What Are Diabetic Foot Problems?
If you have diabetes, having too much glucose (sugar) in your blood for a long time can cause some serious complications, including foot problems.
In severe cases, diabetic foot problems can lead to the amputation of a toe, the foot, or part of the leg. Knowing what issues to look for and how to take care of your feet can help you avoid serious complications. Managing your diabetes is also key to preventing problems with your feet.
How Can Diabetes Affect My Feet?
Diabetes can cause two problems that can affect your feet:
Diabetic neuropathy. Uncontrolled diabetes can damage your nerves. If you have damaged nerves in your legs and feet, you might not feel heat, cold, or pain there. This lack of feeling is called "sensory diabetic neuropathy." If you do not feel a cut or sore on your foot because of neuropathy, the cut could get worse and become infected. The muscles of your foot may not work properly because the nerves to the muscles are damaged. This could cause problems with your foot's alignment and create too much pressure on one part of your foot.
Peripheral vascular disease. Diabetes also affects the flow of blood. Without good blood flow, it takes longer for a sore or cut to heal. Poor blood flow in the arms and legs is called "peripheral vascular disease." If you have an infection that will not heal because of poor blood flow, you are at risk of developing ulcers or gangrene (the death of tissue due to a lack of blood).
Common Foot Problems With Diabetes
Anyone can get these foot problems. For people with diabetes, however, these common foot problems can lead to infection and serious complications, such as amputation.
Athlete's foot is a fungal infection that causes itching, redness, and cracking. Germs can enter through the cracks in your skin and cause an infection. Medicines that kill the fungus can treat athlete's foot. These medicines come in pills or creams.
Fungal infection of nails
Nails that are infected with a fungus may become discolored (yellowish-brown or opaque), thick, and brittle. They may separate from the rest of your nail. In some cases, your nails may even crumble. The dark, moist, and warm environment of shoes can help a fungus grow. An injury to your nail also can lead to a fungal infection.
Fungal nail infections are hard to treat. Medications applied to the nail are available, but they only help a small number of fungal nail problems. You may need prescription medicine that you take by mouth. Your doctor might also remove the damaged nail.
A callus is a buildup of hard skin, usually on the underside of the foot. Calluses are caused by an uneven distribution of weight. Calluses also can be caused by poorly fitting shoes or by a skin problem. It's normal to have some callus on your foot, so your doctor will decide if your callus is causing problems.
If you have a callus, take care of it properly. After your bath or shower, use a pumice stone to gently remove the built-up tissue. Use cushioned pads and insoles in your shoes. Medications can soften calluses. Never try to cut the callus or remove it with a sharp object.
Corns
A corn is a buildup of hard skin near a bony area of a toe or between toes. Corns may happen because of pressure from shoes that rub against your toes or cause friction between your toes. Be sure to take care of them properly. After your bath or shower, use a pumice stone to gently remove the built-up tissue. Do not use over-the-counter remedies to dissolve corns. Never try to cut the corn or remove it with a sharp object.
Blisters can form when your shoes rub the same spot on your foot. Wearing shoes that do not fit properly or wearing shoes without socks can cause blisters, which can become infected. When treating blisters, it's important not to "pop" them. The skin covering the blister helps protect it from infection. Use an antibacterial cream and clean, soft bandages to protect the skin and prevent infection.
Some people develop a specific kind of diabetic blisters on their feet or other parts of the body. These are called bullosis diabeticorum. They're not painful and won't be discolored. In addition to your feet, they might show up on your hands, legs, and forearms. They usually heal by themselves in a few weeks. The best way to treat them is to get your blood sugar under control.
A bunion forms when your big toe bends toward your second toe. Often, the spot where your big toe joins your foot becomes red and callused. This area also may stick out and become hard. Bunions can form on one or both feet.
They may run in the family, but most often they're caused by wearing high-heeled shoes with narrow toes. These shoes put pressure on your big toe, pushing it toward your second toe. Felt or foam padding may help protect the bunion from irritation. Your doctor also can use a device to separate the big and second toes. If the bunion causes severe pain or deformity, you might need surgery to realign your toes.
Dry skin can crack, which can allow germs to enter. Use moisturizing soaps and lotions to keep your skin moist and soft. Ask your doctor which ones to use.
Diabetic foot ulcers
A foot ulcer is a break in the skin or a deep sore. They can become infected. Foot ulcers can result from minor scrapes, cuts that heal slowly, or from the rubbing of shoes that do not fit well.
