Finding out you have type 2 diabetes can be overwhelming. Managing new medications, adjusting your diet, monitoring your blood sugar—the list goes on. With so much to learn, you’re probably not thinking about your feet. But did you know that foot problems are one of the most serious complications of diabetes?¹
Diabetic foot ulcers are an unfortunate reality for many people living with type 2 diabetes. In fact, you have a 1 in 3 chance of developing these open sores at some point in your life.² As if that wasn’t bad enough, if the ulcer becomes infected (and more than half do), you run the risk of needing to have your toes, foot, or part of your leg amputated.²
But what’s the connection between type 2 diabetes and amputation? High blood sugar can wreak havoc with your nerves and blood vessels.³ Let’s take a closer look at how this can impact your feet.
Nerve Damage Can Cause You to Lose Feeling in Your Feet
Over time, high blood sugar can damage your nerves—particularly in your legs and feet.⁴ Sometimes there are no symptoms to warn you that this is happening,³ but you may experience:⁴
· numbness, or
· stabbing pain.
Eventually, nerve damage can cause you to lose “the gift of pain.”² When you lose feeling in your feet, you also lose the ability to sense when something is wrong. You might not think your favorite pair of heels could impact your health, but even minor injuries from poorly-fitted shoes can easily lead to a diabetic foot ulcer if left untreated.¹
Nerve damage can also change the shape of your feet.⁵ Foot deformities, including those affecting how your toes bend, can increase pressure on certain areas of your feet.⁵ Such pressure can cause a callus to form, which can worsen into a diabetic ulcer.⁵ Finding properly fitted shoes is essential if you have foot deformities since changes in your foot structure can cause your shoes to push or rub against your skin. Without feeling in your feet, you may continue to damage the area without realizing it.
While nerve damage is a common type 2 diabetes complication, there are things you can do to help slow its progression.⁴ Keeping your blood sugar in check is key.⁴ Be sure to take your medications as prescribed and follow a diabetes-friendly diet. Maintaining a healthy weight and managing your blood pressure and cholesterol levels can also help.⁴
Poor Blood Circulation Can Damage Your Feet and Slow Healing
Poor circulation in the legs and feet can contribute to diabetic foot ulcers.⁶ Decreased blood flow also slows down wound healing and increases the risk of amputation.¹
Type 2 diabetes can lead to problems with your circulation since high blood sugar can damage and narrow your blood vessels.⁶ This decreases the amount of oxygen and nutrient-rich blood that gets delivered to your feet.⁶ Without enough blood, the tissue in your feet can become damaged, and your body may have a hard time healing the area.⁶ Smoking is an added risk factor for poor blood flow.⁷ So, if you smoke, consider talking to your doctor about tools that can help you quit and reduce your risk of foot complications.
Signs of decreased blood flow in the legs and feet include:
· cramping or pain in your calves, thighs, or buttocks while walking or exercising,⁷
· loss of hair on your legs, feet, or toes,⁸ and
· thin, shiny, or cold skin.⁸
Focusing on Proper Foot Care Can Help Keep You Healthy
Foot ulcers pose a serious risk for those living with type 2 diabetes. Fortunately, following these 7 simple steps can help decrease your chance of developing severe complications:
1. Check your feet every day.
Observe the entire surface of both of your feet, including between your toes, for any signs of blisters, cuts, scratches, calluses, redness, swelling, or ulcers.¹ If you have trouble seeing certain areas, ask a family member to help. You can also use an unbreakable mirror to get a better look.¹ Be sure to contact your healthcare provider if you notice anything of concern.
