In 1990 the National Centers for Disease Control estimated that there were 14 million people affected by diabetes. They estimate that 25 percent will develop foot problems, making it a major public health concern. People with diabetes are at higher risk for developing foot ulcers than the rest of the population. These are open sores that will not heal or keep returning. They may or may not be painful, but can result in discoloration, dry skin, rash, redness or scaly skin.
Diabetic Neuropathy
Altered metabolism in the body as a result of poor glucose control may be a direct cause of neuropathy in diabetics. The American Diabetes Association warns that neuropathy can reduce your ability to feel pain, heat and cold. In other words, you are at higher risk of developing an injury to your foot that you may not recognize immediately. For instance, a pebble in your shoe may remain there all day, causing a sore on the bottom of your foot.
Foot Malformations
According to the National Institute of Diabetes and Digestive and Kidney Diseases, bunions and hammertoes can form when nerve damage causes muscle weakness. Muscle strength is dependent upon the strength of the nerve signals that pass through our nervous system. When this system of nerves is damaged the structure of the foot can be permanently changed. The weakness in the muscle shortens the tendons and muscles and cause deformities in the foot. These malformations become points of friction against ill-fitting shoes. Combined with a lack of sensation or pain response, this can lead to foot sores on the bottom of the feet and the tops of the toes.
Poor Fitting Shoes
Even without foot malformations that create friction, poor fitting shoes can be a cause of diabetic foot sores. The American Diabetes Association recommends that you wear shoes that fit correctly over the toes and heels to reduce the amount of friction and pressure. Pressure over the toe area can result in hammertoes and ingrown toenails, both of which can lead to pressure ulcers or sores on the feet.
Poor Circulation
According to the American Academy of Orthotists & Prosthetists, the process of atherosclerosis is accelerated in diabetic patients. This process can result in a lack of oxygen supply to the tissues in the toes and feet. When the foot is exposed to even minor trauma, such as a pebble in the shoe, an ulceration or sore can result. These sores are usually pale and painful.
Poor Foot Care
You can identify and treat each of these causes of diabetic foot sores when you perform daily foot care. The National Institute of Diabetes and Digestive and Kidney Diseases recommends that you perform daily checks of your feet for sores, blisters, cuts, swelling or redness. Although these areas may not hurt because of your reduced pain sensation they can lead to serious complications, including amputation. Poor foot care is not a direct cause of diabetic foot sores but is a very significant contributing factor.
References
- American Diabetes Association: Living with Diabetes; Foot Complications
- National Institute of Diabetes and Digestive and Kidney Diseases: Prevent Diabetes Problems: Keep Your Feet and Skin Healthy
- American Academy of Orthotists & Prosthetists: Review of Causes of Foot Ulceration in Patients with Diabetes Mellitus
