Diabetes increases the risk of developing peripheral neuropathy, which predisposes one to develop many bacterial and fungal infections in the foot. These infections can develop into foot ulcers that may increase the chances of one having an amputation.
In order to avoid these adverse outcomes, it is very important for a person with diabetes to learn about the methods to care for their feet regularly and prevent the development of foot-related complications secondary to diabetes.
How infections can develop in feet in people who have diabetes?
In diabetes, there is an increased risk of developing a condition called peripheral neuropathy. It is a condition of the nerves in the peripheries of the body, like feet. This can result in loss of sensation in the feet and, in that case, a person may not feel a cut or blister on that area, which can aggravate existing wounds.
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Additionally, there is decreased blood flow to the feet in people with diabetes due to the buildup of plaque in the blood vessels. This will decrease the ability to fight infections and healing capabilities. High blood sugar weakens a person’s immune system. Because of this, white blood cells may have decreased ability to travel to the infection site and defend against microorganisms.
When peripheral neuropathy, decreased blood flow, and weakened immune systems coexist, a person may develop infections in the feet. In some situations, adverse outcomes, like foot ulcers, may develop over time.
Common foot problems caused by diabetes
Diabetes can increase the chances of the development of many foot-related issues. In the absence of proper foot care, the following problems can develop:
Also known as peripheral neuropathy, diabetic neuropathy is the nerve damage that occurs in the foot due to diabetes. This condition causes tingling or numbness in the foot, which can also be painful.
If there is numbness, a person may not notice a minor cut that may get infected. With poor foot care, foot infections may result in foot ulcers and the amputation of a part of the foot may need to be performed.
The chances of developing peripheral neuropathy and its consequent adverse outcomes increase with the duration of one living with diabetes. It must be noted that these outcomes can be prevented by maintaining blood sugar levels and practicing proper foot care.
Swelling of the foot
People with diabetes often have poor circulation that results in decreased blood flow in the feet and may negatively impact the healing capabilities. Poor circulation can result in the accumulation of fluid in the feet and, eventually, results in foot swelling. Certain factors like cardiovascular diseases, long periods of standing, and certain medications for diabetes also increase the likelihood of developing swelling in the foot.
If one has swelling of the feet or legs, it is important to consult a doctor to manage the symptoms and develop plans to decrease the chances of developing these symptoms in the future. Regular exercise and adequate blood sugar level control are helpful in preventing these issues.
Diabetic foot ulcers
According to Dr. Jerry Cooper, DPM of Eastern Idaho Foot Clinic, foot ulcers in diabetes usually develop on the bottom of the foot, particularly the ball of the foot or the bottom of the big toe. These are open wounds that have resulted from the opening of infected fluid cavities.
Some early signs of foot ulcers are the presence of a small swelling at the bottom of your foot, redness of an area, or leakage of fluid from the bottom surface of the foot. Foot ulcers can be caused by poor circulation in the peripheries, too.
If one has peripheral neuropathy, one needs to be very cautious about the development of foot ulcers as one may not feel any pain from a small cut or a blister that can result in a foot ulcer later on. Foot ulcers can be treated by wearing diabetic shoes, staying off feet for longer durations during the day, and treating the underlying infection.
There are increased chances of amputation in diabetic patients as compared to other people. This is primarily due to the development of peripheral arterial disease in patients with diabetes. Decreased blood flow due to this condition, coupled with peripheral neuropathy, can increase one’s chances of foot ulcers, which may require amputation. Please note that smoking increases your risk of amputation; most amputations are performed in patients with a smoking history.
For most people, proper foot care, quitting smoking, and regular visits with a medical professional may prevent amputation in the future.
These are thickened parts of the skin that develop as a consequence of constant rubbing against a rough surface or rubbing of the foot against the shoe. They can also develop if one walks barefoot for longer durations.
In diabetic patients, calluses can pose a significant challenge as good ulcers can develop under them and one may not be able to notice foot ulcers in a timely manner. They can also negatively impact the healing of a wound. To treat calluses and prevent further complications, one should visit a professional to remove the calluses regularly.