It's important to treat them as soon as you notice them. Ask your doctor for advice on how to best care for your ulcer. Up to 10% of people with diabetes will get foot ulcers.
A hammertoe is a toe that's bent because of a weakened muscle. The weakened muscle makes the tendons in your toe shorter, causing your toe to curl under your foot.
Hammertoes can run in families. They also can be caused by shoes that are too short. Hammertoes can cause problems with walking and can lead to blisters, calluses, and sores. Splints and corrective shoes can treat them. In severe cases, you may need surgery to straighten your toes.
Ingrown toenails
Ingrown toenails happen when the edges of the nail grow into your skin. They cause pressure and pain along the nail edges. The edge of the nail may cut into your skin, causing redness, swelling, pain, drainage, and infection.
The most common cause of ingrown toenails is pressure from shoes. Other causes include improperly trimmed nails, crowding of the toes, and repeated trauma to the feet from activities such as running, walking, or doing aerobics. Keep your toenails properly trimmed to prevent ingrown toenails. If you have a persistent problem or if you have a nail infection, you may need a doctor's care. Surgery to remove part of the toenail and growth plate can treat severe cases of ingrown toenails.
Plantar warts look like calluses on the ball of the foot or the heel. They may appear to have small pinholes or tiny black spots in the center. The warts are usually painful and may grow singly or in clusters.
Plantar warts are caused by a virus that infects the outer layer of skin on the soles of the feet. If you're not sure if you have a plantar wart or a callus, let your doctor decide. They have several ways to remove them.
Diabetes and swollen feet
Several factors can cause your feet and legs to swell when you have diabetes. This type of swelling is called edema.
It may be the result of poor circulation. Diabetes complications that affect your heart or kidneys also may play a role. Some medications may cause swelling. If your feet are swollen, try these remedies:
- Wear compression socks.
- Elevate your feet.
- Stay hydrated.
- Get exercise.
- Cut down on salt in your diet.
- Don't sit for long periods.
Diabetic foot pain
Neuropathy can cause pain and tingling in your feet. You can try over-the-counter medicines to start, such as acetaminophen, ibuprofen, or a skin patch with a numbing substance called lidocaine.
If your pain continues, your doctor may suggest a prescription medicine for your neuropathy symptoms. You may have to try a few different ones to find something that works. Drugs used to treat diabetic foot pain include:
- Anti-seizure drugs, including pregabalin (Lyrica) and gabapentin (Gralise, Neurontin)
- Antidepressants, including amitriptyline, nortriptyline (Pamelor), desipramine (Norpramin), duloxetine (Cymbalta, Drizalma Sprinkle), or venlafaxine (Effexor XR).
Researchers also have studied capsaicin, a substance found in chili peppers, as a treatment for neuropathy. Research suggests that patches and creams can reduce neuropathy symptoms.
Prescription painkillers can relieve diabetic foot pain, but using these drugs long-term is not recommended.
Symptoms of Diabetic Foot Problems
If you have diabetes, contact your doctor if you have any of these problems:
- Changes in skin color
- Changes in skin temperature
- Swelling in the foot or ankle
- Pain in the legs
- Open sores on the feet that are slow to heal or are draining
- Ingrown toenails or toenails infected with fungus
- Corns or calluses
- Dry cracks in the skin, especially around the heel
- Foot odor that is unusual or won't go away
Diabetic Foot Exams
Your health care provider should check your feet at every visit. At least once a year, your doctor should conduct a diabetic foot exam (taking an in-depth look at your feet).
During the exam, your doctor will check:
- Skin -- Are there cracks, dryness, calluses, diabetic foot ulcers, or other issues?
- Nerves -- How sensitive are your feet to different feelings?
- Circulation -- How is the blood flow in your feet?
- Bones and muscles -- Do you have structural issues such as bunions or bent toes?
Your doctor also might look at your shoes to make they sure fit properly.
Tips to Prevent Diabetic Foot Problems
Proper foot care can prevent common foot problems or treat them before they cause serious complications. Here are some tips for good foot care:
- Take care of yourself and your diabetes. Follow your doctor's advice regarding nutrition, exercise, and medication. Keep your blood sugar level within the range recommended by your doctor.
- Wash your feet in warm water every day, using a mild soap. Test the temperature of the water with your elbow because nerve damage can affect sensation in your hands, too. Do not soak your feet. Dry your feet well, especially between your toes.
- Check your feet every day for sores, blisters, redness, calluses, or any other problems. If you have poor blood flow, it's especially important to check your feet daily.
