For people with diabetes, having too much glucose in their blood for too long can lead to certain serious complications, including foot problems.
How does diabetes affect the feet?
Diabetes can lead to foot problems by causing two types of lesions.
- Diabetic neuropathy. Uncontrolled diabetes can damage nerves. If nerves in the legs and feet are damaged, you may not feel heat, cold, or pain. This loss of sensation is called “diabetic sensory neuropathy. If you cannot feel a wound or pain in the foot because of neuropathy, the wound may get worse and become infected. Because of damage to the nerves that innervate the foot muscles, the foot muscles may not move properly, which can lead to incomplete alignment of the foot and excessive pressure in localized areas of the foot. It is estimated that foot ulcers occur in up to 10% of people with diabetes. Foot ulcers are usually caused by nerve damage and peripheral vascular disease.
- Peripheral vascular disease. Diabetes also affects the flow of blood. If there is poor blood flow, the wound takes longer to heal. Poor blood flow in the arms and legs is called “peripheral vascular disease,” a circulatory disorder that affects the blood vessels distal to the heart. If the infection does not heal because of poor blood flow, there is a risk of ulceration or gangrene (necrosis of tissue due to lack of blood).
What are common foot problems in people with diabetes?
The following foot problems can happen to anyone. However, for people with diabetes, these common foot problems can lead to infections and serious complications (such as amputation).
- Tinea pedis Tinea pedis is a fungal infection that can cause itching, redness, and cracking. The fungus can enter through skin fissures and cause infection. Antifungal medications may be used to treat tinea pedis. Such medications may be oral medications or creams that are applied directly to the infected area. Ask your doctor to recommend a medication for tinea pedis.
- Toenail fungal infection Infected toenails may become discolored (yellowish brown or opaque), thick and brittle, and may separate from the rest of the toenail. In some cases, the toenail may shatter. Dark, moist, warm conditions in shoes can promote fungal growth. In addition, damaged toenails can put a person at risk for fungal infections. Toenail fungal infections are difficult to cure. Medications applied directly to the toenail may be effective, but only help with a small percentage of toenail fungal infection problems. Oral medications may need to be prescribed by a doctor. Treatment may also include regular removal of the damaged toenail.
- Calls Calls consist of a buildup of hard skin, usually located on the bottom of the foot. Calluses are caused by uneven pressure distribution and are usually located on the forefoot or bottom of the heel. Calluses can also be caused by ill-fitting shoes or skin abnormalities. Keep in mind that it is normal to have a small amount of callus on the bottom of the foot. Proper care is necessary for those with calluses. After bathing, use a pumice stone to gently remove the tissue build-up. Use soft padding and insoles in the shoe. Prescription medications may also be applied to soften the callus. Do not attempt to excise or remove the callus with a sharp instrument.
- Cocksore Cocksores are formed by the accumulation of hard skin near or between the toes in a bony area. Corns may be caused by pressure from shoes or friction between the toes. For those who have corns, proper care is necessary. After bathing, use a pumice stone to gently remove the built-up tissue. Do not use over-the-counter medications to soften and remove corns. Do not attempt to cut or remove the corns with a sharp instrument either.
- Blisters: Blisters can form when shoes rub repeatedly on the same area of the foot. Ill-fitting shoes or wearing shoes without socks can cause blisters, which can then lead to infection. When treating blisters, be especially careful not to “squeeze” the blister. Covering the blistered skin helps protect the blister from infection. Patients can use antibacterial creams and clean, soft bandages to help protect the skin and prevent infection.
- Bunions A bunion occurs when the big toe tilts toward the second toe. Contact between the big toe and the rest of the foot usually results in redness and calluses. The area may also protrude and become hard. Bunions can occur in one or both feet and may run in families, but the most common cause is the wearing of high-heeled shoes with a narrow toe. Such shoes can put pressure on the big toe, pushing it against the second toe. Using a soft pad or foam liner on the foot may help protect the bunion from irritation. Appliances may also be used to separate the big toe from the second toe. If the bunion is causing severe pain and/or deformity, surgery may be needed to realign the toe.
