Diabetes & Your Feet: 5 Things You Need to Do Right Now to Prevent Ulcers, Infection, Amputation

If you have type 1 or type 2 diabetes, your doctor has undoubtedly told you to pay special attention to your feet, since they are prone to infections, ulcers and worse. While it probably seems like enough work to track your blood sugar levels, keeping your feet healthy is crucial, too. 

diabetes and foot health

If you're not convinced, consider these scary statistics:
• Foot ulcers, common in those with diabetes, may heal but are very likely to reoccur. 
• The risk of an uninfected diabetic foot ulcer becoming infected is about 40%.
• The Charcot foot, a condition of severe deformity linked with diabetes, can lead to amputation—and three months or more of difficult movement. Other diabetes-related foot problems can also lead to amputation.1
• Every 30 seconds, a lower limb is lost as a consequence of diabetes. 1,2

Preventive Measures

As somber as those facts are, patients can be proactive about foot health with a number of simple steps, according to podiatric specialists talking at a seminar on the Diabetic Foot at the American Diabetes Association 77th Scientific Sessions in San Diego. Here are five suggestions.

#1. Understand Neuropathy

Diabetic peripheral neuropathy is, unfortunately, common in those with diabetes. It's defined as damage to nerves in your feet, lower legs, hands and elsewhere.

However, patients often don't truly understand what neuropathy is, says Andrew J.M. Boulton, FRCP, professor of medicine at the University of Manchester. "They have a strong vascular connotation, so they think it must have to do with circulation," Dr. Boulton tells Endocrine Web. They think, ''My foot is warm, it doesn't hurt, there must not be anything wrong." Those with neuropathy must understand that ''they have lost the gift of [feeling] pain," he says.

How to better understand it? He likes to use the analogy of a light bulb and electrical wire. "If the wire is broken, the light will go out." In the foot with neuropathy, ''the message is not getting from the foot to the brain,'' Dr. Boulton says. "There is a block, as if the wire is cut."

This is why following guidelines to be screened for neuropathy is important; between screenings, if you feel you are experiencing it, consult your doctor.1

#2. Recognize Your Risk of Infection

Of those with diabetes, about one in four will develop a diabetic foot infection, says Benjamin A. Lipsky, MD, FACP, FIDSA, FRCP, emeritus professor of medicine at the University of Washington and visiting professor at the University of Oxford. 1,3
While up to 35% are mild, the rest can be moderate or severe, he says.

Even if you go to the doctor to get it checked out, and it's not infected, keep an eye on it, he warns. He cites one study, in which ''40% of patients who were uninfected at the time they presented [for medical care] developed an infection." 4

Among the risk factors for infection, this study found, were a delay in healing, a deep infection and having a foot deformity. Younger adults were more likely in this study to develop an infection, and women were more likely than men to develop it. 4 Researchers have focused on whether one oral antibiotic may be better than another to treat diabetic food infections, and the bottom line, Dr. Lipsky says, is that it's not clear if one is better than another.1

#3. Rethink Ulcer ''Healing"

If you get a foot infection or ulcer, you are probably tempted to say it's all healed and you're cured.

Not a good idea, says David G. Armstrong, MD, PhD, DPM, professor of surgery, The University of Arizona, Tucson. "Recurrence in this population is not only possible,'' he says, "I would argue that it is likely."

Instead of thinking ''healed,'' he suggests considering yourself in ''remission." In that way, you may pay more attention to your foot health, he says. Technology can help you pay close attention to your feet, he says, citing products such as bath mats and socks with sensors that detect blood flow and the formation of a pre-ulcer.

#4. Understand the Charcot Foot
Another diabetes-related complication, Charcot foot, is linked with neuropathy and inflammation and affects the bones, joints and soft tissues. It destructs the bone and can cause gross deformity, says Dane Wukich, MD, professor and chairman of orthopaedic surgery at the University of Texas Southwestern Medical Center.

Originally linked with syphilis, researchers then began to realize the role neuropathy plays in this condition. Once the condition sets in, it's a lengthy healing time, which varies according to the area of the foot affected. The midfoot is often affected, Dr. Wukich says, and ''the average healing time is 86 days." Casting is often done to reduce swelling and inflammation and protect the foot from further injury, Dr. Wukich says.1

#5. Get a Podiatrist's Perspective

Foot health ''starts with taking care of the diabetes," Lawrence B. Harkless, DPM, the session moderator, tells DiabeticLifestyle. He is founding dean and professor of podiatric medicine, surgery & biomechanics at the College of Podiatric Medicine, Western University of Health Sciences, Pomona. As blood sugar levels rise, he says, so does the likelihood of progression to neuropathy.

Dr. Boulton reports no conflict of interest.
Dr. Lipsky reports no conflict of interest.

Dr. Wukich disclosed no conflict of interest.

Dr. Harkless reports no relevant  disclosures.


Updated on: January 11, 2018
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Diabetes & Foot Health: An Expert's Guide to Healthy, Happy Feet