How is Diabetes related to Foot Conditions?

Diabetic patients are particularly at risk for significant foot problems that can lead to the loss of their feet or legs. The most common cause of hospitalization for he diabetic patient is foot infections. Foot related problems for the diabetic patient are responsible for significant time off work. Foot ulcerations can take weeks or months to heal.

There are two conditions associated with diabetes that put the patient at risk. The first is called neuropathy, a nerve condition that frequently affects the feet. There is a gradual loss in the patient’s ability to feel sharp touch or pain. As the protective sensation is lost, the patient cannot feel the difference between hot and cold, sharp and dull, vibration or excessive pressure. This loss of sensation can become quite profound. Patients can step on sharp objects or cut themselves and not feel pain. They may burn themselves with scalding water and not be aware of it, and they can develop pressure sores and infections and experience little or no pain.

Because of this condition, diabetic patients must be constantly be aware of their feet and inspect them daily. They should avoid walking barefoot and avoid hot showers or baths. The temperature of the shower or bath water must be checked, usually with the elbow rather than the hand, prior to immersing the feet. It may be a good idea to have the water heater temperature lowered to prevent accidental burns. Avoid soaking the feet since this dries the skin and may cause cracking, leading to infection. Special care should be taken when trimming the toenails. Avoid sharp trimming of corns and calluses and over-the-counter corn removers. Shoe gear must be appropriately fitted to avoid areas of irritation. Frequently this condition causes a burning pain that makes sleeping difficult. Some patients may feel like their feet are ice cold and have difficulty warming them. Avoid using heating pads or hot water bottles to warm the feet since this can cause burns to the skin that may not heal and could lead to the loss of their foot or leg.

The second condition is a loss of circulation that can cause delay in healing of cuts or sores on the feet. In severe cases it can lead to gangrene and amputation. When present the skin may appear to be thin, hair growth on the foot or leg stops. In Caucasians the skin color turns reddish or blue. The feet are cool to the touch and can be very sensitive, making it painful to walk, even short distances.