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Foot Clinic Home | Introduction | Risks | Prevention | Treatments

What's Blood Pressure - Diagram

    Diabetic foot problems can be serious | Are you at risk?

Why are they worse for people with diabetes?

In people with diabetes, these problems frequently lead to infections. If blood glucose levels are high, your ability to fight infection is weakened. High glucose levels cause two other problems that can significantly hurt your feet:

  • Nerve damage: High blood sugar can damage the nerves in your legs and feet. With damaged nerves, you might not feel pain, heat, or cold in your legs and feet. A sore or cut on your foot can get worse because you don't know it is there. This lack of feeling is called diabetic neuropathy. It can make a small problem much worse.

  • Poor blood flow: Diabetes often affects the blood vessels, reducing the amount of blood flowing to your legs and feet. This makes it hard for a sore or infection to heal. Smoking when you have diabetes makes blood flow problems much worse.

These two conditions can work together to cause a foot problem, or to make it harder for a foot condition to heal. See the example in the box.

For example . . . . . . say you get a blister from shoes that don't fit right. You don't feel the pain from the blister because you have nerve damage in your foot. Next, the blister gets infected. If blood sugar is high, the infection gets worse. You still don't feel any pain. Poor blood flow to your legs and feet can slow down healing by failing to bring needed oxygen and nutrients to the area. Sometimes this kind of bad infection never heals. It can cause gangrene, in which the skin and tissue around the sore die. When that happens, amputation is needed to keep the gangrene from spreading.

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How will I know if I'm at risk for diabetic foot problems?

About 15% of people with diabetes will develop foot ulceration at some point, and 14% to 24% of these will have to have an amputation. The majority of these - almost 60% - occur in people who are 65 and older. The risk for foot ulceration leading to amputation increases in people over 40 who have had diabetes for 10 years or longer.

People are at high risk for foot problems if they have loss of protective sensation - such that you can't feel an injury, or vascular disease causing poor blood flow in your feet and legs. Other risk factors are skin disorders such as calluses, especially with redness or bleeding under a callus, and nail abnormalities such as very thick nails. Structural/bony deformities such as hammertoes or bunions and limited joint mobility are also risk factors.

In addition, people who do not have good control of their blood glucose are at increased risk, as are those who have cardiovascular, eye, or kidney complications. People who have had foot ulcers or amputation previously have, by definition, the necessary risk factors for future problems.

The American Podiatric Medical Association has identified specific conditions that warn of impending foot problems - see the box.

Warning Signs of Foot Complications
  • Changes in skin color
  • Elevation in skin temperature
  • Swelling of the foot or ankle
  • Pain in the legs
  • Open sores on the feet that are slow to heal
  • Ingrown and fungal toenails
  • Bleeding corns or calluses
  • Dry cracks in the skin, especially around the heel

If you experience any of these conditions, contact your healthcare provider or podiatrist right away. They should be properly managed in order to avoid complications.

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