Diabetes and the Foot

Impact of diabetes on feet

Diabetes is often referred to as a lifestyle disease where the body’s ability to produce insulin is impaired. Low insulin levels result in high blood sugar. Diabetes is the root of various life threatening complications and disorders which develop later on in life like foot ulcers, loss of sensation, gangrene and many more.

Global statistics suggest that one in six people with diabetes in the world is from India. At 77 million, India has the second highest number of diabetics; becoming the 2nd leader of the world in diabetes. The International Diabetes Federation (IDF) offers projections that continue to order India at the second slot right up to 2045. In the next 25 years over 134 million Indians are expected to suffer from diabetes.

Taking into consideration the complications of diabetes, we will put special focus on one of its biggest secondary effects/ ailments, which is foot diseases.

Reasons behind foot vulnerability in diabetes

With high blood sugar levels, the feet are at an especially higher risk. Diabetes targets the feet more as they are subject to less efficient blood supply and vulnerable to wounds due to lack of sensation. Two conditions called “diabetic neuropathy” and “peripheral vascular disease” cause damage in the feet and other areas of the body of the patient.

What is diabetic neuropathy?

High blood sugar damages the body on a cellular level; hence what follows it up is damage to the nerves. There is a loss of sensation leading to a loss of the ability to sense pain and temperature. This turns into cuts and sores going unnoticed by the patient. Nerve damage can also affect the muscle of the feet leading to structural problems.

What is peripheral vascular disease?

It refers to a compromised circulation of blood in the legs and arms which leads to an increase of risk of infection as wounds do not heal. Further developing them into ulcers and gangrene due to insufficient blood supply.

Foot conditions caused due to diabetes

1) Calluses
A callus is a part of the skin that becomes hard and thickened after being exposed to frequent friction. A diabetic patient is prone to them as they have high pressure areas on their foot, a neglected callus or corn can turn in an ulcer or infection.

2) Foot Ulcers
A foot ulcer is an open sore/ wound on the foot. It is created by skin breaking down and contracting an infection. Nearly 10% of people with diabetes develop foot ulcers due to peripheral vascular disease and nerve damage.They should be treated by a doctor who will clean up the dead tissue and treat it with the best antibiotics to stop the ulcer from further worsening.

3) Corns
A corn looks like a thickened round area of skin that builds up between toes or near a bony area. They are caused due to constant pressure and friction. It should be checked up on with your doctor and not self treated.

4) Ingrown toenails
An ingrown nail is when edges of toenails curve inwards and sinks inside the skin causing pain or sometimes ulcers. Ingrown toenails can also occur due to incorrect footwear. Activities such as running and aerobics contribute to the problem furthermore. Walking, toe crowding, untrimmed toenails may also cause ingrown toenails. Best way to tackle it is to keep your toenails trimmed. Patients with diabetes should be aware of ingrown nails as loss of sensation can make them more vulnerable to it.

5) Fungal Nail Infection
Thick, brittle, yellow-brown, or opaque nails are common with fungal nail infections. The very unsightly nails are weak and prone to crumbling. Fungus thrives in dark and moist areas hence wearing closed-toe shoes is a highly contributing factor. It can be treated with oral medication and topical ointments.

6) Athlete's Foot
Dryness, redness and itching of the skin on the feet is referred to as Athlete’s foot. It occurs when fungal infection enters your skin through the cracks. It can be treated with doctor prescribed antifungal medication.

7) Skin Changes
Diabetes can affect the small blood vessels of the body that supply blood to the skin. Altered perspiration reduces natural skin oil and moisture, thereby making the skin dry. The problem can be managed by applying a thin layer of hand cream or petroleum jelly after a bath.

8) Foot Charcot
It is physical disfigurement of the feet in people with neuropathy. There is weakening of bones which can lead to fractures; but the fractures go unnoticed by a patient with neuropathy as they cannot sense pain sensation well. If they keep walking on their feet regardless of this, it can lead to bone destruction and cause deformity of the feet.

9) Gangrene
Neuropathy and Angiopathy causes diminished ability of oxygen-rich blood going into a tissue; which can lead to the death of the tissue. Dead tissue can contribute to more dying tissue hence it’s an urgent matter and one should go to the hospital immediately. It can even lead to amputation of the body part.

Preventive action to take

• Inspect your feet everyday: Check your feet for small skin breaks, cut,    blisters, ingrown nails-- anything to make sure it’s all under a watch.

• Check your blood pressure regularly.

• Wash feet daily with lukewarm, not hot water and pat dry your feet, do    not leave them moist.

• Keep the top and bottom of your feet moisturised as diabetic feet can    be dry.

• Don’t go barefoot. It’s best to avoid going barefoot to reduce the risks.

• Do regular exercise. Taking a short walk everyday can help increase the blood flow and circulation.

• Wear appropriate shoes. Do not compromise with the shoes you wear, choose what’s the best in comfort and the safest to avoid ulcers and blisters happening due to the shoes.

• Avoid at home “remedies” for sores, warts or calluses. They may turn into starting points for new infections.

• Quit smoking. Smoking has proven to further decrease blood flow.

• Don’t be hesitant to call your doctor. Even the smallest things can be managed better with your doctor.

In closing:

Diabetes may remain to be a part of your life but let it become who you are. Please do still enjoy doing the things you love. Have confidence in your doctors and be diligent in following instructions to take care of your own health. Lastly, do not try to self treat; your feet are in the safest hands when the hands belong to your doctor.

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Diabetes and
the foot