When it comes to managing diabetes, much attention goes to stabilizing blood sugar levels—and for good reason. Preventing hypoglycemia and hyperglycemia are crucial aspects of diabetes that can require, at times, minute-by-minute attention. However, diabetes affects more than just monitoring glucose: It can impact several parts of the body, especially the feet.
“We know that diabetes affects foot health, and the reason is because diabetes affects the nerves of the feet, and it affects blood flow,” says Paul Knoepflmacher, MD, a clinical instructor in medicine at The Mount Sinai Hospital.
Peripheral Neuropathy and Diabetes
Nerve damage in the feet from diabetes is called peripheral neuropathy, and it typically develops in patients who have had diabetes for many years. Nerves can help you detect pain, which signals to the brain that something is wrong. When these nerves are damaged, which is common among people with diabetes, you could be injuring yourself and not even feel it.
“[When] somebody has peripheral neuropathy, you have a lack of sensation in your feet,” says William Spielfogel, chief of the division of podiatry at Lenox Hill Hospital. “[If] there’s a tack on the ground and you step on the tack while you’re barefoot, you might not even realize you stepped on a tack.”
Patients with peripheral neuropathy may say that their feet feel tingly, numb, weak, or insensitive to cold or heat, according to the American Diabetes Association. In other cases, the feet may become more sensitive to the touch or to temperature changes.
Blood Circulation and Diabetes
When blood circulates, it transports red blood cells, which helps produce collagen. These tough, white fibers help form new tissue, a crucial part of healing wounds, according to the U.S. National Library of Medicine.
In someone with diabetes, whose blood circulation may be restricted, wounds on the foot may take a long time to heal because the foot isn’t getting enough red blood cells to form new tissue. Without proper healing, more minor cuts can turn into ulcerations (a break on the skin where surface skin cells die), according to Dr. Spielfogel.
Common Foot Problems in Diabetes
Foot problems caused by diabetes fall on a spectrum of severity. Here are some possible issues patients may see, according to Minisha Sood, MD, an endocrinologist in New York City.
Cracked skin, especially on the heels
Slow wound healing
Sores and ulcers
Amputation, in severe cases
Someone without diabetes might find bunions, corns, and calluses just a nuisance, but these minor foot problems could be potentially dangerous for someone with diabetes. If a shoe rubs against a bunion all day and a person with diabetes does not feel it because of nerve damage, it may become a sore which could develop an ulceration, according to Dr. Spielfogel. People with diabetes are more prone to athlete’s foot; hammertoes are another foot problem that can affect diabetics.
How to Have Healthy Feet
There are three main components to preventing foot problems with diabetes: regular checkups with a podiatrist, daily self-care strategies, and blood sugar management.
Here are strategies for self-care at home, according to Dr. Sood:
Wash feet regularly
Avoid walking around barefoot
Wear comfortable socks
Wear well-fitting shoes
Check feet daily for cuts or wounds
Patients should see a podiatrist regularly (even if their feet seem fine) to catch potential issues early. At foot evaluations, a podiatrist can check for nerve damage, blood circulation, skin texture, and cracks or wounds, and look for changes over time, according to Dr. Spielfogel.
These self-care strategies and regular checkups can help prevent severe complications or even foot amputation. Annually, amputation affects between 0.25 and 1.8 percent of people with diabetes, according to a 2011 study. The good news: This unfortunate outcome can be prevented with good glucose control. In fact, for every one percent reduction in a person’s A1C levels, there is a 40 percent reduction in the risk of amputation, according to Dr. Sood.
Bottom line: When it comes to diabetes complications, prevention is key. Here’s how often to see your doctor with diabetes, tips for monitoring blood sugar, and rules for a healthy diet with diabetes.