Changes in the skin of the foot
Common skin changes occurring in diabetic patients are dryness, peeling, and cracking of the skin. Nerve damage is the primary problem that leads to these changes. This is because nerve damage impairs the body’s system to control the oil and moisture of the skin.
To prevent these changes, it is important to apply petroleum jelly to your feet after bathing and drying your feet.
If they are left intact, ingrown nails can be the site of infection. Due to peripheral neuropathy, any pain from an ingrown nail will not be felt by the patient, hence it can lead to the development of infection.
To prevent the infection, one should regularly check their feet regularly for redness or swelling. It is very important to regularly visit a medical professional and get the ingrown nail removed. Other precautions are trimming the nails and not cutting the nails too short.
Methods for proper foot care in diabetes
To understand and implement common methods for foot care, one should consult a health professional for a personalized foot care plan. A podiatrist and a medical professional who specializes in treating diabetic patients may be a part of your healthcare team.
According to Eastern Idaho Foot Clinic, the common methods for proper foot care in diabetic patients are the following:
Checking feet regularly
Checking your feet daily will allow you to notice any problems in your feet earlier. You may have foot problems but may not be feeling any sensation because of peripheral neuropathy.
Whenever you remove your shoes, you should make it a practice to check your foot for any changes. Common problems to look for are cuts, swelling, ingrown toenails, warm spots, and calluses.
Washing your feet daily
Wash your feet in warm water daily–use a thermometer to check the temperature of the water before washing your feet (90-95 F is the optimum level). After washing your feet, it’s important to dry them and put talcum powder on them. As the skin between toes tends to stay moist, the powder should reach those areas of the feet, too. Powder helps keep the feet dry and prevents infection.
Smoothing corns and calluses
Corns and calluses are thick parts of skin that grow on the bottom of the feet. One should consult a medical professional if one has corns or calluses on feet.
Using pumice stone and applying lotion on feet is the best way to go. It is best to avoid cutting the corns and calluses and avoiding using over-the-counter products.
Trimming nails straight across
It is important to trim your toenails straight across to prevent ingrowth of toenails and cutting your skin. You should cut into corners of your toenail.
In case you cannot see or reach your toenails, your toenails are thick or they are curved, you should consult a health professional to trim your toenails. It is also important to bring your own toolkit for toenail trimming if you are visiting a salon for toenail trimming.
Wearing shoes and socks at all times
Develop a practice to wear shoes and socks at all times. You should not walk while wearing socks only even indoors because you may step on something that may cut into your skin, which you may not feel the pain due to peripheral neuropathy. Additionally, always check the inside of your shoes before wearing them to remove any object that can cause any injury to your feet.
It is recommended to wear shoes that are well-fitting. Also, if you are wearing new shoes for a few hours, check your feet for areas of soreness.
Protecting feet from heat and cold
You can burn your feet and may not know it because of nerve damage. So, it is important to take protective measures against hot weather.
You should wear shoes while walking on hot pavement or a beach. You should keep your feet away from fires and open ovens and you should not put a hot water bottle on your feet. Also, put sunscreen on your feet while you are out in the sun.
Similarly, it is important to protect your feet from extreme cold. If your feet get cold while you are sleeping, you should wear socks to prevent your feet from getting cold.
Keeping the blood flowing in your feet
Quitting smoking, being more physically active, doing exercises to move your toes and feet multiple times a day, and avoiding tight socks are some steps to keep a steady blood flow in your feet.
Foot exam at every health visit: It is important to ask your health professional to check your feet during each visit. You should ask your doctor to check your feet for loss of sensation, peripheral artery disease, and foot ulcers.
National institute of diabetes and digestive and kidney diseases, diabetes and foot problems Accessed May 17, 2021, https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/foot-problems
American diabetes association, Foot complications, Accessed May 17, 2021, https://www.diabetes.org/diabetes/complications/foot-complications