“Diabetic Foot” is a term used to describe foot complications experienced by diabetics. If you have diabetes, you are more likely to have problems with your feet.

Diabetic foot conditions develop from a combination of causes related to a sustained high blood sugar level over time (poor control), which is known to cause damage to nerves and blood vessels.

Nerve damage caused by diabetes is called “neuropathy,” and it can cause you to lose sensation in your feet. If this happens, you may not feel an injury or a developing wound until you sustain severe damage or an infection develops.

When diabetes damages blood vessels, the body is not able to provide the feet with enough blood and oxygen, resulting in weakened skin that is prone to breaking down and slow to heal when injured.

Diabetes also hinders your body’s ability to fight infections. Small sores or cuts can lead to deep ulcerations, which often become infected, possibly requiring amputation of limbs or digits.

The lack of oxygen supplied to the feet as a result of the diminished blood flow makes it harder for the feet to heal after an injury or when damage occurs.

Diabetics should keep a close eye on their feet, inspecting them regularly to avoid wounds that can lead to infections. Diabetics should consult a podiatrist on a regular basis to avoid foot problems and to learn about proper preventive measures.

Diabetics can often avoid these problems by controlling their blood sugar levels and practicing proper daily hygiene habits.

Diabetic Foot Ulcers

Diabetic foot ulcers are extremely common—85 percent of all lower limb amputations are attributed to them.

Diabetic foot ulcers affect approximately 15 percent of all diabetic patients. Of those, 15–20 percent lose a limb to amputation. Foot ulcers usually begin as small sores or cuts in the skin.

Because of the loss of sensation, a small sore or a minor cut or abrasion may not be felt and may develop into a serious infection or ulcer. Walking around barefoot increases the risk of incurring a minor injury that can progress quickly to an ulceration or infection.

People who suffer from peripheral sensory neuropathy are highly susceptible to foot ulcers. Peripheral sensory neuropathy is a condition in which damage has occurred to the peripheral nervous system (the communication network that transmits information from the brain and spinal cord to all parts of the body).

For example, when you have cold feet, this system informs your brain that your feet are cold. If this system is damaged, transmitters may send mixed signals, or they may not transmit at all.

Diabetic Foot Symptoms To Be Aware Of

Here are some symptoms that may accompany a developing diabetic foot problem:

• Persistent burning pain or numbness
• Redness around a wound
• Swelling of the feet or legs
• Hair no longer growing on lower legs and feet
• Hard, shiny skin on legs and feet
• Localized warm sensation on foot
• Breaks in skin
• Wound that is draining
• Difficulty walking
• Fever or chills (this usually means the infection is life- or limb-threatening)

What Causes the Diabetic Foot?

Diabetes is known to cause many complications that contribute to diabetic foot problems. Diabetes disrupts our vascular system and affects many parts of the body, including the eyes, kidneys, legs, and feet.

Several risk factors can increase your chances of developing a diabetic foot problem. These factors may include:

• Improper footwear, which may lead to calluses, corns, blisters, red spots, and pain
• Foot abnormalities such as flat feet, bunions, or hammertoes
• Nerve damage, known medically as peripheral neuropathy
• Poor circulation
• Trauma to the foot
• Infections such as athlete’s foot, ingrown toenails, or fungal infections

Diabetic Foot Prevention Tips to Know About

Prevention is generally the patient’s responsibility, but all preventive measures should be discussed first with your podiatrist or doctor. Here are some ways you can reduce your chances of developing a diabetic foot problem:

