If your diabetes is not controlled properly or you have poor diabetic control it can lead to complications with your feet, this happens when blood circulation and nerves to the feet are damaged. If they are not checked regularly it can lead to further problems with your feet and legs and in the worst case may require amputation. The different diabetes complications are explained in detail below
Studies have shown that people with diabetes that have better sugar control have fewer complications with their diabetes and with nerve damage that lead to foot problems.
COMMON FOOT PROBLEMS BLISTERS, CORNS & CALLUSES
Blisters are a swelling of the skin which contains a watery fluid. These develop when wearing new shoes and rubbing. Corns are hard thickened skin on or between toes they appear as a pyramid that presses down into the skin causing pain. This is a result of shoes that do not fit properly. Calluses are hard thick areas of skin occurring in parts of the foot where there has been increased pressure or friction; especially soles of the feet, if a lot of hard dead skin develops this can become very painful.
You should visit your podiatrist regularly. to have these examined or treated.
2. FUNGAL INFECTIONS
Fungal nail infections tend to occur under the nail, thickening, lifting and destroying it. Usually thick, crumbly and white, grey or yellow nails are a sign of fungal Infection.
These are treated by scraping the top of the nail and using anti- fungal medicines at the first sign of fungal infection. Once an infection is established, a professional should carry out scraping and removal of the infected area. In some cases an anti fungal medicine may be required.
DIABETES RELATED PROBLEMS: 1. POOR CIRCULATION
If you do develop poor blood circulation or circulation to your legs and feet is reduced (Ischaemia) you may experience cramp like pains in the calf, feet and/or buttocks.
Smoking increases further damage to your circulation; therefore it is in your best interest to stop. It also reduces the oxygen levels in your blood, which will make wounds, take longer to heal.
Tip: When resting do not cross your legs as this can restrict your circulation.
2. THE ISCHAEMIC (LACK OF BLOOD SUPPLY) FOOT
The ischaemic foot is cold and without a pulse, causes pain when resting, and is prone to ulceration and gangrene. Ischaemic ulceration usually affects the sides of the foot. Medical treatment alone is often effective reconstructive surgery is also a possibility.
3. POOR SENSATION (NEUROPATHY)
Diabetes can affect the nerves in your feet causing loss of feelings and sensation. Awareness in changes in temperature, touch pain may all be reduced. As a result foot problems may occur without you being aware of them. Such damage may lead to infection that can spread and also slow down healing.
You may experience some of the following symptoms:
Loss of pain sensation
Tingling
Pins and Needles
Shooting pain burning sensations. Detailed Explanation of Neuropathatic Pain
It is essential in all cases that you examine your feet everyday for changes, cuts and abrasions as walking on an injured foot could cause further damage. Loss of feeling makes you more prone to accidental injury, if you suffer a foot injury, however minor this is potentially serious and you MUST seek medical help. Contact your podiatrist, see below
4. ALTERING THE SHAPE OF YOUR FEET
Diabetes can cause damage to the nerves in your feet which can alter the shape of your feet. You may develop a high arch, which will cause the ball of your foot to become prominent and the toes to claw. If you have difficulty finding shoes to fit, you may need specially made shoes. See your doctor or podiatrist as these are only made on prescription.
5. THE NEUROPATHIC FOOT(damage of nerves and loss of sensation)
The neuropathic foot is numb, warm and dry, with pulses; complications include neuropathic ulcer, Charcot arthropathy and (rarely) neuropathic swelling (oedema). Neuropathic ulcers occur at points of high pressure loading, especially on the soles or at the sites where the foot has changed shape. Pressure damage causes hard bumpy skin areas (callosity), the self destruction of tissue (autolysis) and finally ulceration. Secondary infection is common.
6. FOOT ULCERATION
One of the complications of diabetes is ulceration of the foot (cuts and abrasions/ scraped areas) on the skin, which does not heal and is accompanied by inflammation. This can be because of the conditions mentioned neuropathy and ischaemia (lack of blood supply), frequently acting in combination and often complicated by infection, leading to ulceration of the diabetic foot. Bruising under callous can indicate that tissue breakdown or ulceration can be underneath the hard skin.
Foot ulcers are the most common complication leading to hospitalisation in diabetes. If it’s not checked it can lead to greater problems with your legs. In the worst case amputation may be required.
RISK FACTORS
Hyperglycaemia
Smoking
High blood pressure (Hypertension)
Neuropathy (damage to nerves and loss of sensation)
Circulation problems
Callus (hard skin) Foot ulcers are a common problem in people with diabetes. Risk is reduced with careful daily foot care.
7. CHARCOT ARTHROPATHY
This is a damaged, swollen and deformed joint in the foot (Charcot’s joint) caused by repeated a minor injury which you can be unaware of because the nerves that normally register pain are damaged. The foot is swollen, warm and red which is sometimes painful. Bone scans allow early diagnosis and radiographs later show disorganisation of the joint and new bone formation. The treatment is by immobilising (not moving) the limb with non- steroidal anti- inflammatory drugs for pain.
The Diabetes Foot Clinic specialises in the treatment of diabetes related foot problems and in particular foot ulcers
