a foot ulcer. Poor blood flow to the ulceration site can slow wound healing. 

In addition, PVD in itself can cause ulcers themselves, such as arterial ulcers. These ulcers can be painful and can eventually lead to tissue death (gangrene). 

What  Are the Main Causes of Diabetic Foot Problems?

Diabetic-related foot conditions encompass various conditions that individuals with diabetes are more prone to developing. 

One such problem is the formation of calluses, which can potentially progress into ulcers, particularly in the presence of neuropathy.

Calluses are thickened areas of skin that form as a protective response to repetitive pressure. However, diabetics with neuropathy lack the ability to perceive sensations in their feet, making it challenging for them to adjust their gait and redistribute pressure. 

Consequently, prolonged and repetitive pressure in specific areas can lead to ulceration. Regular treatment by a healthcare professional, including debridement and appropriate wound care, is necessary for ulcer management. 

Another common issue for diabetics is ingrown toenails, which can easily become infected due to reduced foot sensation. Tight shoes or socks can cause impingement of the nail, leading to bacterial infection. In such cases, it is important to consult a doctor for ingrown toenail surgery and antibiotic treatment. 

Diabetics also tend to experience dry and flaky skin on the soles of their feet, along with thinning, hair loss, dryness, cracks, and increased callus formation. 

Proper care is essential for heel fissures, as they have the potential to progress into ulcers and become easily infected. 

Additionally, individuals with diabetes and neuropathy may be at risk of developing Charcot arthropathy, a condition characterized by the breakdown and fracture of foot bones. 

Although the exact cause of Charcot foot is not fully understood, previous foot injuries are often associated with its occurrence. Multiple fractures can cause the foot to collapse, leading to a “rocker bottom” contour and an increased susceptibility to foot ulcers. 

It is crucial for individuals with diabetes to protect their feet from extreme temperatures, be cautious when exposed to heat or cold, use sunscreen, avoid walking barefoot on hot surfaces, and take measures to prevent burns.

Symptoms

Diabetic foot problems can manifest through various symptoms, including those associated with neuropathy. Individuals with neuropathy may experience a range of sensations in their feet, such as burning pain, tingling pain, numbness, and a “leathery” type feeling. 

They may also have a persistent sensation of wearing socks on their feet, even when barefoot. Moreover, the inability to differentiate between hot and cold temperatures and experiencing toes that feel either cold or hot are common indicators of neuropathy. 

Another symptom of diabetic foot problems is peripheral vascular disease, which affects the blood vessels and circulation in the feet. Individuals may experience decreased blood flow to their extremities, resulting in symptoms like cold feet, pale or bluish skin, and slow-healing wounds or sores. 

Additionally, ingrown toenails can be a concern for diabetics, especially due to reduced foot sensation. Symptoms may include pain, redness, swelling, and potential signs of infection if the toenail becomes ingrown. 

Dry and cracked skin, along with the formation of foot fissures, is another common symptom. These fissures can be painful. Lastly, individuals with Charcot foot may experience swelling, warmth, and redness in the affected foot. 

As the condition progresses, the foot may become unstable and develop a “rocker bottom” contour, increasing the risk of ulcers. 

semmes weinstein monofilament

Diagnosis

Diabetic foot problems are diagnosed through a combination of clinical evaluation and diagnostic tests. 

A healthcare professional will assess the patient’s medical history, symptoms, and perform a thorough physical examination of the feet. They will look for signs of neuropathy, peripheral vascular disease, calluses, ulcers, ingrown toenails, and other related foot issues.

 Diagnostic tests may include checking the patient’s blood sugar levels, conducting nerve conduction studies, assessing blood flow to the feet using Doppler ultrasound, and performing X-rays or MRI scans to evaluate bone and joint abnormalities. 

12 Ways to Prevent Diabetic Foot Problems

1)Perform a Daily Foot Examination to Keep Feet Healthy.

  • Check both the top and bottom of your feet for cuts, scrapes, and signs of infection.
  • Pay special attention to the area between your toes, as sweat accumulation can lead to athlete’s foot.
  • Avoid walking barefoot in communal public areas like gyms and locker rooms to minimize the risk of fungal infection.

2) Watch for Any Signs of Foot Infections.

