Diabetes – The Number.1 Suspect for Creating Foot Problems…
As someone with diabetes, why should you be making a special effort to look after your feet?
After all, diabetes is all about controlling blood sugar levels, eating healthily, and taking prescribed doses of insulin or other medication isn’t it?
Well, yes, but it’s complicated – in that diabetes can bring a host of complications.
Over time, if you’re not on the ball with maintaining your sugar levels within what’s considered a healthy range, you’re effectively inviting in the negative effects of an excessive glycemic load within the body.
As well as making you feel bad in the now, persistently high blood sugars over time causes long-term damage to blood vessels and nerves throughout the body.
Your feet might look like they are a long way away, but that is part of the problem!
Feet are particularly prone to issues if blood flow isn’t good, and you don’t have good sensation. This is particularly problematic for people with diabetes.
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Your feet have to handle the pressure and friction of your body weight during all of your day-to-day activities. This is no small task!
There’s also our tendency to prioritize how a pair of shoes look rather than how comfortable and supportive they are.
Getting an uncomfortable blister on your foot because you really wanted to wear a pair of killer heels on a night out is annoying for everyone. Having poor sensation and blood flow leads to that blister taking a long time to heal & makes you prone to infection.
What is an inconvenience for the healthy foot can be a legitimate threat to the health of a person with diabetes.
This may well sound like exaggeration but, the next time you find yourself in a foot specialist’s clinic, take a subtle and sneaky peak around you. If you’re in the company of people with diabetes, you will often see people managing wounds and amputations.
Unfortunately, amputation is a common occurrence in the diabetic population. However, rather than letting this horrify you, let it motivate you.
With some simple day-to-day care and consideration, you can dramatically reduce the risk of long-term complications striking your own two feet.
In this first of two articles, let’s begin with a closer look at what goes wrong when diabetes walks you straight towards foot problems…
Diabetic Foot Conditions
1/ Diabetic Peripheral Neuropathy (DPN) & Poor Sensitivity in the Feet
The main foot problem that, as a diabetic, you want to avoid is diabetic peripheral neuropathy (DPN).
DPN brings a whole array of unpleasant symptoms including painful tingling or burning sensations within the foot and lower legs, muscle weakness around the ankle and a lack of ability to sense what’s going on underfoot.
Many studies have found that up to 50% of diabetics will develop DPN over their lifetime, usually within 25 years of their diagnosis. The side-effects of DPN result from nerve damage caused by high blood sugar.
Conventional painkillers do not tend to counteract the pain that arises from the condition, affecting daily activity as well as sleep patterns. Meanwhile, muscle weakness can lead to difficulty walking and an increased likelihood of having a nasty fall.
The lack of underfoot sensation that comes with DPN makes detecting problems beneath you difficult.
From standing on something that could cause injury (a pebble within your shoe), sensing damaging temperatures (e.g., bath water that is too hot) or the fact that your shoes are proving uncomfortable (an impending blister), you can significantly increase your chances of gaining an unnecessary injury that will likely be slow to heal and may even require medical intervention.
2/ Peripheral Arterial Disease (PAD) & Poor Circulation
Although caused by many different conditions, diabetes is one of the main risk factors for developing poor circulation, which is most usually detected in the lower legs and feet.
Often, peripheral arterial disease (PAD) is at the root of the problem and this is where the arteries within the outer limbs both harden and narrow, decreasing blood flow.
When the blood isn’t circulating around the body as strongly as it should, many symptoms present themselves. These can include painful tingling sensations within the feet and lower limbs, unpredictable and sharp muscle cramps and numbness.
You may feel like no matter what you try, your feet always feel cold.
PAD and poor circulation are both helped along by the detrimental effects of diabetes, with over a third of all diabetics over the age of 50 having PAD.
In turn, these issues lead to reduced oxygen and nutrient flow to the cells within the feet and lower limbs, slowing down the healing of any other issues that may develop.
