Diabetes is a chronic condition that requires careful observation, medication, monitoring blood sugar levels, watching the diet, staying active and regular visits to the doctor. Paying special attention to the feet and visiting a foot specialist is also important. Foot specialists are often part of the health team because foot care is essential for someone with diabetes. Diabetes can cause a variety of complications affecting the foot- from diabetic neuropathy to ulcers, infections, and gangrenes, which may require amputation.
How diabetes can affect the feet
- Nerve damage. One of the main complications of diabetes is diabetic neuropathy or nerve damage. Symptoms of neuropathy include tingling, numbness and pain in the arms of legs. Blood flow to the limbs is also decreased due to diabetes. Therefore the impairments in the nerve and blood vessels contribute to foot problems. Loss of sensation leads to inability to feel a cut, injury or blister on the foot, which can become infected. The sensation of hot and cold may be lost as well. People with diabetes tend to have slower healing of the wounds, and more likely to see complications like gangrene. The shape of the foot may also change due to nerve damage. So called Charcot foot begins with swelling and redness of the foot, which later causes the toes to shift and have a “rocker” bottom shape. Special therapeutic shoes and inserts are recommended, to avoid more damage to the foot. If this therapy fails, surgery helps correct the foot deformities.
- Infections. Individuals with diabetes are more likely to experience infections. Foot infections are often caused by bacteria Staphylococcus aureus, Streptococcus, Pseudomonas aeruginosa, rarely E. color and fungal infections with Candida species. Minor infections require topical treatment, while more severe forms are treated with oral or even intravenous medication. Special wound dressings that promote faster wound healing are available.
- Skin and deeper tissues. Diabetes is associated with dry skin, cracks and peeling of the skin because nerve damage interferes with the body’s ability to control the oil and moisture of the foot. Calluses tend to build up faster in those with diabetes. If not removed or trimmed, they can become very thick, break and lead to ulcers. Diabetic foot ulcer develops due to a combination of factors: poor control of the blood sugar levels, diabetic neuropathy, damage to blood vessels and poor foot care. Ulcers typically develop at the ball of the foot or on the bottom of the big toes. Foot ulcers are a leading cause of bone infections and gangrene. In some cases amputation is required to avoid the spread of the infection. When evaluating a foot ulcer, a doctor may order an X ray to see if the infection has spread to the bones and culture the wound to see which bacteria is causing the infection. The majority of foot ulcers (up to 80% of cases) heal, some remain active, and the rest require amputation within the next 18 months from the time of the diagnosis. Treatments include antibiotics, surgical debridement and wound care. Gangrene can complicate foot ulcers and infections. A gangrene is made of death cells due to lack of blood flow and infections. They can affect a toe or extend to the foot and leg. Signs and symptoms include changes in the skin cold (from pale to blue, red or purple), swelling, blisters, pain or numbness. The skin feels cooler than normal to touch and a smelly discharge may leak from the skin. Depending on the severity, a foot gangrene is treated with medication, surgery (from debirdment, to amputation or skin grafting) or hyperbaric oxygen therapy.
Proper foot care is essential to prevent infections and other complications
Most amputations and other serious complications can be prevented with frequent inspection of the foot, regular visits to the doctors, and wearing proper footwear.
Feet should be inspected regularly, looking for sores, cuts, blisters, ingrown toenails, or swelling. Medical advice should be sought if there are any changes. They should be washed every day, get them dry, and apply moisturizers (on the feet but not between toes, which should be kept dry). The nails should be kept trimmed, cut straight across.
Socks should be dry, breathable, and wear shoes that fit well. Avoid walking barefoot.
A simple exercise for the toes and feet can be incorporated into the daily routine- for example wiggling the toes for a few minutes, a few times daily.
Be aware of the risk factors that increase the odds of developing nerve damage and foot complications: poorly controlled blood sugar levels, high blood pressure, high cholesterol levels, and being overweight. All these risk factors can be prevented or better managed with a healthy diet, regular exercise (foot-friendly workouts include walking, walking, riding a bike, and swimming). Sleeping well and managing stress with yoga or mindfulness meditation is also part of a healthy lifestyle.