The Foot in Diabetes

Changes in the feet caused by diabetes are common and difficult to treat.

• Neuropathy (damage to the nerves) affects sensation in the feet, so that pain is not felt. Irritation and other forms of injury may go unnoticed; an injury may wear through the skin before any pain is felt.
• Other changes in sensation alter the way people with diabetes carry weight on their feet, concentrating weight in certain areas so that calluses form. Calluses (along with dry skin) increase the risk of skin breakdown and ulcers.
• Diabetes can cause poor circulation in the feet, making it more likely that ulcers will form when the skin is damaged and making the ulcers slower to heal.

In addition to the changes in the foot, diabetes can affect the body's ability to fight infections. Therefore, once an ulcer forms, it easily becomes infected; the infection may become serious and difficult to treat, leading to gangrene. People with diabetes are more than 30 times more likely to require an amputation of a foot or leg than are people without diabetes.

Foot care is critical. The feet should be protected from injury, and the skin should be kept moist with a good moisturizer. Shoes should fit properly and not cause areas of irritation. Shoes should have appropriate cushioning to spread out the pressure caused by standing. Going barefoot is ill advised. Regular care from a podiatrist, such as having toenails cut and calluses removed, may also be helpful. Also, sensation and blood flow to the feet should be regularly evaluated by a doctor.