3/ Blisters & Foot Ulcers
Not only are blisters and diabetic foot ulcers ugly, they are also incredibly common, highly problematic and a leading cause of amputations below the knee.
It is therefore very important for those with diabetes to keep a keen look out for foot ulcers on the soles of their feet and take action straight away if they think an ulcer is starting to form.
Ulcers usually develop from the simplest of scenarios, such as standing on something sharp by accident, wearing shoes that are too small and tight, or gaining a blister that then refuses to heal.
Because of the impacts of DPN and PAD (described above), a diabetic may then not feel the ulcer on their underfoot while a lack of circulation impedes the natural healing that would otherwise have happened.
Around a quarter of diabetics will develop a foot ulcer at some point, resulting in numerous appointments to a foot specialist, as well as anxiety on what might happen if it doesn’t eventually heal or becomes infected.
If this happens, the tissue can break down right back to the bone within the foot. Alarmingly, more than half of diabetic foot ulcers become infected, 20% of which then lead to amputation.
Bunions are prominent bumps situated alongside where either the large toe or the small toe appear to end. They are caused by misalignment within the toe joints and can get progressively worse, causing more pronounced visible effects as well as increased pain.
Bunions are usually caused by poor foot biomechanics or unsuitable footwear. High heels are notorious for increasing the risk of bunions, as they concentrate the pressure of weight-bearing down through the toes, hence why diabetics are encouraged to avoid high heels or limit the height of the heel.
Both DPN and PAD contribute to the development of bunions as well as making their treatment more problematic.
5/ Severe Callusing
Even among non-diabetics, callusing on the foot is a common affliction as skin builds up in response to repeated use and pressure. Callusing is usually seen on the heel and ball of the foot, and should serve as a protective mechanism.
However, where callusing builds up significantly, this can lead to rubbing between the skin, socks and shoes.
In turn, this friction can cause unpleasant blistering and pain on the underside of the foot.
For someone with diabetes, with increased nerve damage and reduced circulation also comes the possibility of callusing developing into a dreaded diabetic foot ulcer and all of its associated risks.
6/ Charcot Foot
Charcot foot is not terribly common, but it is severe condition that needs to be addressed as soon as it is suspected. Failure to do so can lead to significant foot deformities that last a lifetime, and create tremendous challenges with footwear and foot health.
Charcot foot is caused by the most common diabetic condition – DPN. As diabetic neuropathy takes hold within the foot and ankle, many soft tissues are affected, including the nerves and blood vessels.
With Charcot foot, the limb becomes terribly swollen without any notice. It is usually red and hot to touch, but not very painful because the nerves aren’t working correctly. A process occurs within the foot leading to bones and joints breaking down.
Bearing weight on the foot during this process leads to joint deformity. Injuries within the foot that occur during active Charcot flare up can lead to deformities that make mobility and skin protection difficult for years to come.
A deformed foot no longer sits correctly while in contact with the ground and weight distribution is therefore affected. This can cause pressure sores to develop, subsequently increasing the chances of developing a foot ulcer and possible amputation.
This is especially true if the problem is initially ignored but the demands of walking and activity continue.
Diabetes & Foot Care: What’s To Come
Although it’s tricky to initially see the link between foot problems and diabetes, the two are intrinsically linked.
Many of the potential problems feed into each other, further amplifying the chances of a person with diabetes gaining one of the conditions we’ve described.
However, despite high incidence rates of foot problems in diabetic patients, prevention is entirely possible through making appropriate lifestyle choices and some straight-forward care and maintenance that can be performed at home.
Both education, and therefore prevention, are key. Often, many diabetics are surprised at how little goes a long way when it comes to foot care.
In our up-coming blog post, we’ll guide you on how to prevent these foot nasties that you may have previously thought unavoidable simply because you have diabetes.
In the meantime, why not take a look at our Diabetic Foot Care page?
Want to talk to us about anything that you’ve read in this article? Get in touch through our contact page.