The feet are a frequent site of diabetes-related problems. Nerve damage and decreased circulation are important contributing factors to diabetic foot problems. Diminished or abnormal sensation, skin changes, wounds, infections and toe deformities are among the most common foot problems experienced by people with diabetes. Good foot care significantly decreases the risk for serious diabetes-related foot problems.
Diabetic Neuropathy
Long-standing diabetes frequently causes nerve damage, or diabetic neuropathy. The sensory nerves of the feet are usually affected. The University of Chicago Center for Peripheral Neuropathy notes that early symptoms typically include tingling, pinprick sensations, numbness or pain. Diabetic neuropathy is a progressive condition, which causes insensitivity to temperature, pain and pressure. Loss of sensation can lead to unnoticed toe or foot injuries. The National Institute of Diabetes and Digestive and Kidney Diseases recommends that diabetics check their feet daily for blisters, calluses, sores, cuts, ingrown toenails or other abnormalities.
Skin Fragility and Irritation
Diabetes often leads to poor foot circulation due to the deposition of plaques in the blood vessels of the legs, notes Dr. Michael Fowler in a 2008 review article published in "Clinical Diabetes." Poor circulation typically leads to dryness and thinning of the skin of the feet and lower legs. Dry, thin skin is prone to easy injury and cracking, which may lead to infection. Additionally, calluses, corns and blisters often form due to decreased pain sensation caused by diabetic neuropathy. Infection may develop in sites of irritation, leading to foot ulcers.
Foot Ulcers
Diabetic foot ulcers are open, crater-like wounds. An ulcer often begins as a small sore or cut that fails to heal due to poor circulation. Over time, the injury site often grows. Infection remains a serious threat with diabetic foot ulcers. The National Diabetes Education Program reports that approximately 15 percent of people with diabetes develop one or more foot ulcers. Up to 24 percent of those with foot ulcers undergo amputation due to complications.
Toe Deformities
Diabetic neuropathy affecting the lower extremity muscles may cause foot weakness, which can lead to toe deformities. Hammer toe is an abnormal upward bend in the middle toe joint, notes the University of Iowa Hospitals and Clinics. This deformity most commonly affects the second toe, but other toes may also be involved. Persistent bending of the first and middle toe joints, leading to upward rounding of the toes is termed claw toe. All toes, including the big toe, are usually affected. These toe deformities increase the risk for blisters, calluses, corns and sores, which may precipitate the development of a foot ulcer. An increased risk for foot injury also accompanies diabetes-related toe deformities, due to interruption of normal balance and toe function. According to the American Academy of Orthopaedic Surgeons, treatment may include special shoes or shoe inserts, toe exercises or surgical correction.
References
- National Diabetes Education Program: Feet Can Last a Lifetime: A Health Care Provider's Guide to Preventing Diabetes Foot Problems
- American Diabetes Association: Living with Diabetes, Foot Complications
- Foot Health Facts: Diabetic Complications and Amputation Prevention
- University of Chicago Center for Peripheral Neuropathy: Diabetic Neuropathy
- National Institute of Diabetes and Digestive and Kidney Diseases: Prevent Diabetes Problems--Keep Your Feet and Skin Healthy
