Diabetes is a chronic, or lifelong, condition in which your body is unable to maintain a proper blood sugar level. Foot problems are among the most common health concerns diabetics face. Several types of diabetes exist, yet they all may cause similar changes in your feet. Prolonged elevated blood sugar levels may lead to a serious health complication known as neuropathy—a condition involving nerve damage or dysfunction. The nerves in your feet perform many important functions, and they may be particularly susceptible to diabetes-related damage.
Diabetic neuropathy can cause significant foot health problems and often affects the following foot functions:
- Position sense (proprioception): Proprioception is your ability to determine where your body parts are in space. Proprioception is dependent on you having intact position sensors. Elevated blood sugar levels can damage your position sensors, making it difficult for you to know where your feet are in relation to the ground or within your shoe. You may damage your feet or other body parts because you’re unable to properly adapt to varying terrain.
- Sensation: Most diabetics experience “pins and needles” sensations or burning in their feet and legs about one year before numbness sets in. The numbness usually begins at the ends of your toes and progresses up into your feet. Because of this numbness, you may be unable to feel if your shoe is rubbing a blister on your feet or if an object has fallen into your shoe and is causing foot damage. Diabetics who suffer foot nerve damage may also be unable to appreciate how hot his or her bath water is or how hot the sand at the beach is. Going barefoot is strongly discouraged for this reason.
- Sebum production: Your sebaceous glands produce an oily substance called sebum that helps lubricate your skin and hair. The production of sebum in your feet, and therefore the moisture level of your feet, is controlled by nerves. Your nerves will lose their ability to regulate the amount of moisture in the skin of your foot if they are damaged by prolonged elevated blood sugar levels. Nerve damage in your feet makes your skin more susceptible to cracking and rubbing from your shoe.
- Vasodilation: Vasodilation is a medical term that describes a widening of your blood vessels, due to the relaxation of the vessels’ muscular wall. Your nerves, if damaged by diabetes, may lose their ability to regulate the amount of blood flowing into your foot, which causes the mineral content of your bones to be washed away, rendering your bones weak and brittle.
- Intrinsic foot muscle weakness: Your intrinsic foot muscles are the muscles that are located within your foot and do not cross your ankle joint. Optimal stimulation of your feet’s nerves is lost when these nerves are damaged, causing your toes to contract. This is also a serious problem because the force of your body weight is now concentrated on the ball of your foot, which you are unable to feel. Over time, the forces on this part of your foot may cause skin breakdown and ulceration. Ulcers are among the leading causes of hospital admissions, intravenous antibiotic use, and amputations in diabetics.
Causes and Symptoms
Certain factors may increase your likelihood of developing diabetes, including:
- Excessive body weight
- Sedentary lifestyle
- A family history of this condition
- Elevated blood pressure
Common signs and symptoms associated with diabetes include:
- Extremity sores that are slow to heal
- Increased thirst, hunger, and urination
- Weight loss
- Vision changes
- Frequent infections
Neuropathy is the most significant problem associated with diabetic feet, although immune deficiency, decreased circulation, and other problems may also accompany this health problem.
Diabetic individuals are particularly susceptible to fungal and yeast infections of the feet, especially the toenails. Important signs of infection include:
- Foul odor
- Pain (although pain is not a reliable indicator in diabetics)
Numerous treatment methods may be helpful in controlling your diabetes and reducing your chances of developing diabetic neuropathy.
Controlling your high blood sugar levels is the most important factor in reducing your chances of diabetic neuropathy, and it is up to you and your primary caregiver. Long-term tests such as Hemoglobin A1c or Fructosamine will help determine how well-controlled your sugars have been and allow you to rate the effectiveness of whatever protocol you are following to keep your blood sugar levels in check.
Examine your feet every day, especially the underside of your feet and between your toes. Have a family member or caregiver examine your feet if you have poor vision. Note any blisters, cracks, redness, swelling, or other signs and report them to your doctor as soon as possible.
Avoid walking barefoot, even in your own house. Certain objects may become embedded in your feet, including sewing needles, and you may not experience a sensation of pain. Also avoid applying lotion between your toes, as this can increase your likelihood of infection, particularly from fungus (athlete’s foot).
Choose appropriate shoes. Tight-fitting shoes are one of the most common causes of blisters and ulcers in diabetics. Diabetes who are covered by Medicare are entitled to one free pair of shoes per year and three free inserts made of a material called plastizote, which helps protect your numb feet.
Setting and maintaining regular examinations are another important treatment measure for diabetics. Periodic reduction of long, thick toenails greatly reduces your chances of ingrown toenails and subsequent infection. Proper nutrition and weight loss are also encouraged as part of an overall well-being program for diabetics.
In his 18 years as a podiatrist, Dr. Ray McClanahan has learned that most foot problems can be corr...