  • Look for redness, swelling, heat, pain, pus, or streaking red lines on your feet, which may indicate an infection.
  • If you suspect an infection, contact your doctor immediately. Keep the area clean, apply antibiotic cream, and cover it with a dry dressing until you can see a healthcare professional.
diabetic insoles

3) Wear Proper Footwear.

  • Choose shoes that are comfortable, well-fitting, and designed for your specific foot structure.
  • Avoid shoes that are too narrow, have a shallow toe box, or are too tight, as they can lead to blisters, calluses, and ulcerations.
  • Diabetic shoes are recommended, as they provide extra-depth, a deep toe box, and a thick sole for support while walking.
  • Consider getting prescription diabetic shoes and inserts from a foot doctor. If not covered by insurance, check local shoe stores or reputable websites for diabetic footwear options.

4) Get Diabetic Inserts.

  • Diabetic inserts, which can be custom-made or purchased over-the-counter, are beneficial for individuals with diabetic neuropathy.
  • They provide cushioning, distribute forces evenly while walking, and help prevent pressure ulcers and blister formation.
  • Look for multi-density insoles with appropriate thickness, and avoid thin inserts that don’t offer sufficient cushioning.

5) Wear the Right Running Shoes.

  • Running shoes with stiff-soles and forgiving toe boxes can be beneficial for individuals with diabetes and neuropathy.
  • They provide better support and protection and will help keep your feet healthy.

6) Schedule Regular Exams With Your Podiatrist

  • Individuals with diabetes and neuropathy should see their doctor every 3 to 6 months for a foot exam.
  • Sensation, reflexes, and gait will be checked to assess nerve function and balance.
  • Early detection of foot issues can prevent complications and ensure prompt treatment.

7) Wear the Right Footwear and Padding.

  • Diabetic shoes and inserts can help prevent calluses and ulcers caused by diabetes-related foot neuropathy. It can help by reducing pressure on specific areas of the feet.
  • Offloading donut pads, toe pads, and metatarsal pads can be used for additional padding and pressure relief.
  • Proper application of metatarsal pads is crucial, as they should be placed under the knucklebones to offload pressure effectively.

8) Manage Peripheral Vascular Disease if You Have Diabetes.

  • Maintain a healthy lifestyle by exercising regularly, following a balanced diet, and managing your blood sugar levels effectively. These lifestyle factors can help improve circulation and reduce the risk of complications associated with peripheral vascular disease.
  • Quit smoking if you are a smoker. Smoking damages blood vessels and exacerbates peripheral vascular disease. By quitting smoking, you can significantly improve blood flow to your feet and lower the risk of developing foot complications.
ingrown toenail

9) Prevent Ingrown Toenails.

    • Ensure shoes and socks provide ample space for toes.
    • Cut toenails straight across, allowing a 2 mm extension beyond the nail bed.
    • Seek professional assistance for cutting toenails if difficulty arises due to toenail fungus.

    10) Moisturize Regularly for Dry Skin to Prevent Diabetic Foot Issues.

    • Use a pumice stone gently to remove dead skin from the soles of the feet.
    • Moisturize the feet with products like Vaseline, pure coconut oil, or diabetic foot creams containing urea.
    • Applying moisturizer and covering the feet with plastic wrap can lock in moisture.
    • Avoid foot soaks, especially in vinegar, as they can further dry out the feet.

    11) Take Care to Avoid Burns and Frostbite Injuries, Especially if You Suffer From Diabetes-Related Neuropathy.

    • Use TENS units cautiously to avoid burns.
    • Protect feet in cold weather with appropriate footwear, socks, and avoid barefoot walking.
    • Avoid direct exposure to space heaters and electric heated blankets.

    12) Monitor for Charcot Changes.

    • If you notice changes in foot structure or flattening, consult your doctor immediately.
    • Treatment may involve staying off the affected foot, using custom diabetic shoes, inserts, or a CROW walker (a specialized offloading boot).
    • Surgery might be necessary in severe cases to prevent further bone damage.

    When Should You See a Health Care Provider?

    Knowing when to seek medical attention for diabetic foot problems is crucial for early intervention and preventing complications. If you have diabetes and notice any concerning symptoms or changes in your feet, it is essential to promptly consult a healthcare provider. 

