- Things to Know
- Symptoms & Signs
Things to know about diabetes foot problems
- A number of different kinds of foot problems can occur in people with diabetes.
- Two main conditions, peripheral artery disease (PAD) and peripheral neuropathy, are responsible for the increased risk of foot problems in people with diabetes.
- Symptoms and signs of diabetic foot problems arise due to the decreased sensation from nerve damage as well as the lack of oxygen delivery to the feet caused by vascular disease.
- People with diabetes have an increased risk of ulcers and damage to their feet.
- Diabetic foot problems also include bunions, corns, calluses, hammertoes, fungal infections, dryness of the skin, and ingrown toenails. These problems are not specific to diabetes but may occur more commonly due to the nerve and vascular damage caused by diabetes.
- Treatment depends on the exact type of foot problem. Surgery or even amputation may be required in some cases.
- Gangrene (dry gangrene) is tissue death due to the absence of blood circulation. It can be life-threatening if a bacterial infection develops (wet gangrene).
- Many diabetes-related foot problems can be prevented by good control of blood sugar levels combined with appropriate care of the feet.
How can diabetes cause foot problems?
Both type 1 and type 2 diabetes cause damage to blood vessels and peripheral nerves that can result in problems in the legs and feet. Two main conditions, 1) peripheral artery disease (PAD), and 2) peripheral neuropathy are responsible for the increased risk of foot problems in people with diabetes.
- Peripheral artery disease (PAD), sometimes referred to as peripheral vascular disease (PVD), means that there is narrowing or occlusion by atherosclerotic plaques of arteries outside of the heart and brain. This is sometimes referred to as "hardening" of the arteries. Diabetes is a known risk factor for developing peripheral artery disease. In addition to pain in the calves during exercise (medically known as intermittent claudication), the signs and symptoms of peripheral artery disease relate to a decreased delivery of oxygen to the lower legs and feet. In severe cases, the lack of oxygen delivery to tissues can result in ulcers and even gangrene (tissue death).
- Peripheral neuropathy refers to damage to the peripheral nerves directly as a result of diabetes. Symptoms of peripheral neuropathy include decreased sensation in the nerves of the legs and feet, making it difficult to perceive injuries due to lack of feeling. Peripheral neuropathy also causes tingling, pain, or burning in the involved areas. It can also cause the muscles of the feet to work improperly, leading to misalignment of the foot that can put pressure on certain areas of the foot.
What are the symptoms and signs of foot problems caused by diabetes?
In the most severe case, as mentioned above, due to a combination of decreased sensation and reduced blood flow to the feet, ulcers may develop. If the tissues continue to receive insufficient oxygen, tissue death (gangrene) occurs. Gangrene is a serious and potentially life-threatening condition. Other potentially serious problems that may develop include cellulitis (infection of the tissues beneath the skin) and osteomyelitis (infection of the bone); sepsis (the infection spreads to the bloodstream) also is possible.
People with diabetes are at increased risk for milder problems with the feet that are not specific to diabetes but may occur more frequently due to problems with the nerves and circulation to the feet.
Some of these conditions are: (This list is not exhaustive.)
- Calluses and corns, that may develop due to abnormal alignment of the feet or abnormal gait
- Fungal infections of the nails, which can appear as thickened, discolored, and at times brittle nails
- Tinea pedis, or athlete's foot, a fungal infection of the skin of the feet
- Hammertoes, or bent toes due to muscle weakness.
- Bunions, or the angling of the big toe toward the second toe. The area of the bunion may become reddened and irritated, leading to callus formation.
- Ingrown toenails
- Cracking of the skin of the feet, especially the heels, due to dry skin
What are treatment options for diabetes foot problems?
Treatment depends upon the type of foot problem. For example, some problems such as corns may require wearing corrective shoes, while others such as mild infections may be treated with antibiotics or antifungals. Other problems may need surgical debridement and antibiotics. Gangrene, or tissue death, cannot be reversed, but treatments are available to prevent gangrene (often termed dry gangrene) from spreading or becoming infected (dry gangrene becomes infected and develops into wet gangrene). Surgical removal of the dead tissue is typically required, and antibiotics are given to prevent the development of life-threatening infections in the dead tissue. In severe cases of gangrene, amputation of the affected part may be necessary.
Other types of foot problems can be relieved by proper footwear, sometimes with orthotic devices, and splinting or bracing. For some conditions like hammertoes, bunions, and ingrown toenails; surgery may be necessary to correct severe cases.
Taking proper care of your feet (see Prevention section) can help prevent or relieve many common foot problems in people with diabetes.
Is it possible to prevent diabetes-related foot problems?
Some diabetes foot-related problems can be prevented by taking careful steps to observe and care for your feet. Keeping blood sugar levels under control (in the ranges advised by your doctor), and following your recommended diet and exercise program are the best ways to prevent all complications of diabetes, including foot problems. In addition to keeping your diabetes under control, you can take steps to care for your feet, including the following:
- Wear comfortable, closed-toe footwear at all times. Special shoes are available for people with bunions or foot deformities if these are necessary. Be sure no objects are trapped inside the shoes that could cut or injure your feet.
- Don't walk barefoot, even at home. Be sure your feet do not get burned by walking on very hot pavement in summer
- Always wash your feet with warm water and dry them well after washing.
- Check your feet daily for any sores or problems.
- Apply lotion to dry areas, especially heels, but don't use lotion between the toes. Corns and calluses can be lightly smoothed with a pumice stone. Never use scissors or razors to cut away corns or calluses.
- Trim toenails straight across, and do not cut the corners shorter than the rest of the nail.
