Overview
Diabetes can damage the nerve endings and blood vessels in your feet. That means you are less likely to notice when your feet are injured. A small skin problem like a callus, blister, or cracked skin can turn into a larger sore, called a foot ulcer. Foot ulcers form most often on the pad (ball) of the foot or the bottom of the big toe. You can also get them on the top and bottom of each toe.
Foot ulcers can get infected. If the infection is severe, then tissue in the foot can die. This is called gangrene. In that case, one or more of the toes, part or all of the foot, and sometimes part of the leg may have to be removed (amputated).
Your doctor may have removed the dead tissue and cleaned the ulcer. Your foot wound may be wrapped in a protective bandage. It is very important to keep your weight off your injured foot. After a foot ulcer has formed, it will not heal as long as you keep putting weight on the area.
Always get early treatment for foot problems. A minor irritation can lead to a major problem if it’s not taken care of soon.
What things increase your risk for diabetic foot problems?
Things that increase your risk for diabetic foot problems include:
- Poor blood glucose control.
If your blood sugar levels are persistently above the target range, you are more likely to have foot problems. - Duration of diabetes.
The longer you have the disease, the greater your risk. - Other complications due to diabetes (small blood vessel disease, atherosclerosis of large vessels).
If you already have other diabetic complications, you are more likely to have foot problems. - Smoking.
Smoking contributes to circulatory problems in your extremities, increasing your likelihood of developing foot problems. - Peripheral neuropathy (damage to the nerves that control sensation and touch).
Peripheral neuropathy results in poor sensation in your extremities, increasing your likelihood of having foot problems.
What are some treatments for diabetic foot problems?
Foot problems in people with diabetes are usually treated by keeping blood sugar levels in a target blood sugar range and by using medicine, surgery, and other types of treatment.
When foot problems develop, those problems need prompt treatment so that serious complications don't develop. Even problems that seem minor—like calluses, blisters, cracked or peeling skin, and athlete's foot—need to be checked by a doctor. These problems frequently occur as a result of reduced sensitivity in the feet and may precede more serious infections or foot ulcers if the cause (poorly fitted shoes, excessive weight-bearing, or dry skin) isn't identified and corrected.
After a foot ulcer has formed, it will not heal as long as weight-bearing on the area continues. Unless your foot ulcer is infected, your doctor may put a cast on your leg to help the ulcer heal. Keeping your weight off your injured foot is very important. Even when you are at home, be careful to stay off that foot. Cushioned shoes, orthotic inserts, support with a cane or crutches, and—in extreme cases—a wheelchair and bed rest may be used to reduce weight and pressure on the feet. Foot infections need to be treated with antibiotics.
If an ulcer or infection becomes severe and the tissue in the foot dies (gangrene), one or more of the toes, part or all of the foot, and sometimes part of the leg may have to be removed (amputated).
Bone and joint deformities can develop on the feet, such as toe joint deformities (hammer toe, claw toe, mallet toe) or Charcot foot. Surgery may sometimes be needed to remove bone that is causing a deformity.
All people with diabetes should check their feet regularly for problems. Regular foot exams by health professionals are also important.
Diabetic foot infection/ulcer: When to call
Call your doctor now or seek immediate medical care if:
- You have symptoms of infection, such as:
- Increased pain, swelling, warmth, or redness.
- Red streaks leading from the area.
- Pus draining from the area.
- A fever.
Watch closely for changes in your health, and be sure to contact your doctor if:
- You have a new problem with your feet, such as:
- A new sore or ulcer.
- A break in the skin that is not healing after several days.
- Bleeding corns or calluses.
- An ingrown toenail.
- You do not get better as expected.