The Diabetic Foot

What are diabetic foot problems?

Of the 16 million people in the United States who have diabetes, 4 million of them (one in four) can expect to develop foot problems related to the disease.  Diabetic foot conditions develop from a combination of causes including poor circulation and neuropathy.  Diabetic neuropathy can cause insensitivity or a loss of ability to feel pain, heat, and cold.  Diabetics suffering from neuropathy can develop minor cuts, scrapes, blisters, or pressure sores that they may not feel. Poor circulation can complicate diabetic foot problems by reducing the amount of oxygen and nutrition supplied to the skin and other tissue, causing injuries to heal poorly. Diabetes-related foot and leg problems can include:

  • Infections and ulcers (sores) that don’t heal. An ulcer is a sore in the skin that may go all the way to the bone. Because of poor circulation and neuropathy in the feet, cuts or blisters can easily turn into ulcers that become infected and won’t heal. This is a common – and serious – complication of diabetes and can lead to a loss of your foot, your leg, or your life.
  • Corns and calluses. When neuropathy is present, you can’t tell if your shoes are causing pressure and producing corns or calluses. Corns and calluses must be treated properly or they can develop into ulcers.
  • Dry, cracked skin. Poor circulation and neuropathy can make your skin dry. This may seem harmless, but dry skin can result in cracks that may become sores and can lead to infection.
  • Nail disorders. Ingrown toenails (which curve into the skin on the sides of the nail) and fungal infections can go unnoticed because of loss of feeling. If they are not properly treated, they can lead to infection.
  • Hammertoes and bunions. Nerve damage affecting muscles can cause muscle weakness and loss of tone in the feet, resulting in hammertoes and bunions. If left untreated, these deformities can cause ulcers.
  • Charcot foot. This is a complex foot deformity. It develops as a result of loss of sensation and an undetected broken bone that leads to destruction of the soft tissue of the foot. Because of neuropathy, the pain of the fracture goes unnoticed and the patient continues to walk on the broken bone, making it worse. This disabling complication is so severe that surgery, and occasionally amputation, may become necessary.

What you can do…

  •  Take care of your diabetes. Make healthy lifestyle choices to keep your blood sugar close to normal. The Center for Diabetes and Metabolic Care can help.
  •  Check your feet every day.  Look for cuts, sores, red spots, swelling, or infected toenails.  Call your doctor immediately if a cut, sore, blister, or bruise on your foot does not heal after one day.
  •  Wash your feet in warm, NOT HOT, water.  Do not soak your feet because your skin will get dry. Dry your feet well and use talcum powder to keep the skin dry between the toes.
  •  Rub a thin coat of lotion or on the tops and bottoms of the feet. Do not put lotion between your toes, because this might cause infection.
  •  Trim your toenails with clippers after you wash and dry your feet.  Trim the toenails straight across and smooth them with an emery board or nail file. DO NOT cut into the corners of the nail or rip off hangnails. If you’re nails are thick or yellowed, DO NOT cut your own nails, have a foot doctor trim them.
  • Wear shoes and socks at all times.  Do not walk barefoot, not even indoors. It is extremely easy to step on something and hurt your feet. Always wear seamless socks, stockings, and nylons with your shoes to help avoid the possibility of blisters and sores. . Always check the insides of your shoes before putting them on.  Make sure the lining is smooth and that there are no foreign objects in the shoe, such as pebbles. Wear shoes that fit well and protect your feet.
  • Always wear shoes at the beach or on hot pavement. Put sunscreen on the tops of your feet for protection from the sun. Keep your feet away from radiators or open fires. DO NOT use hot water bottle or heating pads on your feet. If your feet are cold, wear seamless socks at night.  Lined boots are good to keep your feet warm in the winter.  Choose padded socks to protect your feet and make walking more comfortable. Keep your feet warm avoid frostbite.
  • To keep the blood flowing, elevate your feet when you are sitting. Wiggle your toes for 5 minutes, two or three times a day.  Move your ankles up and down and in and out to improve blood flow in your feet and legs.
  • DO NOT cross your legs for long periods of time.
  • DO NOT smoke.  Smoking reduces blood flow to your feet

How a podiatric physician can help…

If you are a diabetic, you should be particularly alert to any problems with your feet.  It is very important for diabetics with neuropathy to take necessary precautions to prevent injury and keep their feet healthy. If you have diabetes and are experiencing a foot problem, consult your foot doctor immediately.

The podiatric surgical team is an integral part of the Center for Advanced Wound Healing at Saint Francis. We bring the expertise of specialty trained podiatric surgeons who are able to diagnose the etiology of the wound and treat it accordingly.  We are able to treat all lower extremity wounds including wounds caused by diabetes, vascular disease (arterial, venous, lymphatic, vasculitis), radiation, trauma, burns and pressure.

Footwear and orthotics also play an important role in diabetic foot care.  Orthotics designed with Plastazote foam, are the best material for protecting the insensitive diabetic foot.  Plastazote is a material designed to accommodate pressure “hot spots” by conforming to heat and pressure.  By customizing to the foot, Plastazote provides the comfort and protection needed in diabetic foot care.  
Shoes best suited for protecting diabetic feet also should feature:

  • High, wide toe box (high and wide space in the toe area)
  • Removable insoles for fitting flexibility and the option to insert orthotics if necessary.
  • Rocker Soles ­ These soles are designed to reduce pressure in the areas of the foot most susceptible to pain, most notably the ball-of-the-foot.
  • Firm heel counters for support and stability.

Learn more...