Have you ever felt the tingling sensation of your foot or leg “falling asleep,” develop an itchy case of athlete’s foot, or have a painful blister after spending a day in uncomfortable shoes? Many of us have experienced these conditions without worry. However, for a diabetic, they may be warning signs of some very serious problems and can lead to infection and permanent damage.

What is Diabetes?

During digestion, the food you eat is converted into a sugar called glucose which your body uses for energy. But it needs insulin, a chemical secreted by the pancreas, to move the glucose from your blood into your body’s cells. Diabetes is a disease where excessive glucose builds in the bloodstream because your body cannot properly process or create insulin. This extra glucose can lead to many complications in the body, including damage to the nerves and blood vessels in the feet and legs.

If you are a diabetic, then you are at risk of serious foot problems, which, if ignored, can eventually result in the amputation of a toe, foot, or even a leg. It is very important to be aware of the symptoms, the basic facts for foot care, and ways to prevent painful foot ulcers.

Diabetes and its Effects on Nerves, Blood Vessels, and Feet

People with high blood glucose levels are prone to nerve and blood vessel damage.

• Nerve damage: Nerve damage as a result of high blood glucose is called diabetic neuropathy. Neuropathy can result in skin irritation, a burning feeling in the legs or feet, or a partial or complete loss of sensation. This means that a diabetic might not feel cold, heat, or pain in their legs. Because of this loss of sensation, sores, cuts or bruises often go unnoticed. These sores can worsen and become infected, and if left untreated for too long, the infected leg or foot might require amputation.

• Blood vessel damage: Another major problem caused by elevated glucose levels is the narrowing of blood vessels in your legs. High glucose levels cause fat to be deposited on the walls of blood vessels, leaving less room for blood to pass through. Because the blood supply is minimized, sores and cuts do not heal as quickly. If these wounds are left untreated, infection may occur and amputation could become necessary.

Common Diabetic Foot Problems

• Blisters: A blister looks like a bubble of skin filled with fluid and forms from continuous rubbing of the skin against a rough surface. Wearing tight shoes or shoes without socks can cause blisters. Blisters are vulnerable to infections, so it is important that you never “pop” the layer of skin covering the raw skin underneath.

• Corns and calluses: Corns and calluses are a thickening of skin in a particular part of the foot due to constant rubbing or continuous pressure by walking. Keep a close watch on any corns and calluses as they can become infected.

• Ingrown toenails: An ingrown toenail has grown into a fold of skin, causing swelling and redness. They are often caused by cutting the edges of the toenail too deep or by wearing tight shoes. Ingrown toenails can become infected, and in rare cases, may require surgery.

• Bunions: A bunion forms by wearing pointed shoes that push your big toe towards the smaller ones, causing the base of the toe to become red, sore, and infected. Treatments may include applying ice, orthotics, medication, or, in severe cases, surgery.

• Plantar warts: These painful warts are caused by the human papillomavirus (HPV) and often form at the base of the foot. Chemical treatments can be used to remove these warts, but in some cases, surgery is necessary.

• Hammer toes: This condition, which can be caused by genetics or wearing shoes that are too small, occurs due to a weakened muscle that causes toes to curl under the foot.

• Cracked, dry skin: Lack of moisture can cause the skin to become dry and actually crack. Germs and bacteria can enter these cracks and cause an infection. Keep skin moist by using lotion.

• Athlete’s foot: This contagious fungal condition causes itchy, painful cracks in the skin between the toes. While more serious infections sometimes can result, these instances are rare and there are many over-the-counter and prescription drugs that can be used to successfully treat athlete’s foot.

If you are dealing with any of these problems, consult your doctor.

Tests for Diabetic Foot Problems

Your doctor may decide to run some tests based on the conversations you have had with him, your medical history, and a physical examination. Tests may include:

• Visual Examination: Your doctor examines your leg, muscle tone and strength, tendon flexes, and sensitivity to touch, heat, cold, and vibration. He also checks for any sores, cuts, bruises, blisters, or injury.

• Filament Test: A filament is used to test the level of your sense of touch in your legs. The doctor will place a nylon filament on your feet. If you are not able to feel the presence of this nylon filament, it implies that you have lost sensation in your legs.

• Nerve Conduction Study: This test uses mild electrical waves to calculate how rapidly your nerves are able to conduct electrical signals.

• Electromyography: An electromyograph measures the amount of electrical signal produced in your muscles. This test is done with a nerve conduction study.

• Quantitative Sensory Testing: This test is used to analyze how your nerves react to vibration and temperature change.

• Autonomic Testing: This calculates your blood pressure at different points on your body and evaluates your ability to sweat.

Effective Foot Care Practices for Diabetics

Once you are diagnosed with diabetes it is very important to take special care of your legs and feet. It is recommended to get a foot test at every visit to your doctor. But to keep your legs and feet in good health between doctor visits, follow the guidelines below:

• Maintain your blood glucose level, blood pressure level, and cholesterol level

• Keep your feet clean by washing them with warm water, and be sure to dry them well, especially between your toes

• Check your feet every day for cuts, bruises, sores, or any infections, use a mirror to check areas that are hard to see

• Apply lotion when your skin is dry; do not apply lotion between your toes

• Cut your toenails after a shower or bath when they are softer, be careful not cut too deep

• Soften calluses or corns by using a pumice stone; this is especially effective after a shower or bath

• Do not walk barefoot

• Wear socks with your shoes to avoid blisters

• Wear shoes that fit well and do not have any rough edges

• Maintain blood flow in your legs by propping your legs up while sitting and by occasionally shaking your legs gently every five minutes, never cross your legs or keep them in a single position for a long period of time

• Naturally, always try to avoid injuries. However, accidents do happen. So, if you do get injured, immediately clean the wound with a mild antiseptic lotion and change the dressing at least once a day. Consult your doctor if you see any signs of infection, such as redness or itching.

Keeping the Right Foot Forward

Diabetes can cause many serious issues and infections of the legs and feet, but it is possible to reduce the risk of infection or limb amputation. Frequent doctor visits, self-monitoring, careful skin and foot care, and proper footwear are the keys to healthy feet and limbs while living with diabetes