Diabetes-Related Foot Conditions

What are diabetes-related foot conditions?

People with diabetes are at an increased risk of foot conditions and complications if they have diabetes-related neuropathy and/or poor circulation. Diabetes-related neuropathy happens when you experience nerve damage due to persistently high blood sugar (hyperglycemia). It most commonly affects your feet.

Diabetes-related foot complications can happen due to a snowball effect of issues:

• A sore or blister goes unnoticed: Neuropathy causes numbness, tingling or pain in your feet, which can make it hard to tell you have a wound.
• The wound gets infected: People with diabetes are at an increased risk of skin infections due to a weakened immune system and inflammation.
• The infection may not heal well: Diabetes can damage blood vessels and reduce blood flow in your feet. This slows healing.
• Slow healing can lead to severe complications: Left untreated, infections can spread to other areas of your body and/or lead to gangrene (tissue death).

For all these reasons, taking care of your feet and managing diabetes well are very important. Several simple steps can help you prevent foot issues.

Types of diabetes-related foot conditions

Any skin-, nerve- or circulation-related issue with your foot has an increased risk of turning into an infection or another complication when you have diabetes. Examples of foot and toe conditions that could lead to complications include:

• Cuts, ulcers, burns and blisters that don’t heal.
• Dry, cracked skin.
• Corns and calluses.
• Fungal infections, like athlete’s foot and toenail fungus.
• Ingrown toenails.
• Hammertoes and bunions.

Diabetes-related foot ulcer

Foot and toe ulcers (open sores) are some of the most common types of foot problems for people with diabetes. About 15% of people with diabetes will get a foot or toe ulcer. The ulcers typically develop in areas where your foot repeatedly rubs or presses against shoes or other surfaces.

Ulcers can lead to infections. Sometimes, the infection doesn’t go away, and you may need to have part of your foot or toe surgically removed (amputated). Know that early treatment greatly reduces your risk of amputation.

What are the symptoms of diabetes-related foot conditions?

Symptoms of diabetes-related foot conditions vary based on the type. But in general, you should look out for the following symptoms:

• Any changes to your skin or toenails, like cuts, blisters, calluses or sores.
• Frequent bleeding.
• Discharge of fluid or pus.
• Foul smell.
• Pain.
• Skin discoloration.
• Swelling.

See your healthcare provider if you have these symptoms.

What are the complications of diabetes-related foot conditions?

Gangrene and Charcot foot are the main serious complications of diabetes-related foot conditions.

Gangrene

A foot infection that’s not treated in time can lead to gangrene. Gangrene is a medical emergency in which blood stops flowing to a specific part of your body, and tissues in that area die. Without prompt treatment, gangrene can be fatal.

Symptoms of gangrene include:

• Changes in skin color (from red to brown, and ultimately to purple or greenish black).
• Swollen skin.
• Severe pain or a loss of feeling.
• Skin that feels cool to the touch.
• A crackling sound when you press on your skin.
• Sores and blisters that release blood or foul-smelling pus.
• Chills.
• Fast breathing and heart rate.
• Fever.
• Loss of appetite.
• Vomiting.

Go to the emergency room (ER) if you have signs of gangrene.

Charcot foot

Charcot foot is a rare complication of diabetes-related neuropathy. If it’s not treated soon enough, Charcot foot can make the joints in your foot collapse and permanently affect your ability to use your foot. It can also make it more likely for an infection in your foot to worsen or spread to the rest of your body.

Early symptoms of Charcot foot include:

• Foot pain.
• Discoloration or redness.
• Swelling.
• A feeling of heat or warmth (especially one foot feeling noticeably warmer than the other).

See your healthcare provider if you have these early signs.

What causes diabetes-related foot conditions?

The two main underlying causes of diabetes-related foot conditions are:

• Diabetes-related neuropathy: Neuropathy is nerve damage. Diabetes-related neuropathy — peripheral neuropathy, specifically — makes it difficult to feel issues with your feet. This can lead to delayed diagnosis and treatment of foot conditions.
• Peripheral artery disease (PAD): People with diabetes are more likely to develop PAD, which can affect blood flow to your legs and feet. Reduced blood flow (poor circulation) can make it difficult for foot issues (like sores) to heal.

Perpetually high blood sugar levels can damage nerves and small blood vessels. Each person is different, so it’s impossible to predict how high blood sugar levels have to be — and for how long — to cause neuropathy or PAD. One study on people with Type 2 diabetes shows that having an A1C over 7% for at least 3 years increases your risk of diabetes-related neuropathy.

Poor foot care, like wearing ill-fitting shoes, walking barefoot or not treating sores and cuts with basic first-aid methods, can also increase your risk of foot conditions.

How are diabetes-related foot conditions diagnosed?

To diagnose diabetes-related foot conditions, a healthcare provider will:

• Ask about your symptoms.
• Ask about your diabetes history and management.
• Examine your toes, feet and legs.
• Touch your toes, feet and legs with various tools to check if you have numbness.

If you have a diabetes-related ulcer or blister, your provider will likely:

• Examine it for any signs of infection, like swelling, warmth, discoloration or discharge.
• Recommend imaging tests (like an X-ray or MRI) to look for any issues that may be deeper than your skin.
• Take a sample of the affected skin or discharge (biopsy) to test it for infection.

What is the treatment for diabetes-related foot conditions?

