Diabetes and the Feet

Diabetes is the most common cause of limb loss, other than accidents, in the United States. Problems begin in your legs or feet due to changes in your blood vessels and nerves; those changes are caused by excess glucose, advanced glycated end products (AGEs), and oxidation. Blood vessels become blocked, and your legs and feet do not receive enough blood. This causes aching pains in your legs and feet, especially when walking, and sores that heal slowly.

To compound the problem, your nerves become poisoned by the high levels of glucose, resulting in pain, numbness, and a tingling feeling in your feet and legs, all of which dull the sensitivity of your nerves and your ability to sense a potential problem with your feet. You may not notice a sore caused by a tight, rubbing shoe or a blister from a new pair of shoes. If ignored and left untreated, the sore can become infected and, due to poor blood circulation, the toe or foot may need to be amputated.

Amputation is not an inevitable part of living with diabetes, however. Proper foot care and regular visits to your diabetes care team can prevent foot and leg sores and ensure that any that do appear don't become infected and painful. Proper foot care requires a combined effort by you and your doctor. You need to know what you can do to prevent problems and what to expect from your doctor as well.

Self-care includes the inspection of your feet for sores, cuts, or infection. Get a handheld mirror and examine your feet thoroughly every day. Clean your feet daily and dry them well, especially between the toes, and keep them soft by using lotion after a bath or shower. Each time you buy shoes, have both the width and length of each foot measured to make sure your shoes fit well and have enough space for your toes. Always wear shoes; never go barefoot, even in the home, where you can accidentally kick furniture or step on something sharp hidden in carpeting.

If you go to the beach, wear sandals or water socks to protect your feet from sharp objects and pointy rocks in the sand. And finally, never, ever, do bathroom surgery on your feet. Corns, calluses, ingrown toenails, and thick, fungal nails are best left to a podiatrist. A podiatrist can do foot surgery, trim your nails (or teach you how to safely and properly trim them at home), and prescribe medications for your feet when needed. You need to see a podiatrist regularly if you have lost any sensation in your feet, if you cannot cut your own nails, or if you have a foot ulcer.

It is also your responsibility to assist your team in the care of your feet by being prepared for appointments. Uncover your feet once you're in the examining room. Tell your doctor about any foot-care concerns. Have the doctor inspect all surfaces of your feet, including the soles and between the toes. Make sure your doctor checks the pulses in both feet; this indicates how well the blood is circulating to your feet. Finally, your doctor should do a special test to check the sensation in your feet. If you have lost the protective sensation in your feet, you are vulnerable to infections, sores, and, ultimately, foot loss.

This problem alone, or in combination with limited circulation, can potentially spell real trouble. It means you need to take extra precautions to keep your feet safe. And while you cannot always avoid a loss of sensation or decreased circulation in your legs, studies have shown that you have a better chance of avoiding problems if you take good care of your feet, do not smoke, and keep both your blood pressure and diabetes under good control.

As you've seen, diabetes complications can have a devastating impact on your body. Great care must be taken, then, to prevent these complications from getting out of control.