As diabetic patients age or the duration of diabetes increases, patients tend to develop diminished sensation and decreased peripheral circulation in feet. These patients are also at an increased risk of developing foot infections, especially those with poorly regulated diabetes.

As diabetic patients age or the duration of diabetes increases, patients tend to develop diminished sensation and decreased peripheral circulation in feet. These patients are also at an increased risk of developing foot infections, especially those with poorly regulated diabetes.

Common Foot Problems associated with Diabetics

1. Decreased Blood Supply (Ischaemia)

Diabetes can affect the blood vessels of feet causing poor circulation. Any damage to the foot may lead to infection which can spread and may cause foot ulcers.

Ischaemic leg, besides absent or reduced pulses, also has other characteristic features. Skin may become thin and loss of hair on the foot and ankle are common. Fissures are very common and ulcers may be painful. It may also be cold to touch.

2. Decreased Sensation (Neuropathy)

Neuropathy is damage to the nerves that travel between the brain and spinal cord to the muscles, skin and other parts of the body.Neuropathy can be caused by diabetes, but it can sometimes be caused by other illnesses also.

In Diabetic patients, High blood glucose levels over a period of time can lead to chemical changes in the nerves that cause damage.

High blood glucose levels can also damage the blood vessels that supply the nerves with oxygen.  This can also cause the nerves to become damaged.

Sensory neuropathy is the most common type and usually affects nerves in the feet and legs but can sometimes affect nerves in the hands and arms as well. Sensory neuropathy can cause a feeling of numbness, tingling or ‘pins and needles’. Some patients develop a feeling as if they are walking over sharp stones.

The neuropathic foot also has some characteristic features. The feet tend to be warm and dry and relatively insensitive to touch. Neuropathy may affect the muscles of the foot causing clawing of the foot. All this causes the fat pads covering the bones of the feet to be moved away from its position, thus exposing it to weight bearing areas. Any weight bearing area without adequate protection tends to open and form a wound called as an ulcer. In order to protect the leg, nature offers a mechanism by which it thickens the skin to avoid forming a wound.This protective mechanism will lead to problems such as callus and corns in later stages due to irritation of the tissues beneath. These can break down and lead to ulcers.

3. Infection

Diabetes can affect the blood vessels to your feet causing poor circulation. Any damage to the foot may lead to infection which can spread which may cause foot ulcers. Both ischaemic and neuropathic lesions are commonly complicated by infection. Common symptoms of infection are fever, redness, swelling or pain. Pus may also be seen in the lesions.

4. Combined Lesions

It is common for a patient to have all the processes mentioned above occurring at the same time. Thus a person can have an infected, neuropathic lesion with poor blood circulation.

To identify and treat the common problems of diabetic foot every individual with diabetes should know what are the abnormalities to look for in their feet.

Early detection and prompt attention can not only help save feet, they can also be life-saving.

1. Keep feet clean – wash them regularly.
2. Use only lukewarm water – no hot water, heating pads, hot water bottles, iodine or alcohol.
3. Keep the feet dry – especially between toes-use unscented lotion or cream to keep skin soft.
4. Use only medicines recommended by your doctor or chiropodist (podiatrist).
5. Cut toe nails straight across, not deep into the corners to help avoid ingrown toe nails.
6. Never use razors, knives or corn caps to remove corns.
7. Wear shoes or slippers at all times -never walk bare foot even at home.
8. Wear good fitting shoes/slippers – not tight or wornout ones. Boots should be used only for short periods.
9. Check your feet daily and see your doctor or chiropodist immediately about foot problems.

1. Sit on a bed or comfortable flat surface with legs drawn close to your body.
2. Hold a big size mirror beneath your feet 6 – 12 inches away.

1. Any cracks
2. Peeling of the skin
3. Abnormally dry skin
4. Colour change in any area
5. Any wound that has occurred
6. Any shiny appearance on the feet

1. Abnormally cold feet
2. Thickening of skin in the soles, especially beneath the big toe
3. Protruding bone beneath the feet
4. Change in the shape of the feet
5. Swelling of the feet
6. Localised redness or warmth of the feet
7. Ulcers or wounds

In case of any of the above symptoms, one should contact his / her family physician / diabetologist immediately