    Signs that warrant a visit include persistent foot pain, numbness or tingling, open sores or wounds, redness, swelling, or signs of infection such as pus or streaking red lines. Additionally, if you experience difficulty walking, foot deformities, or notice any structural changes in your feet, it is important to seek medical evaluation. 

    Regular at-risk foot exams with a Podiatrist or healthcare professional are recommended every 3 to 6 months for individuals with diabetes and neuropathy to assess nerve function, balance, and detect any early signs of foot issues. It can also help to avoid an injury that may happen. 

    Remember, early detection and proper management are key in preventing further complications and promoting overall foot health.

    Conclusion 

    In conclusion, this article has provided valuable information on diabetic foot problems, highlighting the importance of understanding the causes, symptoms, and preventive measures associated with these conditions. 

    Diabetic individuals, as well as any person at risk, should be aware of the potential complications from diabetes and the impact they can have on foot health. Nerve damage and poor circulation can lead to serious foot problems, making it crucial to prioritize foot and ankle care. 

    By being proactive and informed about topics such as neuropathy, peripheral vascular disease, calluses, ulcers, and ingrown toenails, individuals can take necessary steps to protect their feet. 

    Regular check-ups at a foot clinic or with a healthcare provider, such as a Podiatrist, are key in maintaining optimal foot health and addressing any concerns promptly. 

    It is important for anyone experiencing symptoms like persistent foot pain, numbness/irritated nerves, open sores, or signs of infection to seek medical attention at a specialized center or clinic. 

    By staying informed and taking appropriate measures, individuals can effectively prevent serious complications and ensure the overall well-being of their feet, avoiding the development of sore and potentially debilitating foot problems associated with diabetes or any foot problem in general.

    Related post:

    Pedicures and Diabetes- Safety Tips for a Diabetic Considering a Pedicure

    Gangrene and Diabetes: Causes & Treatment

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     References

    1. Lavery, L. A., Armstrong, D. G., Wunderlich, R. P., Mohler, M. J., Wendel, C. S., & Lipsky, B. A. (2006). Risk factors for foot infections in individuals with diabetes. Diabetes care, 29(6), 1288-1293. 
    2. Singh N, Armstrong DG, Lipsky BA. Preventing Foot Ulcers in Patients With Diabetes. JAMA. 2005;293(2):217–228. doi:10.1001/jama.293.2.217
    3. Boulton, A. J., Cavanagh, P. R., & Rayman, G. (Eds.). (2006). The foot in diabetes. John Wiley & Sons.
    4. DiPreta, J. A. (2014). Outpatient assessment and management of the diabetic foot. Medical Clinics, 98(2)
    5. Mayfield, J. A., Reiber, G. E., Sanders, L. J., Janisse, D., & Pogach, L. M. (1998). Preventive foot care in people with diabetes. Diabetes care, 21(12)
    6. Ulbrecht, J. S., Cavanagh, P. R., & Caputo, G. M. (2004). Foot problems in diabetes: an overview. Clinical Infectious Diseases, 39(Supplement_2), S73-S82.
    7. Bus, S. A., Lavery, L. A., Monteiro‐Soares, M., Rasmussen, A., Raspovic, A., Sacco, I. C., … & International Working Group on the Diabetic Foot. (2020). Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes/metabolism research and reviews, 36
    8. Aalaa, M., Malazy, O. T., Sanjari, M., Peimani, M., & Mohajeri-Tehrani, M. R. (2012). Nurses’ role in diabetic foot prevention and care; a review. Journal of Diabetes & Metabolic Disorders, 11(1), 1-6.
    9. Schaper, N. C., Van Netten, J. J., Apelqvist, J., Lipsky, B. A., Bakker, K., & International Working Group on the Diabetic Foot (IWGDF). (2016). Prevention and management of foot problems in diabetes: a Summary Guidance for Daily Practice 2015, based on the IWGDF Guidance Documents. Diabetes/metabolism research and reviews, 32, 7-15. 
    10. Boulton, A. J., Cavanagh, P. R., & Rayman, G. (Eds.). (2006). The foot in diabetes. John Wiley & Sons. 
    11. Forlee, M. (2010). What is the diabetic foot?. CME: Your SA Journal of CPD, 28(4), 152-156.

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    Vaishnavi Bawa
    Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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