Diabetes (Diabetes Mellitus) is a condition where the body can't use glucose for energy because it doesn’t have any or enough insulin. Insulin controls how much glucose can pass from the blood into body’s cells. If this is impaired, it results in higher blood sugar levels than normal and is called Diabetes. Over time, high blood sugar levels can damage the blood vessels and nerves in the body. Of those people with diabetes, it is estimated that 25% will develop foot problems related to the disease from a combination of causes. People with diabetes should pay particular attention to their feet and legs, because they are prone to foot problems such as:
Loss of feeling and circulation in the feet
Changes in the shape of the feet
Foot ulcers or sores that do not heal
Increased rate of infection in the feet and legs
Leg and foot problems are the most common reason for diabetes-related hospitalisation, and diabetes related problems are the leading cause of non trauma amputation in the lower leg and foot. Regular examinations and assessment by a podiatrist of the feet and legs are strongly recommended in diabetics every 6-12 months, to detect early changes in neurological or vascular deficiencies. Vascular testing is important to help diagnose inadequate blood flow in the legs and feet, whilst neurological testing determines if your diabetes is having an affect on the sensation in your feet. These tests are quick, painless and can be performed by your podiatrist.
Diabetes can affect the nerves in your feet. Nerves are the 'wiring' of the body. They carry feelings to the brain from the rest of the body. The nerves to the feet are the longest in the body and the most likely to be affected by diabetes. Diabetic Neuropathy can cause insensitivity or a loss of ability to feel sensations such as touch, pressure, vibration, pain, position in space and temperature. A person whose nerves are damaged by diabetes may not realise they have cuts, corns, blisters, pressure sores or ulcers, which in extreme cases may end up requiring amputation. Neuropathy can also cause deformities such as Bunions, Hammer Toes, and Charcot Feet.
As well as a loss in sensation, nerve damage can cause:
- Painful feet
- Numbness in the feet
- Pins and needles or shooting pain in the feet
- Burning sensation, particularly on the soles of the feet.
Prevention of neuropathy is very important in diabetics as once the nerves are destroyed, sensation rarely improves. It is important for those who do experience a loss of sensation to protect their feet as much as possible from harm. Daily foot checks are extremely important, as is timely treatment for cuts, bruises, burns, redness, cracks or blisters etc. The good news is that when a diabetic person takes the necessary preventative foot care measures, he or she reduces the risk of serious foot conditions significantly.
Diabetes often leads to peripheral vascular disease which reduces the amount of blood flow to the feet. Poor circulation can lead to a number of problems. When the blood vessels are damaged, vital oxygen and nutrients have trouble getting to the feet. A lack of circulation can lead to swelling and dryness of the feet and can impair the healing process. Poor circulation can also lead to ulcers, infection, and other serious foot conditions.
Poor blood supply can cause these common symptoms:
- Cold feet
- Painful legs (in particularly the calves) when walking
- Painful calves in bed at night.
- decreased healing rate in feet
You can improve circulation if you:
- Avoid smoking and decrease caffeine intake
- Are physically active
- Control cholesterol, blood sugar levels and blood pressure.
Note: If you control blood glucose levels it will also reduce the risk of nerve damage.
How to prevent foot problems
- Keep your blood sugars within normal healthy levels
- Check feet daily for any signs of injury or changes. You may need a mirror to look at the bottom of your feet or even get a little help from someone else if required.
- Wash feet daily and dry well between the toes to avoid problems such as tinea.
- For those people with no foot concerns and who don't require the assistance of a podiatrist for nail care, keep toenails trimmed. Cut toenails straight across and file rough edges to avoid Ingrown toe nails. It may help to soak your toenails in warm water to soften them before you cut them.
- Avoid injury by wearing well-fitting, protective shoes.
- Have corns or calluses treated by a podiatrist.
- Keep the skin on your feet in good condition by moisturising daily. Avoiding putting cream between your toes to reduce the risk of tinea.
- Don't let your feet get too hot or cold.
- Don't go barefoot (especially outside).
- Avoid talcum powder where possible.
- Choose appropriate shoes and socks for diabetics
- And always remember to keep up with your 6-12 month foot checks at your podiatrist.