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What are diabetes problems?

Too much glucose (sugar) in the blood for a long time can cause diabetes problems. This high blood glucose (also called blood sugar) can damage many parts of the body, such as the heart, blood vessels, eyes, and kidneys. Heart and blood vessel disease can lead to heart attacks and strokes. You can do a lot to prevent or slow down diabetes problems.

This article is about feet and skin problems caused by diabetes. You will learn the things you can do each day and during each year to stay healthy and prevent diabetes problems.

High blood glucose can cause feet and skin problems.

What should I do each day to stay healthy with diabetes?

• Follow the healthy eating plan that you and your doctor or dietitian have worked out.
• Be active a total of 30 minutes most days. Ask your doctor what activities are best for you.
• Take your diabetes medicines at the same times each day.
• Check your blood glucose every day. Each time you check your blood glucose, write the number in your record book.
• Check your feet every day for cuts, blisters, sores, swelling, redness, or sore toenails.
• Brush and floss your teeth and gums every day.
• Don't smoke.

How can diabetes hurt my feet?

High blood glucose from diabetes causes two problems that can hurt your feet:

Nerve damage

One problem is damage to nerves in your legs and feet. With damaged nerves, you might not feel pain, heat, or cold in your legs and feet. A sore or cut on your foot may get worse because you do not know it is there. This lack of feeling is caused by nerve damage, also called diabetic neuropathy (ne-ROP-uh-thee). It can lead to a large sore or infection.

Poor Circulation

The second problem happens when not enough blood flows to your legs and feet. Poor circulation makes it hard for a sore or infection to heal. This problem is called peripheral (puh-RIF-uh-rul) vascular disease. Smoking when you have diabetes makes circulation problems much worse.

Make sure you wear shoes that fit well.

These two problems can work together to cause a foot problem.

For example, you get a blister from shoes that do not fit. You do not feel the pain from the blister because you have nerve damage in your foot. Next, the blister gets infected. If blood glucose is high, the extra glucose feeds the germs. Germs grow and the infection gets worse. Poor circulation  to your legs and feet can slow or prevent healing.  One of the greatest risks for diabetics is from ulcerations that develop infections. If the infection never heals, gangrene can set in and ultimately lead to amputation of toes, feet and even legs.  It is the goal of our doctors to keep your feet healthy and to monitor them closely for cuts/wounds or pressure points that can develop into ulcerations.  Patients with ulcerations are the recipient of aggressive treatment and are seen sometimes several times a week until the ulcer is healed.  We believe that immediate and aggressive treatment modalities are warranted when a toe, foot or leg is at risk.  Our endeavor is to keep you on your feet -- and we take that mission seriously.

What can I do to take care of my feet

Wash your feet in warm water every day. Make sure the water is not too hot by testing the temperature with your elbow. Do not soak your feet unless your doctor has advised you to do so. Dry your feet well, especially between your toes.

Look at your feet every day to check for cuts, sores, blisters, redness, calluses, or other problems

• Checking every day is even more important if you have nerve damage or poor blood flow. If you cannot bend over or pull your feet up to check them, use a mirror. If you cannot see well, ask someone else to check your feet.
• If your skin is dry, rub lotion on your feet after you wash and dry them
• Do not put lotion between your toes
• File corns and calluses gently with an emery board or pumice stone. Do this after your bath or shower. Do not rub hard enough to cause the skin to turn red or develop raw spots!
• Cut your toenails once a week or when needed. Cut toenails when they are soft from washing. Cut them to the shape of the toe and not too short, especially at the corners. File any rough edges with an emery board.  If your nails are thick or painful, allow one of our doctors or our clinician to cut them for you. We have special instruments and are very experienced with cutting even the thickest of nails.
• Always wear shoes or slippers to protect your feet from injuries.
• Always wear socks or stockings to avoid blisters. Do not wear socks or knee-high stockings that are too tight below your knee.
• Wear shoes that fit well. Shop for shoes at the end of the day when your feet are bigger. Break in shoes slowly. Wear them 1 to 2 hours each day for the first 1 to 2 weeks.
• Before putting your shoes on, feel the insides to make sure they have no sharp edges or objects that might injure your feet.
• When visiting your family doctor or internist, remember to take your shoes and socks off so he/she can check your feet for any signs of problems and make the appropriate referral to a podiatrist.

 

How can I get my doctor to help me take care of my feet?

• Tell your doctor right away about any foot problems.
• Ask your doctor to look at your feet at each diabetes checkup. To make sure your doctor checks your feet, take off your shoes and socks before your doctor comes into the room.
• Ask your doctor to check how well the nerves in your feet sense feeling.
• Ask your doctor to check how well blood is flowing to your legs and feet.
• Ask your doctor to show you the best way to trim your toenails. Ask what lotion or cream to use on your legs and feet.
• If you cannot cut your toenails or you have a foot problem, ask your doctor to send you to a podiatrist.

What are common diabetic foot problems?

Anyone can have corns, blisters, and athlete's foot. If you have diabetes and your blood glucose stays high, these foot problems can lead to infections.

	Corns and callouses are thick layers of skin caused by too much rubbing or pressure on the same spot. Corns and callouses can become infected.
	Blisters can form if shoes always rub the same spot. Wearing shoes that do not fit or wearing shoes without socks can cause blisters. Blisters can become infected.
	Ingrown toenails happen when an edge of the nail grows into the skin. The skin can get red and infected. Ingrown toenails can happen if you cut into the corners of your toenails when you trim them. If toenail edges are sharp, smooth them with an emery board. You can also get an ingrown toenail if your shoes are too tight.
	A bunion forms when your big toe slants toward the small toes and the place between the bones near the base of your big toe grows big. This spot can get red, sore, and infected. Bunions can form on one or both feet. Pointy shoes may cause bunions. Bunions often run in the family. Prescription orthotics can accommodate some bunion deformities and prevent the furtherance of the deformity. In more serious cases surgery is the best alternative.
	Plantar warts are caused by a virus and appear on the bottom of your feet.  Sometimes warts occur on the toes or sides of the foot, but the treatment is the same.  There are many different ways to treat warts, depending on how many you have, have large they are and whether or not they have been treated before.
	Hammertoes form when a foot muscle gets weak. The weakness may be from diabetic nerve damage. The weakened muscle makes the tendons in the foot shorter and makes the toes curl under the feet. You may get sores on the bottoms of your feet and on the tops of your toes. The feet can change their shape. Hammertoes can cause problems with walking and finding shoes that fit well. Hammertoes can run in the family. Wearing shoes that are too short can also cause hammertoes.
	Dry and cracked skin can happen because the nerves in your legs and feet do not get the message to keep your skin soft and moist. Dry skin can become cracked and allow germs to enter. If your blood glucose is high, it feeds the germs and makes the infection worse.
	Athlete's foot is a fungus that causes redness and cracking of the skin. It is itchy. The cracks between the toes allow germs to get under the skin. If your blood glucose is high, it feeds the germs and makes the infection worse. The infection can spread to the toenails and make them thick, yellow, and hard to cut.

All of these foot problems can be taken care of. Tell your doctor about any foot problem as soon as you see it.

How can special shoes help my feet?

Special shoes can be made to fit softly around your sore feet or feet that have changed shape. These special shoes help protect your feet. Medicare and other health insurance programs may pay for special shoes. Talk to your doctor about how and where to get them.