Treatment for diabetes-related foot conditions depends on the type. It’s essential to get medical help for diabetes-related foot conditions — don’t try to treat them yourself. Treatment for these issues may involve a podiatrist — a healthcare provider who specializes in foot care.

If you have a diabetes-related ulcer, for example, your provider may:

• Clean the wound.
• Drain any fluid or pus from the ulcer.
• Remove or cut away dead or infected tissue (debridement).
• Apply special bandages and ointments to absorb extra fluid, protect the wound and help it heal.
• Prescribe a wheelchair or crutches to take weight off the affected foot (called offloading).
• Prescribe oral or IV antibiotics to manage and eliminate infection.

Depending on how severe the infection is, your provider may recommend hospitalization. Sometimes, amputation is necessary to prevent infection from spreading to other parts of your body. Early treatment greatly reduces your risk of amputation.

How can I prevent diabetes-related foot conditions?

There are several steps you can take to help prevent diabetes-related foot conditions.

The most important step is to manage your blood sugar and diabetes well to try to avoid or delay diabetes-related neuropathy and blood flow issues. See your diabetes healthcare provider (like an endocrinologist) regularly for help with your management plan. Your medication needs will change as your life changes. Also, ask about advances in diabetes management technology, like continuous glucose monitoring (CGM), that can help you.

You can also reduce the risk of diabetes-related foot problems by:

• Checking your feet every day: Look for any changes and don’t forget to look between your toes. Use a mirror to check the bottom of your feet or ask someone for help.
• Keeping your toenails trimmed and filed: Cut your nails straight across with clippers to prevent ingrown toenails and gently smooth any sharp edges with a nail file. Have your podiatrist trim your nails if you can’t see or reach your feet or if you have thick, yellow nails.
• Wearing socks and shoes that fit well: Make sure your socks aren’t too tight and that your shoes fit properly. Some people with diabetes wear therapeutic shoes or shoe inserts (orthotics) to help prevent wounds or sores. Check that there aren’t any stones or other objects inside your shoes before putting them on.
• Protecting your feet from hot and cold temperatures: For example, if you’re wearing sandals, put sunscreen on the tops of your feet to prevent sunburn. Keep your feet away from heaters and open fires to avoid burns. In colder temperatures, make sure to wear socks and insulated shoes to keep your feet warm.
• Maintaining blood flow to your feet: For example, keep your feet elevated when you sit, and wiggle your toes often. Stay active, but choose activities that are gentler on your feet, like walking or swimming.
• Washing and moisturizing your feet every day: Use warm — not hot — water. Dry them thoroughly afterward, including between your toes. Then apply lotion to the tops and bottoms of your feet, but not between your toes.
• Asking your healthcare provider to check your feet at every visit: Ask your provider to examine your feet at least visually. At least once a year, get a thorough foot exam (called a diabetes foot exam), including a check of the feeling and pulses in your feet.

It’s just as important to avoid certain things. Don’t:

• Remove calluses or corns by yourself: Don’t cut off calluses or corns or use over-the-counter (OTC) products (like patches and liquids) to remove them. Instead, talk with your podiatrist about the best way to care for these conditions.
• Smoke: Smoking can damage blood vessels and lower the amount of blood flow to your feet. If you smoke, ask for help to stop.
• Soak your feet: Your skin could get too dry afterward.
• Walk around barefoot: Wear socks, shoes or slippers — even inside — to prevent foot injuries.

What can I expect if I have a diabetes-related foot condition?

Diabetes-related foot conditions are fairly common in people who’ve had diabetes for a long time. Even with foot checks and careful blood glucose monitoring, some people with diabetes develop infections.

Your outlook depends on factors, like:

• How early you find the foot issue and get help for it.
• If there’s an infection and how much it spreads.
• Treatment effectiveness.

Your healthcare provider will give you a better idea of what to expect based on your unique situation.

When should I see my healthcare provider about diabetes-related foot conditions?

Visit your healthcare provider or foot specialist (podiatrist) if you have any of these symptoms affecting your feet or toes:

• Tingling, burning or pain.
• A sore (like a blister or ulcer) that won’t heal.
• Dry, cracked skin.
• Loss of feeling or ability to sense heat or cold.
• A change in color and temperature.
• Any changes in foot shape.
• Thick, yellow toenails.
• A fungal infection, like athlete’s foot, between your toes.
• Hair loss on your toes, feet and lower legs.
• An ingrown toenail.

What questions should I ask my doctor about diabetes-related foot conditions?

It’s never too early to ask your healthcare provider about how to care for your feet if you have diabetes. Some questions that may be helpful to ask include:

• What can I do to better manage diabetes?
• What signs of neuropathy should I look out for?
• How can I care for my feet at home?
• How can I safely take care of corns and calluses?
• What kind of shoes do you recommend?
• Should I get specially fitted shoes or orthotics?
• I need help trimming my toenails. How can I set up appointments for that?
• What kind of treatment will I need for foot issues?
• What signs of infection should I look for?

A note from Cleveland Clinic

There’s a lot to manage when you have diabetes — from monitoring your glucose levels and taking medications to carefully planning meals and going to medical appointments. Your feet might be an afterthought. But adding your feet to your diabetes care checklist is important. There are several steps you can take to prevent foot issues and complications. If you have questions or concerns about the health of your feet, don’t hesitate to reach out to your healthcare provider. They’re available to help you put your best foot forward.