Diabetes and foot problems facts
- Two main conditions, peripheral artery disease (PAD) and peripheral neuropathy, are responsible for the increased risk of foot problems in people with diabetes.
- People with diabetes have an increased risk of ulcers and damage to the feet.
- A number of different kinds of foot problems can occur in people with diabetes. These include bunions, corns, calluses, hammertoes, fungal infections, dryness of the skin, and ingrown toenails.
- Treatment depends on the exact type of foot problem. Surgery may be required for some cases.
- Gangrene (dry gangrene) is tissue death due to absence of blood circulation. It can be life-threatening if bacterial infection develops (wet gangrene).
- Many diabetes-related foot problems can be prevented by good control of blood sugar levels combined with appropriate care of the feet.
How can diabetes cause foot problems?
Both type 1 and type 2 diabetes cause damage to blood vessels and peripheral nerves that can result in problems in the legs and feet. Two main conditions, 1) peripheral artery disease (PAD), and 2) peripheral neuropathy are responsible for the increased risk of foot problems in people with diabetes.
- Peripheral artery disease (PAD), sometimes referred to as peripheral vascular disease (PVD), means that there is narrowing or occlusion by atherosclerotic plaques of arteries outside of the heart and brain. This is sometimes referred to as "hardening" of the arteries. Diabetes is a known risk factor for developing peripheral artery disease. In addition to pain in the calves during exercise (medically known as intermittent claudication), the signs and symptoms of peripheral artery disease relate to a decreased delivery of oxygen to the lower legs and feet. In severe cases, the lack of oxygen delivery to tissues can result in ulcers and even gangrene (tissue death).
- Peripheral neuropathy refers to damage to the peripheral nerves directly as a result of diabetes. Symptoms of peripheral neuropathy include decreased sensation in the nerves of the legs and feet, making it difficult to perceive injuries due to lack of feeling. Peripheral neuropathy also causes a tingling, pain, or burning in the involved areas. It can also cause the muscles of the feet to work improperly, leading to misalignment of the foot that can put pressure on certain areas of the foot.
What are examples and symptoms of foot problems caused by diabetes?
In the most severe case, as mentioned above, due to a combination of decreased sensation and reduced blood flow to the feet, ulcers may develop. If the tissues continue to receive insufficient oxygen, tissue death (gangrene) occurs. Gangrene is a serious and potentially life-threatening condition. Other potentially serious problems that may develop include cellulitis (infection of the tissues beneath the skin) and osteomyelitis (infection of the bone); sepsis (the infection spreads to the bloodstream) also is possible.
People with diabetes are at increased risk for milder problems with the feet that are not specific to diabetes but may occur more frequently due to problems with the nerves and circulation to the feet.
Some of these conditions are:
- Calluses and corns, that may develop due to abnormal alignment of the feet or abnormal gait
- Fungal infections of the nails, which can appear as thickened, discolored, and at times brittle nails
- Tinea pedis, or athlete's foot, a fungal infection of the skin of the feet
- Hammertoes, or bent toes due to muscle weakness.
- Bunions, or the angling of the big toe toward the second toe. The area of the bunion may become reddened and irritated, leading to callus formation.
- Ingrown toenails
- Cracking of the skin of the feet, especially the heels, due to dry skin