What Causes Diabetes-related Foot Problems?
Foot care is an important, but often overlooked, part of the overall healthcare regimen for people living with diabetes. This is because diabetic foot problems—which can include everything from ulcers and infections, to foot deformities and circulation problems—can be caused by a number of internal and external factors that can be prevented or delayed if diabetes control is a priority.
While the following list of causes may seem daunting, there is some good news: many of the factors that lead to foot problems in people with diabetes can be avoided or delayed by properly managing your blood glucose levels and making some small lifestyle changes.
Internal Factors that Can Lead to Foot Problems
- Nerve damage: Diabetic peripheral neuropathy is nerve damage caused by diabetes and consistently high blood glucose levels (over many years). Approximately two-thirds of people with diabetes suffer from some type of neuropathy1. Nerve damage can lead to a loss of feeling and sensation in the feet, which makes you more prone to injuries and other foot problems. Working to keep your blood glucose levels in check (70-130 mg/dl before meals and less than 180 mg/dl after meals2) can help lower your risk of nerve damage and resulting problems.
- Lowered immune system: People with diabetes may have immune systems that are suppressed, making it difficult for them to fight off infections in all parts of the body, including the feet. Because of this, sores and ulcers on the feet may worsen quickly, leading to foot infections.
- Circulation problems: Many people with diabetes have circulation problems in their extremities due to a condition, called arteriosclerosis, which causes the arteries to harden. In people with diabetes, it's caused by the effect poor blood glucose control has on the arteries. Arteriosclerosis restricts blood from flowing to the feet, which can cause tingling and numbness. Loss of circulation may make it difficult for you to feel injuries, and it may delay healing in affected areas.
- Foot deformities: Nerve damage in the feet can also lead to foot deformities. Deformities such as hammertoes or claw toes may provide extra challenges for people with diabetes, since they may rub against shoes (or other toes) and lead to blisters or other foot problems.
External Factors that Can Lead to Foot Problems
- Physical activity: People with diabetes should talk to their doctors about participating in sports, exercise, and other physical activities. These activities are necessary for maintaining overall health; however, it is important to make sure that you are taking steps to protect your feet from injury. It is possible to suffer serious foot injuries and not even know it due to nerve damage or circulation problems. Even simple activities such as getting up for a drink of water in the middle of the night, or cutting your toe nails, can lead to foot injuries that may not be noticed in early stages.
- Ill-fitting shoes: People with diabetes should pay careful attention to their shoes, particularly shoes used for exercise and other physical activities. Poorly-fitting shoes can cause foot problems such as calluses, bunions, foot deformities and other common foot ailments, and it may be difficult for you to detect that pain.
- Hot showers, cold air: Nerve loss in the feet can make it difficult for you to gauge very hot or very cold temperatures (such as a bath that’s too warm). This can lead to burns and frostbite. Try using the tip of your elbow to test water temperature, as may be more sensitive to the heat. Additionally, make sure to wear warm socks in the winter and to frequently check your feet and toes for signs of frostbite.
- Smoking cigarettes: Smoking can contribute to arteriosclerosis, which can further raise your risk of developing circulation problems in the feet.
How to Prevent Foot Problems
- It is important to check your feet daily. If it is not possible to lift your feet close enough to see them, use a mirror to look at the bottom of your feet to make sure there are no cuts or sores.
- If cuts or sores are present, contact your healthcare professional and see a podiatrist (foot doctor) who specializes in diabetes. The podiatrist can cut your toenails properly, review your feet, and let you know if special shoes can help you prevent further problems.
As you can see, there are many factors that contribute to your risk of developing diabetes-related foot problems. However, by taking good care of your feet and working to stay on top of your blood glucose levels, you can help protect your feet—and bolster your health overall, too.