• Wash feet daily with mild soap and warm (not hot) water.
• Do not soak your feet; this leads to dry skin.
• Keep the skin on the top and bottom of your feet smooth and moisturized.
• Do not use lotions between your toes.
• Do not smoke.
• Control your blood sugar levels.
• Inspect your feet daily for changes in your skin.
• Use custom-molded orthotics to protect your feet.
• Always wear properly fitting, undamaged, and supportive shoes and socks.
• Discontinue using shoes and socks with holes in them.
• Avoid sandals, high heels, and other forms of open-toe shoes.
• Avoid antiseptic solutions on the feet, as they can burn or injure the skin.
• Do not step barefoot on hot surfaces, and avoid extreme heat on your feet.
• Do not treat sores, corns, or calluses on your own without consulting your doctor.
• Report any damage, pain, or changes in your feet immediately.
• Seek medical care for any wounds that develop.
• Wear socks to bed if your feet are cold.
• Remove obstacles around your home and workplace to reduce the chances of tripping or injuring your feet.
• Exercise or move around often; this helps to improve circulation.
• Avoid wearing tight clothes and shoes that may cut off circulation to your legs and feet.
• Avoid crossing your legs for long periods.
• Before exercising, always perform a quick warm-up routine.
• After exercising, always perform a quick cool-down routine.
• Proper socks to cushion your and wick away moisture

When to See Your Doctor

If you suspect you may be developing a diabetic foot problem, it is usually best to contact your doctor at the first sign of symptoms. Early intervention can usually prevent a trip to the emergency room or a hospitalization.

Write down a list of symptoms so you have them handy when talking with the doctor. This information will help the doctor to determine the relative urgency of the situation and establish a plan of action.

Your doctor may wish to see you immediately, but should make an appointment to see you within 72 hours or less. Call your doctor if any of the following occurs:

• Trauma to the legs or feet, ranging from minor to severe
• Persistent mild-to-moderate pain in the feet
• New blisters, wounds, or ulcers appear
• New areas of warmth, redness, or swelling in the feet
• Pain or soreness around the toenail
• New or constant numbness in foot (this could be a sign of neuropathy)
• Constant itching of the skin on foot
• Difficulty walking

TIP: Talk with your doctor about removing calluses and corns that may develop on your feet. These should be professionally removed.

Diabetic Foot Treatment Options

Treatment for your diabetic foot problem will be based on the symptoms you are experiencing. If you are suffering from mild to moderate foot ulcers, simple wound-care measures are usually recommended, and oral antibiotics may be prescribed if a mild infection is present.

For more serious ulcers or infections, hospital admission for IV antibiotics may be necessary. Proper wound care is essential to the healing process. For more serious cases, the doctor may prescribe a home-health nurse to help care for the wounds and dressings.

If the infection cannot be cured with wound-care and antibiotic medications, surgical debridement to remove infected and damaged tissue will likely be necessary. Severe or extensive tissue damage may require amputation of the foot.

During all stages of a diabetic’s life, preventive measures such as those listed above are highly recommended to avoid diabetes-related foot problems.

Even if you are not suffering from ulcers, your podiatrist can help you improve other aspects of your life, such as your footwear, dietary habits, and physical fitness, which can reduce your chances of developing a diabetic foot problem.

Talking to Your Doctor

Here are some questions you may want to ask your doctor if you are currently being treated for a diabetic foot problem:

• Can I still travel by airplane, boat, car, bus, train, etc.?
• Will I need to alter my diet during the healing process?
• Have there been any recent advancements that you are aware of in treatment for the diabetic foot?
• Will controlling my diabetes prevent this problem?
• How often do I need to check my blood sugar?
• Can I start an exercise program?
• Do I need custom molded diabetic shoes and insoles?  Do I qualify?
• What type of socks should I wear?

Diabetic Foot Resources

If you have diabetes and think you may be suffering from a diabetic foot, take a look at these additional resources that may provide the information you are looking for:

American Diabetes Association
1701 North Beauregard Street Alexandria, VA 22311-1
Phone: 1-800-DIABETES
Website: http://www.diabetes.org/
Email: AskADA@diabetes.org

Centers for Disease Control and Prevention
1600 Clifton Rd. Atlanta, GA 30333
Phone: 1-800-CDC-INFO
Website: http://www.cdc.gov/diabetes
Email: cdcinfo@cdc.gov

National Diabetes Information Clearinghouse (NDIC)
1 Information Way Bethesda, MD 20892
Phone: 1-800-860-8747
Website: http://diabetes.niddk.nih.gov/index.htm
Email: ndic@info.niddk.nih.gov