Over time, diabetes can lead to various complications, many of which can be serious if they are not identified and addressed promptly. Foot problems are a common complication in people with diabetes.
In general, you can lower your risk of diabetes-related complications by keeping your blood sugar in the goal range and seeing your doctors for regular checkups. You can also lower your risk of developing foot problems by examining your feet regularly. This way, if problems do occur, you are more likely to notice them right away so you can get the proper treatment. It may take time and effort to build good foot care habits, but it is an essential part of diabetes management.
This article will discuss the foot-related complications that can happen in people with diabetes, as well as guidelines for good foot care and tips for lowering your risk of developing these problems.
RISK FACTORS
Over time, diabetes that is not carefully managed can lead to foot complications. You have an increased risk of developing foot problems if you:
- Have had a foot ulcer in the past
- Have nerve damage
- Have any foot deformities
- Have poor circulation
If you have any of these risk factors mentioned, particularly a previous foot ulcer, you may be at increased risk of foot problems if you take medications called sodium-glucose co-transporter 2 (SGLT2) inhibitors to manage your blood sugar. SGLT2 inhibitors, particularly canagliflozin, may increase your risk of requiring toe amputations. Your health care provider can talk to you about other medication options.
- Past foot ulcer — Once you have had a foot ulcer, even if it heals completely, you are at an increased risk of developing ulcers again in the future.
- Nerve damage — Over time, high blood sugar levels can damage the nerves that carry sensation; this nerve damage is known as “diabetic neuropathy.” Because people with neuropathy may lose their ability to sense pain, they are at increased risk for injuring the feet; even a minor injury can become serious quickly if it goes unnoticed. Nerve damage can also weaken certain foot muscles and contribute to foot deformities.
- Foot deformity — Abnormalities in the shape of the toes, arches, or bottoms of the feet can raise the risk of complications.
- Poor circulation — Longstanding high blood sugar levels can cause damage to the blood vessels, decreasing blood flow to the feet. Poor circulation can weaken the skin, contribute to the formation of foot ulcers, and impair wound healing. Some bacteria and fungi thrive on high levels of sugar in the bloodstream; if a wound gets infected, this can break down the skin and make ulcers worse.
More serious complications include deep skin and bone infections. Gangrene (decay and death of tissue) is a very serious complication; widespread gangrene may require amputation. Approximately 5 percent of people with diabetes eventually require amputation of a toe or foot. However, this can be prevented in most situations by managing blood sugar levels and committing to daily foot care.
FOOT EXAMINATIONS
Regular foot exams to check for problems or changes are a critical part of managing your diabetes.
Self-exams — It is important to examine your feet every day. This should include looking carefully at all parts of your feet, especially the area between the toes. Look for broken skin, ulcers, blisters, areas of increased warmth or redness, or changes in callus formation; let your health care provider know if you notice if any of these changes or have any concerns.
Clinical exams — During your routine medical visits, your health care provider will check the blood flow and sensation in your feet. The frequency of these clinical exams will depend on which type of diabetes you have:
- In people with type 1 diabetes, annual foot exams should begin five years after diagnosis.
- In people with type 2 diabetes, annual foot exams should begin at the time of diagnosis.
During a foot exam, your health care provider will check for poor circulation, nerve damage, skin changes, and deformities. They will also ask you about any problems you have noticed in your feet. An exam can check for decreased or absent reflexes or decreased ability to sense pressure, vibration, pinpricks, and changes in temperature.
What to look for — You and your health care provider can look for certain signs and symptoms that could indicate problems with your feet.
- Skin changes or wounds — Excessive skin dryness, scaling and cracking may be signs of problems. Ulcers can start out as sores affecting just the top layer of skin, but if left untreated, they can go deeper into the skin and muscle.
- Signs of nerve damage — Nerve damage may lead to unusual sensations in the feet and legs, including pain, burning, tingling, or numbness. Over years, if nerve damage becomes advanced, the foot and leg can eventually lose sensation completely. This can be very dangerous because if you cannot feel pain, you may not notice if the skin is irritated or if you have injured your foot.
- Deformities — The structure and appearance of the feet and foot joints can indicate diabetic complications. Nerve damage can lead to joint and other foot deformities.
- Signs of poor circulation — A weak pulse, cold feet, thin or blue skin, and lack of hair in the area suggest that your feet are not getting enough blood flow.
PREVENTING FOOT PROBLEMS IN DIABETES
There are several things you can do to reduce your chances of developing foot problems. In addition to managing your blood sugar, practicing good foot care habits and checking your feet daily are important for preventing complications.
Importance of blood sugar management — In general, you can reduce your risk of all diabetes-related complications by keeping your blood sugar levels as close to your target as possible. Managing your blood sugar requires seeing your doctor regularly, making a healthy diet and lifestyle changes, and taking your medications as directed. More information about managing your diabetes is available separately.
Careful management of blood sugar levels can reduce the risk of circulation problems and nerve damage that often lead to diabetic foot complications.
- Quit smoking — Smoking can worsen heart and vascular problems and reduce circulation to the feet.
- Avoid activities that can injure the feet — Certain activities increase the risk of foot injury or burns and are not recommended. This includes walking barefoot.
- Use care when trimming the nails — Trim your toenails straight across, and avoid cutting them down the sides or too short. You can use a nail file to remove any sharp edges to prevent the toenail from digging into your skin. Never cut your cuticles or allow anyone else (eg, a manicurist) to do so.
- Wash and check your feet daily — Use lukewarm water and mild soap to clean your feet. Thoroughly dry your feet, paying special attention to the spaces between the toes, by gently patting them with a clean, absorbent towel. Apply a moisturizing cream or lotion.
- Choose socks and shoes carefully — Wear cotton socks that fit loosely, and be sure to change your socks every day. Select shoes that are snug but not tight, with a wide toe box, and break new shoes in gradually to prevent any blisters.
- Be sure to get regular foot exams — Checking for foot-related complications should be a routine part of most medical visits; however, this is sometimes overlooked. Don’t hesitate to ask your provider for a foot check at least once a year.
TALK TO DR. ARIEL LEPOFF
If you have concerns about your legs or feet, please call (561) 622-6111 and make an appointment to come see Dr. Ariel Lepoff at The Medical Group of South Florida.
Dr. Lepoff will do an examination and evaluate the overall condition of your legs and feet. Then together with you, determine the best course of treatment to bring about proper healing. Whenever, wherever you need us, we’re here for you.