Daily care can prevent serious complications from diabetes.
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.
Dr. Knoepflmacher is a clinical instructor of medicine at The Mount Sinai Hospital in New York City, where he also maintains a private practice.William Spielfogel
Dr. Spielfogel is the chief of podiatry in the department of orthopaedic surgery at Lenox Hill Hospital in New York City.Minisha Sood
Dr. Sood is a board-certified endocrinologist in private practice in New York City and an assistant professor at Hofstra School of Medicine.
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We know that diabetes affects foot health.
00:00:05,050 --> 00:00:08,338
And the reason is because diabetes
affects the nerves in the feet and
00:00:08,338 --> 00:00:09,502
it affects blood flow.
00:00:09,502 --> 00:00:14,265
00:00:14,265 --> 00:00:16,772
Somebody has a peripheral neuropathy,
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you have a lack of sensation in
your feet and you are walking.
00:00:20,550 --> 00:00:24,780
There's a tack on the ground and you step
on the tack, and while you're barefoot,
00:00:24,780 --> 00:00:27,010
you may not even realize
you stepped on a tack.
00:00:27,010 --> 00:00:30,730
If you have a sore on the bottom of your
foot, which can turn into an ulceration,
00:00:30,730 --> 00:00:35,470
in order for these wounds to heal,
you need to have adequate circulation.
00:00:35,470 --> 00:00:39,960
Foot problems in patients with
diabetes can be as simple as dry skin,
00:00:39,960 --> 00:00:42,220
cracked skin on the heel.
00:00:42,220 --> 00:00:46,240
It can progress further from
there to cuts that don't heal,
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to outright ulcers that maybe even can go
into the muscle layer, or to the bone.
00:00:51,320 --> 00:00:55,050
If an individual has a bunion
deformity where there's a protrusion
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on the side of their foot,
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and you put your foot into a shoe that's
a little too snug and not fitting well.
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And you have a lack of sensation, and you
get a lot of pressure and rubbing there,
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you could develop a sore on the side
of the foot overlying the bunion,
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which could lead to an ulceration.
00:01:13,810 --> 00:01:16,830
I not only send my patients to
podiatrists on a regular basis,
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especially if they've had diabetes for
a number of years, but
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I also reinforce healthy
foot care at every visit.
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That would mean washing
your feet regularly,
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not walking barefoot,
wearing comfortable socks,
00:01:29,530 --> 00:01:34,180
making sure that your shoes fit properly,
examining your feet daily.
00:01:34,180 --> 00:01:37,950
I have them use moisturizer on their
feet just to prevent cracked skin from
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to bring problems to someone's
attention sooner rather than later.
00:01:42,740 --> 00:01:47,570
Patients with diabetes should be
seen regularly for foot evaluations.
00:01:47,570 --> 00:01:52,380
When we do the examination we're checking
circulation, we're checking skin texture,
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we're checking to see if
there are any cracks.
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We do a neurological examination, and
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what that means is we test to see if
the patient has sensation in their feet.
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The topic of amputation is a sensitive
one for my patients with diabetes.
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I start out by talking about
good glucose control and
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we go through the data that
we know about risk reduction.
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So I tell them for every 1% A1C reduction
or hemoglobin A1C that they have,
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there is a significantly lower risk
of foot amputation by about 40%.
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The key with all diabetic
patients is prevention.
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In order to prevent foot problems, number
one is keep your sugar under control.
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You should see your primary care
physician on a regular basis,
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you should see your endocrinologist
on a regular basis,
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and you should see your
podiatrist on a regular basis.
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Definition of ulceration. Bethesda, MD: National Cancer Institute. (Accessed on May 5, 2021 at https://www.cancer.gov/publications/dictionaries/cancer-terms/def/ulceration.)How wounds heal. Washington, DC: U.S. National Library of Medicine. (Accessed on May 5, 2021 at https://medlineplus.gov/ency/patientinstructions/000741.htm.) Hunt DL. Diabetes: foot ulcers and amputations. BMJ Clin Evid. 2011 Aug;2011. Neuropathy (nerve damage). Arlington, VA: American Diabetes Association. (Accessed on May 5, 2021 at http://www.diabetes.org/living-with-diabetes/complications/neuropathy/.)