Diabetes Mellitus (DM) is a lifelong chronic disease that is caused by high levels of sugar in the blood. It can also decrease your body's ability to fight off infections, which is especially harmful in your feet. When diabetes is not properly controlled, damage can occur to the organs and impairment of the immune system is also likely to occur.

With damage to your nervous system, you may not be able to feel your feet properly. This is called Diabetic Peripheral Neuropathy. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired, which can lead to an abnormal pressure on the skin, bones, and joints of the foot during walking and other activities. This can even lead to the breakdown of the skin of the foot, which often causes ulcers to develop. If you have diabetes, it is important to prevent foot problems before they occur, recognize problems early, and seek the right treatment when a problem does happen.

Diabetes Has Two Forms; Type 1 and Type 2

blood sugar levels

In Type 1 DM (usually onset at a younger age), genetics and other factors cause your body to make antibodies to certain cells in the pancreas that normally make insulin. These antibodies start to destroy the pancreatic cells, and therefore less insulin is able to be made. One of insulin’s normal functions is to push glucose from your blood into your muscle and other tissue to be used as a source of energy. Therefore without insulin from the pancreas, the glucose just stays in the blood, causing high blood sugar.

Type 2 DM (adult onset) is typically related to obesity, lack of exercise, and a diet high in fats and sugars. The increased body fat causes the muscles and other tissue to be resistant to insulin,therefore keeping the glucose in your blood and causing high blood sugar. Increased body weight also leads to pancreatic dysfunction, therefore decreasing the amount of insulin secreted and also leading to high blood sugar. Type 2 DM is also associated with other factors such hypertension, (high blood pressure), high cholesterol/triglycerides and increased abdominal fat.

Diabetic Complications of the Feet

When it comes to your feet, there are several risk factors that can increase your chances of developing foot problems and diabetic infections in the legs and feet. 

  • Poorly fitting shoes are one of the biggest culprits of diabetic foot complications. If you have red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new proper fitted shoes must be obtained immediately.

Properly fitted shoe vs. poorly fitted shoe

  • Common foot abnormalities such as bunions and hammertoes can increase the risk for calluses, abrasions, dry skin, and ulcers. These problems need to be resolved to lessen their impact.
  • Nerve damage or peripheral neuropathy (often patients with this condition cannot feel their feet normally and be able to sense when shoes are too tight or rubbing too much. Minor injuries such as cuts and blisters can be missed due to lack of sensation. 

The following can also compromise the health of your feet:

  • Poor circulation
  • Trauma to the foot
  • Infections
  • Smoking

Fungal Nails and Diabetes

Diabetic patients are at greater risk for developing a fungal nail infection than those who don't. In addition, fungal nails may lead to a limb threatening infection in diabetics. A diabetic patient who develops peripheral neuropathy or loss of sensation, may not be able to feel increased pressure on the nail. For example, wearing shoes that are too tight can cause the nail to lift letting in fungus.

From there, the fungus may spread to the surrounding skin, causing tinea pedis or athlete’s foot with cracks opening and further infection developing. In one study, there was a 15% rate of secondary infections in diabetic patients with fungus toenails compared to a 6% rate in diabetic patients without fungus toenails. In addition, diabetic patients with toenail fungus, had three times greater risk of developing a foot ulceration (wound).

If you have diabetes and thickened fungal toenails, you should consider treatment to resolve this problem. Learn more about how we treat fungal toenails here.

Diabetes can be extremely dangerous to your feet, so take precautions now. You can avoid serious problems such as losing a toe, foot, or leg by following proper prevention techniques offered by your podiatrist. Remember, prevention is the key to saving your feet and eliminating pain.

Management of the Diabetic Foot

Comprehensive Diabetic Foot Exam (CDFE)

The American Diabetes Association now recommends that all patients with diabetes obtain an annual Comprehensive Diabetic Foot Exam (CDFE). This exam helps the podiatrist identify problems to prevent foot complications from diabetes. There are several tests involved in this exam including PressureStat testing, a systems review, temperature stat testing, and vibratory stat testing.

Self-Exam and Other Recommendations

  • Check your feet and toes and look for cuts, sores, bruises or and changes to your toenails.
  • Wear thick, soft socks without seams.
  • Exercise daily to improve your circulation and to manage weight. Make sure you choose an exercise you like to do and that you wear well fitted shoes.
  • Obtain new shoes that fit properly - if you qualify you can obtain new shoes annually through your podiatrist's office.
  • Never go barefoot even in your home to avoid cuts and scrapes
  • Don't ever try to remove calluses or corns as this can cause damage to your foot.

Download Printable "Caring For Your Diabetic Feet."

Prescriptive Shoes

As a result of the CDFE, the podiatrist will determine if you need to obtain therapeutic shoes provided through a special Medicare Therapeutic Shoe Program. Sometimes your podiatrist will recommend prescriptive orthotics to help prevent protect your feet from further damage.

Request an appointment today so we can help you prevent problems with your feet. Call us at 206-368-7000.

Dr. Rion Berg
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A podiatrist in North Seattle treating families for over 40 years.