2. Never walk barefoot.
Wear shoes and socks both inside and outside to prevent injury.¹ Before putting on your shoes, look and feel inside to check for objects or rough edges that may cause harm.¹
3. Wash your feet daily.
Washing your feet is an essential part of foot care.¹ Make sure the water is not too hot and dry your feet well, especially between your toes.¹ Apply lotion to the tops and bottoms of your feet daily to moisturize dry skin and prevent cracking.¹ Avoid getting lotion between your toes, as a moist environment can increase your risk of developing a fungal infection.⁹
4. Wear well-fitted footwear.
Avoid shoes that are too tight or have rough edges.¹ Look for options with a broad, square toe box.³ Because feet tend to swell as the day goes on, try on new shoes later in the day when your feet are at their largest.¹ If you’re having trouble finding shoes that fit, your healthcare provider may be able to recommend specialty footwear options or custom-made shoes.¹
5. Cut toenails straight across.
Trim toenails after a shower or bath when your nails are clean and soft.⁹ Be sure to cut your toenails in a straight line and avoid rounding the corners.⁹ Otherwise, you may end up with an ingrown toenail, foot ulcer, or infection.⁹
6. Don’t remove calluses or corns yourself.
Products sold to remove calluses or corns might damage your skin.¹ Always consult with a podiatrist (foot specialist) for safe removal.
7. Get annual feet check-ups.
Ask your doctor to examine your feet each year to check for signs of nerve damage or poor blood flow.³ You may need more frequent checks if you have certain risk factors, such as a history of prior foot ulcers or if you’ve lost feeling in your feet.³
Contacting Your Doctor Right Away Can Prevent Complications
Regularly monitoring your feet for changes can let you know as soon as there’s a problem. Be sure to contact your doctor right away if you notice any of the following:
· An abnormal foot shape or structure⁵
· Calluses, corns, blisters, cracks, or ulcers⁵
· Color or temperature changes¹
· Cramping, pain, or aching in your legs or buttocks after walking or exercising⁷
· Ingrown toenails⁵
· Hair loss on your legs, feet, or toes⁸
· Pain, burning, or stinging in your legs or feet³
· Signs of an infection, including redness, warmth, skin hardness, pain, tenderness, or pus¹
· Thin, shiny, or cold skin⁸
Foot care is one of the most important parts of managing type 2 diabetes because ulcers can lead to infections, hospitalizations, and amputations. Following good foot care practices and reporting any changes to your doctor as soon as they occur can help keep you healthy.
1. Schaper NC, van Netten JJ, Apelqvist J, et al. Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36 Suppl 1:e3266. doi:10.1002/dmrr.3266
2. Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017;376(24):2367-2375. doi:10.1056/NEJMra1615439
3. American Diabetes Association Professional Practice Committee, American Diabetes Association Professional Practice Committee:, Draznin B, et al. 12. Retinopathy, Neuropathy, and Foot Care: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Supplement_1):S185-S194. doi:10.2337/dc22-S012
4. Hicks CW, Selvin E. Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Curr Diab Rep. 2019;19(10):86. doi:10.1007/s11892-019-1212-8
5. Alavi A, Sibbald RG, Mayer D, et al. Diabetic foot ulcers: Part I. Pathophysiology and prevention. J Am Acad Dermatol. 2014;70(1):1.e1-18; quiz 19-20. doi:10.1016/j.jaad.2013.06.055
6. Bandyk DF. The diabetic foot: Pathophysiology, evaluation, and treatment. Semin Vasc Surg. 2018;31(2-4):43-48. doi:10.1053/j.semvascsurg.2019.02.001
7. Thiruvoipati T, Kielhorn CE, Armstrong EJ. Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms, and outcomes. World J Diabetes. 2015;6(7):961-969. doi:10.4239/wjd.v6.i7.961
8. Ahmad J. The diabetic foot. Diabetes Metab Syndr. 2016;10(1):48-60. doi:10.1016/j.dsx.2015.04.002
9. Pourkazemi A, Ghanbari A, Khojamli M, et al. Diabetic foot care: knowledge and practice. BMC Endocr Disord. 2020;20(1):40. doi:10.1186/s12902-020-0512-y
10. Makiling M, Smart H. Patient-Centered Health Education Intervention to Empower Preventive Diabetic Foot Self-care. Adv Skin Wound Care. 2020;33(7):360-365. doi:10.1097/01.ASW.0000666896.46860.d7