- Be sure that your doctor checks your feet at every checkup.
- Stop smoking if you are a smoker. Smoking further increases the risk of arteriosclerosis and poor circulation to the feet.
What is the prognosis for diabetes-related foot problems?
The outlook depends upon the severity of the foot problem. As mentioned before, gangrene can be life-threatening if a bacterial infection develops in the dead tissue area. Severe gangrene may result in the necessity for amputation of the affected area. Other foot problems are less severe but may nevertheless lead to reduced function or discomfort. Patients need to understand that the best outcome of foot problems caused by diabetes is life-long monitoring of their feet for problems and consulting their doctor immediately if a problem begins to develop.
Khardori, R.K. "Type 2 Diabetes." Medscape. May 31, 2022. <https://emedicine.medscape.com/article/117853-overview>.
National Diabetes Information Clearinghouse.
Top Foot Problems (Diabetes) Related Articles
Broken ToeA broken toe is one of the most common fractures among individuals. There are many causes of a broken toe, whether it is the big toe, middle toes, or little toe (pinky). Common symptoms and signs of a broken toe include pain, swelling, stiffness, and bruising. A broken toe can be treated with buddy taping the toe. There are instances where a doctor should be consulted for a broken toe.
CellulitisCellulitis is an acute spreading bacterial infection below the surface of the skin characterized by redness, warmth, inflammation, and pain. The most common cause of cellulitis is the bacteria staph (Staphylococcus aureus).
Corns and Calluses PictureCorns generally occur on the tops and sides of the toes. See a picture of Corns and Calluses and learn more about the health topic.
Diabetes Foot ProblemsLearn more about diabetes related foot problems. For people with diabetes, too much glucose in the blood can cause serious foot complications such as nerve damage, infection, and ulcers. Find tips for proper foot care to help prevent serious complications.
Diabetes (Type 1 and Type 2)Diabetes is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Diabetes QuizTake the Diabetes Quiz and learn the causes, signs, symptoms, and types of this growing epidemic. What does diabetes have to do with obesity and diet? Learn about life as a diabetic.
Does My Toe Need Amputation?Toe amputation is a common procedure performed by a wide variety of healthcare providers. One of the most common indications for toe amputation is patients with a diabetic foot. Toe amputation is usually performed as a last resort when medical treatment fails, or the toe cannot be salvaged. Complications of toe amputation include pain, swelling, bruising, blood clotting, and hematoma (blood clot).
Feet Facts QuizDid you know that certain shoes and common diseases can wreak havoc on your feet? If you've been having problems with your feet, this quiz is for you.
Hemoglobin A1c TestHemoglobin A1c or HbA1c is a protein on the surface of red blood cells. The HbA1c test is used to monitor blood sugar levels in people with type 1 and type 2 diabetes over time. Normal HbA1c levels are 6% or less. HbA1c levels can be affected by insulin use, fasting, glucose intake (oral or IV), or a combination of these and other factors. High hemoglobin A1c levels in the blood increases the risk of microvascular complications, for example, diabetic neuropathy, eye, and kidney disease.
Low Blood Sugar (Hypoglycemia)Low blood sugar or hypoglycemia occurs when blood sugar is dangerously low and is often complication of type 1 and type 2 diabetes. Learn about symptoms, dangers, and treatment.
Peripheral NeuropathyPeripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, shingles, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Peripheral neuropathy is diagnosed with exams and tests. Treatment for the condition depends on the cause. Usually, the prognosis for peripheral neuropathy is good if the cause can be successfully treated or prevented.
Type 1 DiabetesWhat is type 1 diabetes? There are new treatments for juvenile diabetes, and more people with diabetes can be treated than ever before. Learn the symptoms of T1D, the causes, and find ways to control your blood glucose levels naturally.
Type 2 Diabetes QuizWhat causes type 2 diabetes? Can it be prevented? Take this online quiz and challenge your knowledge of this common condition. Also, get the truth about myths and facts!
Type 2 Diabetes SignsLearn about type 2 diabetes warning signs, symptoms, diagnosis, and treatment options. Find out why thirst, headaches, and infections could be signs of diabetes. Discover the treatment options for people with type 2 diabetes, including medicines and lifestyle improvements.
What Diseases Does an Endocrinologist Treat?Hormones are secreted by the endocrine glands of the body. Different hormones have different actions. Each hormone acts on a specific body part. An endocrinologist is a specialist doctor who treats imbalances of hormones in the endocrine system.
What Is Reconstructive Foot Surgery?Foot reconstruction is a surgery performed to correct the anatomy of the foot and restore function lost due to trauma, birth defects, infection and other illnesses. Foot reconstruction considers the tissue reconstruction, function restoration, cosmetic rehabilitation and whether the foot can or should be saved by reconstructing. Severe foot conditions often require long-term care and rehabilitation. Many foot injuries result from motor vehicle or work-related accidents.
What Is Transmetatarsal Amputation?Transmetatarsal amputation (TMA) involves surgical removal of a part of the foot that includes the metatarsals. TMA is a relatively common operation performed to treat a severely infected foot or a foot with lack of oxygen supply (ischemic). Surgeons resort to this type of surgery when all other nonsurgical options to save the foot or limb have failed. Removing the infected part prevents the infection from spreading to the other parts of the limb and thus saves the limb in the long run.
The Worst Shoes for Your FeetStilettos, platforms or flip-flops... which are the worst shoes for your feet? See how some of the hottest styles can be torture on your feet, learn how damage and foot pain can occur, and discover how to stop foot pain.