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Diseases & Conditions

Diabetes and Your Feet

What is diabetes?

Diabetes is a disease of the pancreas. The pancreas produces a substance called insulin. Insulin plays an important role in the distribution and use of the energy the body needs to function.

When food is digested, much of it is broken down into a simple sugar called glucose. Glucose is the energy source the body's cells need to keep them functioning. Insulin enables the glucose to enter the cells. The digestive process will continue to create glucose whether or not the pancreas makes insulin. When the pancreas isn't making enough insulin, the bloodstream begins to get overloaded with glucose. This is called "high blood sugar" and is considered the prime indicator of diabetes.

There are three levels of diabetes: The pancreas does not make any insulin; the pancreas makes a small amount of insulin; the pancreas makes insulin but it does not work right. Any level can cause complications in other areas of the body. One of the most common areas of concern is the feet.

How can diabetes affect my feet?

Diabetes can contribute to foot problems in two ways: diabetic neuropathy — which is a nerve disorder that causes numbing and pain in the hands, legs and feet, and damage to internal organs — and poor circulation to the feet.

What are the foot problems can be caused by diabetes?

Diabetic peripheral neuropathy can cause toe deformities, the collapse of the arch, and dry skin. The foot often becomes wider and shorter, which puts pressure on parts of the foot that are less protected. This can cause ulcers to develop. Injuries such as scrapes or cuts can go unnoticed, which can also lead to foot ulcers and infections. If left untreated, infections can lead to gangrene and amputation. Poor circulation means a reduced blood flow, which can result in a lowered ability to fight infection and heal wounds. If an infection gets into the bone it can also lead to amputation.

Fifteen percent of all people with diabetes will eventually have a foot ulcer, and six out of every 1,000 will have an amputation (50,000 per year). However, doctors estimate that nearly three quarters of all amputations caused by poor circulation and diabetic neuropathy can be prevented with proper foot care.

Understanding diabetic neuropathy

There are three types of neuropathy: Diffuse (peripheral), which affects the limbs; diffuse (autonomic), which affects the internal organs; and focal, which affects the eyes, ears, facial muscles, pelvis, lower back, thighs, and abdomen. While the exact cause of diabetic neuropathy is unknown, researchers believe that higher blood glucose levels will lead to the onset of neuropathy more quickly. A study by the National Institute of Diabetes and Digestive and Kidney Diseases proved that keeping blood sugar levels as close to normal as possible slowed the onset and progression of neuropathy. Generally, neuropathy will develop within the first 10 years after diabetes is diagnosed. The risk for developing the disease increases the longer you have diabetes.

Peripheral neuropathy damages the limbs, particularly the feet. Common symptoms include, numbness or insensitivity to pain or temperature; tingling, burning, or prickling; sharp pains or cramps; extreme sensitivity to touch; and a loss of balance and coordination.

Treatment usually begins by bringing blood sugar levels under control. Lower blood sugar levels help reverse loss of sensation and pain, and might help delay the onset of other problems.

What can I do to better take care of my feet?

There are many steps you can take to greatly reduce the chance of major injury to your feet.

  • Visually check your feet and toes daily for any cuts, sores, blisters, bruises, bumps, infections, or nail problems.
  • Wash your feet daily using warm water and mild soap. Check the water temperature with your wrist to make sure it isn't too hot, and do not soak your feet for long periods.
  • If you have dry skin, cover your feet — except between your toes — with petroleum jelly or cold cream before putting on shoes and socks.
  • Wear thick, soft, and loose-fitting socks and shoes that fit well and allow your toes to move. Rotate your shoes and do not wear new shoes for more than a few hours at a time.
  • Cut your toenails straight across and don't leave sharp edges that could cut the next toe.
  • Never go barefoot on the beach or anywhere else.
  • Have your feet checked at every doctor visit.
  • Do not sit with your legs crossed. Crossed legs can cut circulation to the feet.
  • Do not use tobacco products. Smoking impairs circulation.

What if I find a foot injury?

The following are tips on how to take care of minor injuries to your feet. You should always have available — especially if you're traveling — antibacterial cream, gauze pads, hypoallergenic tape or paper tape, and pre-packaged cleansing towelettes (in case soap and water are not available). Always notify your doctor if you find any injuries to your feet. Contact your doctor immediately if discomfort lasts for more than two days or if you notice any pus developing on or near the sore.

Caring for small cuts

Gently wash the area with mild soap and warm water or use a cleansing towelette, then apply antibacterial cream to the cut. Cover with gauze and secure with hypoallergenic tape. Change the dressing at least once a day.

Caring for blisters

Do not break the blister. Gently wash the area with mild soap and water or use a cleansing towelette, then apply antibacterial cream to the blister. Cover with gauze and secure with hypoallergenic tape. Change the dressing at least once a day and wear different shoes until the blister heals.

Caring for minor burns

Do not break the blister. Gently wash the area with mild soap and water or use a cleansing towelette, then apply antibacterial cream to the blister. Cover with gauze and secure with hypoallergenic tape. Change the dressing at least once a day.

Caring for frostbite

Use warm water (98-104F) to warm the skin, and call for medical help immediately. Do not rub the area or apply creams and don't walk on the affected foot.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 3/15/2010...#8536