People with diabetes have to be especially careful with their feet, as decreased circulation and other diabetes-related conditions could affect overall foot health. Diabetes affects the circulation (red on the illustration) and immune system, which in turn weakens the body’s capacity to heal itself. Furthermore, diabetes can injure sensory nerves (yellow in the illustration) especially in the hands and feet. This is called “neuropathy” and it can affect 60 to 70 percent of people with diabetes. As a result, people with diabetes are less likely to notice foot damage, such as a blister or cut. A wound with poor blood supply may become infected or lead to gangrene. Gangrene is a serious infection which could even require cutting off the infected part of foot or leg. Unnoticed and untreated, even a small foot wound can rapidly become infected, potentially leading to severe complications.
The risk of developing a wide range of foot problems increases with nerve damage and poor circulation, two complications of diabetes.
For those with diabetes, small foot problems can turn into serious problems, including:
- Ulcers (sores) that don’t heal
- Corns: thick and hard skin on toes
- Calluses: thick skin on bottom of feet
- Dry skin, cracked heels
- Ingrown toenails
Patients with diabetes can also get common foot problems that others do but, when left untreated, it can possibly lead to infection and serious complications, such as amputation. Some examples of these problems are athlete’s foot, fungal infection of the nails, foot ulcer and plantar warts. It is important to ask your healthcare professional for recommendations on how to best treat these disorders. One of the most severe foot problems you can have is called Charcot (pronounced "sharko") foot. The shape of your foot distorts when your bones fracture and disintegrate, and yet you continue to walk on it because you can’t notice it. This deformity requires attention from your doctor.
Prevention of foot problems
To avoid severe foot problems that could result in losing a toe, foot, or leg, follow these recommendations and consult your doctor if you notice anything abnormal.
- Inspect your feet daily. Use a magnifying hand mirror to look at the bottom of your feet. Check six major locations on the bottom of each foot: The tip of the big toe, base of the little toes, base of the middle toes, heel, outside edge of the foot and across the ball of the foot. Check for cuts, blisters, redness, swelling, or nail problems.
- Wash your feet in lukewarm water. Keep your feet clean by washing them daily using a soft washcloth or sponge. Dry by blotting or patting, and carefully dry between the toes.
- Moisturize your feet – but not between your toes. Use a lotion/cream daily to keep dry skin from itching or cracking. But do not moisturize between the toes since this could lead to a fungal infection.
- Cut nails carefully. Cut them straight across and file the edges. Don’t cut nails too short, as this could lead to ingrown toe nails.
- Never treat corns or calluses yourself.
- Wear clean, dry socks. Change them daily. Avoid tight elastic bands that reduce circulation in the foot. Don’t wear thick socks or socks that fit poorly and irritate the skin.
- Wear socks to bed. If your feet get cold at night, wear socks. Never use a heating pad or hot water bottle.
- Feel the inside of your shoe before wearing. Since your feet may not be able to feel a small object, always look inside your shoes before putting them on.
- Keep your feet warm and dry at all times.
- Never walk barefoot. Always wear shoes or slippers to avoid getting a scratch or cut.
- Take care of your diabetes. Keep your blood sugar levels under control.
- Don’t smoke. Smoking decreases blood flow in your feet.
- Get periodic foot exams. Ask your doctor to inspect your feet at every diabetes-related visit. In addition, ask to be screened for neuropathy and loss of circulation at least once a year.
When to consult a doctor
- If you have any swelling, warmth, redness or pain in your legs or feet.
- If you have any corns, calluses, in-grown toenails, warts or slivers, do not try to treat them yourself.