Diabetic Foot: Facts, Causes, Symptoms & Treatment

For people with diabetes, having too much glucose (sugar) in their blood for a long time can cause some serious complications, including foot problems.

Diabetes Foot problems facts

• Two main conditions, peripheral artery disease (PAD) and peripheral neuropathy, are responsible for the increased risk of foot problems in people with diabetes.
• People with diabetes have an increased risk of ulcers and damage to the feet.
• A number of different kinds of foot problems can occur in people with diabetes. These include bunions, corns, calluses, hammertoes, fungal infections, dryness of the skin, and ingrown toenails.
• Treatment depends on the exact type of foot problem. Surgery may be required for some cases.
• Gangrene (dry gangrene) is tissue death due to absence of blood circulation. It can be life-threatening if bacterial infection develops (wet gangrene).
• Many diabetes-related foot problems can be prevented by good control of blood sugar levels combined with appropriate care of the feet.

Causes of Diabetic Foot Care

Several risk factors increase a person with diabetes chances of developing foot problems and diabetic infections in the legs and feet.

Footwear: Poorly fitting shoes are a common cause of diabetic foot problems.

• If the patient has red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new properly fitting footwear must be obtained as soon as possible.
• If the patient has common foot abnormalities such as flat feet, bunions, or hammertoes, prescription shoes or shoe inserts may be necessary.

Nerve damage: People with long-standing or poorly controlled diabetes are at risk for having damage to the nerves in their feet. The medical term for this is peripheral neuropathy.

• Because of the nerve damage, the patient may be unable to feel their feet normally. Also, they may be unable to sense the position of their feet and toes while walking and balancing. With normal nerves, a person can usually sense if their shoes are rubbing on the feet or if one part of the foot is becoming strained while walking.
• A person with diabetes may not properly sense minor injuries (such as cuts, scrapes, blisters), signs of abnormal wear and tear (that turn into calluses and corns), and foot strain. Normally, people can feel if there is a stone in their shoe, then remove it immediately. A person who has diabetes may not be able to perceive a stone. Its constant rubbing can easily create a sore.
• Poor circulation: Especially when poorly controlled, diabetes can lead to accelerated hardening of the arteries or atherosclerosis. When blood flow to injured tissues is poor, healing does not occur properly.
• Trauma to the foot: Any trauma to the foot can increase the risk for a more serious problem to develop.

Infections

• Athlete’s foot, a fungal infection of the skin or toenails, can lead to more serious bacterial infections and should be treated promptly.
• Ingrown toenails should be handled right away by a foot specialist. Toenail fungus should also be treated.
• Smoking: Smoking any form of tobacco causes damage to the small blood vessels in the feet and legs. This damage can disrupt the healing process and is a major risk factor for infections and amputations. The importance of smoking cessation cannot be overemphasized.

Symptoms of Diabetic Foot Problems

In the most severe case, as mentioned above, due to a combination of decreased sensation and reduced blood flow to the feet, ulcers may develop. If the tissues continue to receive insufficient oxygen, tissue death (gangrene) occurs. Gangrene is a serious and potentially life-threatening condition. Other potentially serious problems that may develop include cellulitis (infection of the tissues beneath the skin) and osteomyelitis (infection of the bone); sepsis (the infection spreads to the bloodstream) also is possible.

People with diabetes are at increased risk for milder problems with the feet that are not specific to diabetes but may occur more frequently due to problems with the nerves and circulation to the feet.

Some of these conditions are:

• Calluses and corns, that may develop due to abnormal alignment of the feet or abnormal gait
• Fungal infections of the nails, which can appear as thickened, discolored, and at times brittle nails
• Tinea pedis, or athlete’s foot, a fungal infection of the skin of the feet
• Hammertoes, or bent toes due to muscle weakness.
• Bunions, or the angling of the big toe toward the second toe. The area of the bunion may become reddened and irritated, leading to callus formation.
• Ingrown toenails
• Cracking of the skin of the feet, especially the heels, due to dry skin

Treatment for Diabetic Foot

Effective management of diabetic foot infection requires appropriate antibiotic therapy, surgical drainage, debridement and resection of dead tissue, appropriate wound care, and correction of metabolic abnormalities.