When you were diagnosed with diabetes, you’ve probably been told you have to take extra care of your feet and get them checked at least once a year.
Both Type 1 and Type 2 diabetes increase the risk of developing and/or aggravating foot problems. Cases of tiny blisters never healing and leading to not less than amputation do happen. This is a reality we all need to be well aware of. That being said, it’s not because you have diabetes that you will necessarily have feet problems.
First things first: let’s try and understand why people with diabetes are more likely to have foot problems, and which problems we’re talking about exactly. Then, we’ll see how a proper foot care routine, and sometimes a specialised diabetic footwear gear can help you stay away from most of these problems.
Remember that diabetes foot problems are directly linked to diabetes management. If your diabetes is under control and your glycated haemoglobin (HbA1c) stays below 7%, there is no reason you should develop more foot conditions than the general population.
Diabetes foot problems start appearing when diabetes is not properly managed over a long period of time. To simplify things a bit, foot problems arise when one or both of these diabetes complication symptoms happen:
1- A decreased sensation in your feet. This is due to a common serious diabetes complication called Diabetic Neuropathy that affects the nerves of the legs and the feet.
2- A lack of oxygen delivery to the legs and feet. This is caused by another common diabetes complication called Peripheral Artery Disease.
Diabetic neuropathy is a type of nerve damage caused by long-term high blood sugar levels. It usually develops over decades. This damage caused to the nerves of the legs and the feet leads to a loss of feeling.
Loosing feeling in your feet and legs is quite worrying. It means you sometimes won’t notice a burn, a cut, or any sort of pain. That’s mostly why a tiny wound that would be insignificant for most people can become very serious for people with diabetic neuropathy. It can easily get worst and infected without you even noticing it.
Diabetic neuropathy also has a big impact on our muscles. Our nerves send and receive electrical messages which allow us to voluntarily control our muscles. With our nerves being affecting, the messages they sent and receive are less clear, and our feet and legs muscles cannot work properly. This can sometimes lead to another kind of foot problems among people with diabetes: the foot is not properly aligned, which start creating points of pressure leading to conditions such as hammertoes, or bunions (which we’ll talk about in section 2).
Peripheral artery disease is the other diabetes complication that can seriously affect our feet. Basically, it reduces the blood flow in our arms and legs. Without proper blood flow, oxygen lacks, and it takes longer for a wound to heal. This is why people with diabetes are more at risk of developing infections, ulcers, or even gangrene.
Ok… So, these are the 2 main reasons why people with (uncontrolled) diabetes are more likely to get foot problems. Now let’s have a look at what these foot problems are exactly and try to identify them.
Here are the 12 most common foot problems you should be concerned about if you have diabetes. In any case, if you ever feel any foot pain or notice wounds on your feet, always ask for your doctor’s diagnosis and advice. Although they may seem insignificant, remember that even tiny blisters can lead to severe conditions.
Foot ulcers are open sores in the feet that won’t heal over a long period of time. It generally comes from the breakdown of a dry skin, and looks like a red crater. Mostly found on the bottom or side of the feet, or even on top of a toe.
If the foot nerves are functioning, the ulcer can be very painful. But if not, you may not even notice you have a foot ulcer. Without treatment, a foot ulcer can become infected and lead to serious complications such as a reduced functioning of your foot or even, in some cases, an amputation (6% of people with a diabetic foot ulcer will be hospitalized due to infection or other ulcer-related complication).
Feet swelling (Edema) is caused by water retention in the feet, ankles, and sometimes legs. It is a common problem among people with diabetes. It can originate from various diabetes-related factors such as poor blood circulation, venous insufficiency, heart or kidney problems, obesity…
Swollen feet can be very painful and cause great difficulty to walk or even stand up. Here’s a great article from Healthine about how to treat and alleviate swollen feet.
Diabetic foot pain is not a condition by itself but it can be a symptom of Diabetic Neuropathy. Due to nerves being affected, your feet can become extremely sensitive to pain. The mere touching of the skin by a sheet in bed could be painful. Massaging your feet with an appropriate diabetic foot pain relief can sometimes help relieve the pain, but if you feel foot pain, you should definitely seek your doctor’s advice first and get a diagnosis as to whether it comes from Diabetic Neuropathy.