- Dry skin Dry skin can crack and bacteria can enter. Using moisturizing soaps and lotions can help keep the skin moist and soft.
- Foot ulcers Foot ulcers are broken or deep cuts in the skin that can become infected. Foot ulcers can be caused by minor abrasions, slow-healing wounds, or friction from ill-fitting footwear. Early intervention is very important in the treatment of foot ulcers. Talk to your doctor about how to provide the best care for the wound.
- Malleolar toe Malleolar toe is a toe that is bent due to muscle weakness. Muscle weakness shortens the tendon (the tissue that connects muscle to bone), causing the toe to curl at the bottom of the foot. Mallet toe may run in families or may be caused by short shoes. Mallet toe can cause difficulty walking and lead to other foot problems (such as blisters, calluses and ulcers). Splints and orthotic shoes can help treat mallet toe. Severe cases may require surgery to correct the toe.
- An ingrown toenail An ingrown toenail occurs when the edge of the toenail grows inward into the skin, causing pressure and pain at the edge of the toenail. The edge of the toenail may become embedded in the skin, causing redness, swelling, pain, spillage, and infection. The most common cause of ingrown toenails is pressure from wearing ill-fitting shoes. Other causes include improperly trimmed toenails, crowded toes and repeated damage to the foot from activities such as running, walking or aerobics. Proper trimming of the toenail is the best way to prevent ingrown toenails. For those with persistent ingrown toenail problems or infected toenails, medical attention may be required. Severe ingrown toenails can be corrected by surgically removing part of the toenail and growth plate.
- Plantar warts Plantar warts resemble calluses on the bottom of the foot or heel. It has pinhole-like or small black dots in its central area. Warts can often cause pain and may be solitary or multiple. Plantar warts are caused by a virus that infects the outer layer of skin on the bottom of the foot. If you are unsure whether you have plantar warts or calluses, have them diagnosed by your doctor. Your doctor may offer several treatment options, including topical application of salicylic acid, cauterization, liquid nitrogen freezing, laser therapy, or surgical removal. Over-the-counter salicylic acid and freezing sprays are also part of the treatment, but such therapies may not be as effective as the treatment options offered by your doctor.
How can I prevent foot problems?
Proper foot care can help prevent these common foot problems and treat them before they cause serious complications. Here are some effective foot care tips.
- Take care of yourself and manage your diabetes. Follow your health care provider’s recommendations about nutrition, exercise, and medication. Keep your blood sugar levels within the range recommended by your doctor.
- Wash your feet daily with mild soap and warm water. Test the water temperature with your elbow (nerve damage from diabetes can also affect hand sensation), do not take foot baths, and dry your feet gently after washing, paying special attention to drying between the toes.
- Check the foot daily for ulcers, blisters, redness, calluses, or any of the other problems listed above. It is especially important to perform a daily foot exam for those with poor blood flow.
- For those with dry skin on the feet, apply lotion after washing and drying to keep the feet moist. Do not apply lotion between the toes. Your doctor can advise on the best lotion to use.
- Gently buff away corns and calluses using a emery board or pumice stone. Do this with the skin soft after bathing. Move the emery board in one direction only.
- Check your toenails once a week. Trim toenails directly with nail clippers. Do not cut off the corners and sides of the toenail. Use a nail file to smooth the toenail after clipping.
- Always wear footwear or flip-flops that do not show your toes. Don’t wear sandals and don’t walk barefoot, even around the house.
- Always wear short or long socks. Wear well-fitting, soft and flexible footwear.
- Choose shoes that fit well.
- Choose shoes that fit well. Buy shoes made of canvas or leather and visit your podiatrist every two to three months for an examination, even if you don’t have any foot problems.
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When to visit
People with diabetes should consult their doctor if they have any of the following problems.
- Change in skin color.
- Change in skin temperature.
- Swelling of the foot or ankle.
- Pain in the leg.
- Slow healing or fluid spillage from an open wound on the foot.
- Inward growing toenail or toenail fungal infection.
- Cocksore or callus.
- Dry and cracked skin (especially around the heel).
- Abnormal and/or persistent foot odor.