- If the skin on your feet is dry, keep it moist by applying lotion after you wash and dry your feet. Do not put lotion between your toes. Your doctor can tell you which type of lotion is best.
- Gently smooth corns and calluses with an emery board or pumice stone. Do this after your bath or shower, when your skin is soft. Move the emery board in only one direction.
- Check your toenails once a week. Trim your toenails with a nail clipper straight across. Do not round off the corners of your toenails or cut down on the sides of the nails. After clipping, smooth the toenails with a nail file.
- Always wear closed-toed shoes or slippers. Do not wear sandals and do not walk barefoot, even around the house.
- Always wear socks or stockings. Make sure they fit your feet well and have soft elastic.
- Wear shoes that fit well. Buy shoes made of canvas or leather and break them in slowly. Extra wide shoes are also available in specialty stores that will allow for more room if you have a foot deformity.
- Always check the inside of your shoes to make sure that no objects are left inside.
- Protect your feet from heat and cold. Wear shoes at the beach or on hot pavement. Wear socks at night if your feet get cold.
- Keep the blood flowing to your feet. Put your feet up when sitting, wiggle your toes and move your ankles several times a day, and don't cross your legs for long periods.
- If you smoke, stop. Smoking can make problems with blood flow worse.
- If you have a foot problem that gets worse or won't heal, contact your doctor.
- See your podiatrist (a foot doctor) every 2 to 3 months for checkups, even if you don't have any foot problems.
Diabetic Foot Problem Complications
If you have problems with your feet, they can turn into serious complications. Among them are:
Skin and bone infections
A small cut or wound can lead to infections. Nerve and blood vessel damage, along with immune system problems, make them more likely. Infections can be treated with antibiotics. Severe cases may require treatment in a hospital.
Abscess
Sometimes, infections eat into bones or tissue and create a pocket of pus called an abscess. The common treatment is to drain the abscess. It may require the removal of some bone or tissue. But newer methods, such as oxygen therapy, are less invasive.
Gangrene
Diabetes affects the blood vessels that supply your fingers and toes. When blood flow is cut off, tissue can die. Treatment usually involves oxygen therapy or surgery to remove the affected area.
Deformities
Nerve damage can weaken the muscles in your feet and lead to problems such as hammertoes, claw feet, prominent metatarsal heads (ends of the bones below your toes), and pes cavus, or a high arch that won’t flatten when you put weight on it.
Charcot foot
Diabetes can weaken the bones in your foot so much that they break. Nerve damage can lessen sensation and keep you from realizing it. You keep walking on broken bones and your foot will change shape. It might look like your arch has collapsed into a rocker shape.
Amputation
Problems with blood flow and nerves make it more likely for people with diabetes to get a foot injury and not realize it until infection sets in. When an infection can’t be healed, creates an abscess, or if low blood flow leads to gangrene, amputation is often the best treatment.
Takeaways
Diabetes can cause different types of problems with your feet. This usually happens because you have damaged nerves or blood vessels. Managing your blood sugar is crucial for avoiding foot problems. You also can keep your feet healthy by checking regularly for problems, wearing shoes that fit properly, and having your doctor do an in-depth exam at least once a year. Because you may lack feeling in your feet, small problems can go unnoticed and create serious complications.
Diabetic Foot Problem FAQs
What is the best treatment for diabetic neuropathy in feet?
Managing your blood sugar, exercising, and losing weight can help you deal with this issue. You and your doctor may have to try different approaches to pain management, including OTC drugs, topical medicines, anti-seizure drugs, or antidepressants. Prescription painkillers aren't recommended.
What do diabetic feet look like?
Some of the outward signs of diabetic foot problems include:
- Sores that don't heal
- Ingrown toenails
- Toenails that are yellow and thick
- Cracked skin
- Misshapen toes
- Discolored skin
What are the most common diabetic foot problems?
Open sores, called diabetic foot ulcers, are a common issue. They're most likely to happen where your feet or toes rub against your shoes.
Do diabetic feet hurt all the time?
If you have neuropathy, you may find that your pain is worse at night.
How do you treat early-stage diabetic foot ulcers?
If you notice an ulcer on your foot, contact your doctor. Early intervention can keep the problem from getting worse. Among the steps your doctor might take are:
- Relieving the pressure on that area of your foot
- Removing dead skin and tissue from the area
- Applying medicine and bandaging the wound
- Taking steps to prevent infection