Both calluses and corns are thicker and harder layers of skin on the feet or toes. They often develop when the shoe causes a friction or pressure on a specific part of your feet. For most people they’re temporary and benign. But if you have diabetes, you risk developing complications from calluses and corns. That’s why you should avoid them, watch out for them, and seek your doctor’s advice in case they appear.
Tinea Pedis, also called Athlete’s Foot, is a contagious feet fungal infection contracted by approximatively 20% of the population. It looks like redish and itchy scales on the skin between the toes and/or the soles. People with diabetes face a higher risk of catching Tinea Pedis and other foot fungal infections. They often develop more serious complications sometimes leading to foot ulcer, gangrene, and in extreme cases, amputation. Treatment is often an over the counter cream such as Lotrimin Ultra.
Hammertoe is a deformity of toe joints caused by muscle or tendons imbalance, leading to the bending of one or several toes. Diabetic neuropathy weakens feet muscles, making hammertoes more common among people with diabetes. When at advanced stage, it can be very painful, especially when wearing shoes. When orthopaedic shoes are not enough, surgery is sometimes the ultimate treatment.
Bunions are progressive deformity of the big toe which angles in towards the second toe. It often comes with redness and callused skin. Like hammertoes, it can cause severe pain and sometimes lead to surgery to realign the toes.
Ingrown toenails are a common condition in which the corner or side of a toenail grows into the soft flesh. It is not necessarily threatening but can cause extreme pain and risk of infection. People with diabetes are more at risk of getting infection from ingrown toenails than other people. The most common cause is pressure from the shoes, so a good pair of orthotic shoes are often the best long-term treatment.
Although blisters are extremely common, they can be threatening due to a high risk of infection. Remember that diabetic feet are more sensitive and prone to infections. Any blister should be very-well taken care off to avoid further complications. Don’t “pop” them: Their upper skin helps prevent an infection! Here are a few more tips from WEbMD on how to deal with blisters.
As they’re often caused by friction from the shoes or the socks, if you often have blisters, it is recommended you change shoes, use blister-guard diabetic socks or get a Blisters Defense stick like Dr Scholls for example.
High blood sugar levels can cause dehydration, and your skin suffers from it too. At times, the skin of your feet can get very dry. This is not a “medical condition” but it can lead to many of them. Dry skin can peel or crack and get infected, causing further complications such as ulcers. A good feet moisturiser plays a major role in diabetic foot care.
Excessive feet sweating can be a big problem for people with diabetes. To avoid bacterial and fungus infections, your feet need to stay dry. When your feet sweat all the time, it’s pretty impossible. There are several medical solutions when it comes to extreme feet sweating, such as iontophoresis or even botox injections. But before getting to such heavy treatments, try wearing the right socks, or using an anti-perspirant such as Carpe’s antiperspirant foot lotion. Ask for your doctor’s advice!
Gangrene is the death of body tissues due to a reduced blood flow or a bacterial infection. It commonly starts at body extremities such as the toes. If diagnosed at an early stage, gangrene can be cured. But the prognosis can be extremely bad if left untreated for a long time (amputation, or even death).
Amputation. It’s a word people with diabetes have all heard about and that frightens us all. And for a good reason: it does happen. If not taken care of, each of the above mentioned diabetes-related foot problems can ultimately lead to amputation of a toe, a foot, and sometimes even a full leg. We’re not going to enter into too much details about it but the following figures might interest you:
That being said, no need to panic. For most of us living with diabetes, the situation is not that bad at all. There are many ways to avoid foot problems, even if you have diabetes.
It’s not because you have diabetes that you will have foot problems. But you will have to be careful and take extra care of your feet for the rest of your life.
First, if you properly manage your diabetes and keep your HbA1c below 7%, you are not at greater risk of developing nor aggravating any foot condition than the general population. This is the very first step toward avoiding foot problems: controlling your diabetes.
Second, a strict foot care routine following this guideline helps prevent the majority of foot problems, even among people with diabetes.