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People with diabetes are prone to
many foot problems, often
because of two complications of
diabetes: nerve damage (neuropathy)
and poor blood circulation.
Neuropathy causes loss of feeling in
your feet, taking away your ability to
feel pain and discomfort, so you may
not detect an injury or irritation.
Poor circulation in your feet reduces
your ability to heal, making it hard
for even a tiny cut to resist infection.
When you have diabetes, you need
to be aware of how foot problems can
arise from disturbances in the skin,
nails, nerves, bones, muscles, and
blood vessels. Furthermore, in
diabetes, small foot problems can
turn into serious complications.You
can do much to prevent amputation
by taking two important steps: Follow
the proactive measures discussed
below—and see your foot and ankle
surgeon regularly.
Diabetes-related Foot
and Leg Problems
Having diabetes puts you at risk
for developing a wide range of foot
problems:
• Infections and ulcers (sores) that
don’t heal. Because of poor
circulation in the feet, cuts or
blisters can easily turn into ulcers
that become infected and won’t
heal. This is a common—and
serious—complication of diabetes
and can lead to a loss of your
foot, your leg, or your life.An
ulcer is a sore in the skin that
may go all the way to the bone.
• Corns and calluses. When
neuropathy is present, you can’t
tell if your shoes are causing
pressure and producing corns or
calluses. Corns and calluses must
be properly treated or they can
develop into ulcers.
• Dry, cracked skin. Poor
circulation can make your skin
dry. This may seem harmless, but
dry skin can result in cracks that
may become sores.
• Nail disorders. Ingrown toenails
(which curve into the skin on the
sides of the nail) and fungal
infections can go unnoticed
because of loss of feeling. If
they’re not professionally treated,
they can lead to ulcers.
• Hammertoes and bunions. Motor
neuropathy (nerve damage
affecting muscles) can cause
muscle weakness and loss of
tone in the feet, resulting in
hammertoes and bunions. If left
untreated, these deformities can
cause ulcers.
• Brittle bones. Neuropathy and
circulation changes may lead
to brittle bones (osteoporosis).
This makes you susceptible to
breaking a bone, even without a
major blow or injury occurring.
• Charcot foot. This is a complex
foot deformity. It develops as a
result of loss of sensation and an
undetected broken bone that leads
to destruction of the soft tissue of
the foot. Because of neuropathy, the
pain of the fracture goes unnoticed
and the patient continues to walk
on the broken bone,making it
worse. This disabling complication
is so severe that amputation may
become necessary.
• Blocked artery in the calf. In
diabetes, the blood vessels below
the knee often become narrow
and restrict blood flow.A severely
blocked artery is a serious
condition that may require
intervention from a vascular
surgeon. If vascular surgery fails
and the wound does not heal,
amputation may be necessary.
What Your Foot and Ankle
Surgeon Can Do
A major goal of the foot and ankle
surgeon is to prevent amputation.
There are many new surgical
techniques available to save feet and
legs, including joint reconstruction and
wound healing technologies. Getting
regular foot checkups and seeking
immediate help when you notice
something can keep small problems
from worsening.Your foot and ankle
surgeon works together with other
health care providers to prevent and
treat complications from diabetes.
When Is Amputation
Necessary?
The goals of treatment of diabetic
foot problems are not only to save
the life and limb, but also to get the
patient healed and moving about as
soon as possible. If vascular surgery
cannot improve blood flow and
podiatric surgery cannot restore
function, amputation may be the
only solution that gets the patient
walking again.Amputation may
involve one or two toes, part of the
foot, or part of the leg. It is selected
on the basis of the patient’s condition
and level of predicted healing.A
return to normal life is especially
possible today because of advances
in prosthetics.
Your Proactive Measures
You play a vital role in reducing
complications. Follow these guidelines
and contact your foot and ankle
surgeon if you notice any problems:
• Inspect your feet daily. If your
eyesight is poor, have someone
else do it for you. Inspect for:
– Skin or nail problems—Look for
cuts, scrapes, redness, drainage,
swelling, bad odor, rash,
discoloration, loss of hair on
toes, injuries, or nail changes
(deformed, striped, yellowed
or discolored, thickened, or
not growing).
– Signs of fracture—If your foot
is swollen, red, hot, or has
changed in size, shape, or
direction, see your foot and
ankle surgeon immediately.
• Observe for changes in
circulation. Pay attention to the
color of your toes. If they turn
red, pink, or purplish when your
legs hang down while sitting,
poor circulation may be a problem.
• Don’t ignore leg pain. Pain in
the leg that occurs at night or
with a little activity could mean
you have a blocked artery. Seek
care immediately.
• Nail cutting. If you have any nail
problems, hard nails, or reduced
feeling in your feet, your toenails
should be trimmed professionally.
• No “bathroom surgery.” Never
trim calluses or corns yourself,
and don’t use over-the-counter
medicated pads.
• Keep floors free of sharp objects.
Make sure there are no needles,
insulin syringes, or other sharp
objects on the floor.
• Don’t go barefoot. Wear shoes,
indoors and outdoors.
• Check shoes and socks. Shake out
your shoes before putting them
on.Make sure your socks aren’t
bunched up.
• Have your sense of feeling tested.
Your foot and ankle surgeon will
perform various tests to see if
you’ve lost any feeling.
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