If human beings were French cuisine, diabetes would be a mother sauce.
Mother sauces are the basic concoctions upon which numerous culinary delights are built. In a similar way, diabetes is a foundational disease that opens up the door to multiple health problems such as heart attacks, stroke, kidney failure, and foot problems.
How does diabetes affect feet?
Diabetes happens when there is an excess of glucose, or sugar, in the blood. Over time, consistently high levels of glucose in the blood:
- Lead to nerve damage called diabetic neuropathy. This causes tingling, irritation, and pain in the feet. At the same time, nerve damage means your feet gradually grow numb, lose sensitivity, and are no longer able to feel anything or react to external stimuli.
- Reduce blood flow to the feet because the walls of your blood vessels have thickened. This narrows the space inside the blood vessels’ tubular structure and prevents blood from circulating properly.
Do You KnowPatients diagnosed with diabetes may qualify for extra benefits and resources under Medicare. To find out if you are eligible for special diabetes-exclusive benefits, ask a member of staff at your healthcare center.
If you are a patient at any IntraCare Health Center, you can find out more about additional resources and benefits by calling our Patient Relations Team at 800-941-1106.
Foot complications from diabetes
Nerve endings called nociceptors are spread throughout our bodies, in muscles, joints, internal organs, and all over skin. Nociceptors sense pain and send messages to the brain that translate to, “You just got hurt; do something about it.”
The deadly duo of diabetic neuropathy and loss of blood circulation stops nociceptors in the feet from working. This means that if a person with diabetes stubs their toe against the door frame, they might not even notice, let alone yowl in pain. Only hours later when they take off their shoes and see blood on their sock might they realize their foot has been injured.
Similarly, the chafing of a new shoe usually alerts people to painful blisters forming on the back of their foot, but a person with diabetes may not notice simply because their feet have grown too numb to feel pain.
Diabetic ulcers on feet
One of the most frequent foot complications affecting people with diabetes is foot ulcers. A foot ulcer is a sore that usually forms on the underside of the foot. This makes it difficult to see when it starts to form, or even when it has completely formed. And because of diabetic neuropathy, or nerve damage, it is almost impossible to feel a foot ulcer forming.
Consequences of diabetic neuropathy and poor blood circulation in feet
When you can’t sense that your foot has been injured, you will not rush to treat the injury, especially if the problem is somewhere you can’t see, such as the back of the foot, between toes, or on the sole of your foot.
And since there is little to no blood circulation in your feet, any wound or infection will take a long time to heal. In some cases, it may not heal at all. According to one study, among diabetics with a non-healing wound, 1 out of 4 may need a partial or complete amputation.
Gangrene
Gangrene is a life-threatening condition that happens when human tissue dies from a lack of oxygenated blood, or when an infection refuses to clear up. Diabetic gangrene predominantly affects the feet. Signs of gangrene in the feet caused by diabetes are:
- The skin of the foot and lower leg changes color, becoming dark red, purple, blue, or almost black
- Skin appears thin, papery, and shiny. There is no hair on the skin
- Skin feels cold to the touch
- Foot is swollen and puffy
- An open wound that leaks blood or foul-smelling pus
Gangrene can lead to septic shock. The symptoms of septic shock are:
- Fever and shivering
- Confusion, disorientation, and lightheadedness
- Gasping breaths, sped-up heart rate
- Vomiting and diarrhea
- Severe pain all over the body
- Drop in blood pressure
If diagnosed in the very earliest stages, gangrene can be successfully treated with antibiotics. If it has progressed, partial or full amputation of the toe(s), foot, or lower leg may be necessary.
How to care for your feet
Caring for your feet is an essential part of managing diabetes.
- Wash feet daily with lukewarm water and soap, paying special attention to between the toes. Dry thoroughly. You might use a light moisturizer in winter, and switch to a dusting of talcum powder or cornstarch in summer.
- Cut toenails soon after washing feet as damp nails are softer and easier to trim. With dry toenails, you may need to use more force and could end up snapping or tearing the toenail instead of getting a clean edge. Always cut toenails straight across and smooth out sharp or rough edges with an emery board. Avoid metal nail files as they can be sharp, harsh, and may even pierce the skin if not handled properly.
Pedicures at nail salons are not advised, even if you bring your own nailcare tools. If you find it difficult to clean and trim toenails yourself, schedule an appointment with your podiatrist.
- Check feet regularly for cuts, blisters, corns, and ulcers. If it’s difficult to bend for a closer look, use the zoom function on your smartphone’s camera. Examine the sole of feet using a mirror.
- Always wear socks with shoes. Socks should be made of natural, breathable fibers like cotton or wool that efficiently absorb sweat. Many podiatrists recommend choosing white socks instead of darker colors, as white allows any blood or pus to be seen instantly. This alerts you to check your feet for injuries or infections.
- Experts estimate that 7 out of 10 people wear the wrong shoe size, so take your time when buying shoes to make sure they fit well. Shoes that are too small restrict blood circulation in your feet. Shoes that are too big may cause your foot to slip around, chafe against skin, and put you at risk of falling down.
When to shop for shoes, and what to do if you wear two different sizesThe best time to buy a new pair of shoes is after a long day of strolling around the mall. Feet tend to swell a few hours after waking up, and are at their largest by late afternoon or evening. Come prepared with clean socks of the kind you will be wearing with the shoes, for example, sports socks if buying sneakers, and your thicker winter socks if buying a pair of sturdy boots.
One of these feet is not like the other…
An estimated 3 out of 5 people have one foot bigger or wider than the other, so always try on both shoes in the pair. If the difference is minimal, buy the size that fits your bigger foot best and use shoe inserts to get a snug fit for your smaller foot.
If the difference is so big that you have to buy two pairs, you can donate or sell the remaining mismatched pair on online odd-shoe communities like mismateshoes.com.
When to see a doctor
Footcare is an integral part of managing diabetes and your doctor will most likely be keeping tabs on the health of your feet as a matter of routine.
Notify your care provider immediately if you notice the skin on your foot and lower leg darkening, if you develop a foot ulcer, if one or both feet swell up, or if you have a wound that refuses to heal. In some cases, your doctor may refer you to a podiatrist for specialized care