Diabetes Mellitus (DM) is a lifelong chronic disease that is caused by high levels of sugar in the blood. It can also decrease the body's ability to fight off infections and cause damage to the nervous system, which is especially harmful to the feet.

Type 2 Diabetespeople with Type 2 diabetes

Most of the diabetic patients we see at the Foot and Ankle Center, have Type 2 DM (adult onset). This form of diabetes is typically related to family history, obesity, lack of exercise, and a diet high in fats and sugars. The increased body fat causes the muscles and other tissue to become resistant to insulin. As a result, glucose stays in your blood causing high blood sugar.

Diabetic Peripheral Neuropathy

About half of all people with diabetes develop Diabetic Peripheral Neuropathy, a condition which causes damage to the nervous system. With this condition, a person loses their ability to properly feel their feet. Minor injuries can go unnoticed leading to many foot problems including infections and diabetic foot ulcers. In addition, normal sweat secretion and oil production that lubricates the skin of the foot is impaired, which can lead to very dry skin which can break down and cause ulcers.

Symptoms of Diabetic Neuropathy

People with Diabetic Peripheral Neuropathy can experience tingling, pain or numbness in their feet. In addition to ulcers, diabetics with this condition can develop red spots, sore spots, dry skin, blisters, corns, and calluses.

Factors Increasing Risk of Diabetic Foot Problems

Many of the factors that increase the risk of foot problems for people with diabetes can be resolved.bunions can be problematic for patients with diabetes

  • Poorly fitting shoes—this is one of the biggest culprits of diabetic foot complications. Fortunately, Medicare provides access to new diabetic shoes each year to help prevent these symptoms from occurring.
  • Common foot abnormalities such as bunions and hammertoes. These foot problems need to be resolved to prevent them from causing diabetic foot complications.
  • Poor circulation – quitting smoking, exercise, compression stockings, and stress reduction can help with poor circulation.
  • Trauma to the foot—dropping a heavy object on the foot or running into furniture, punctures to the skin by a foreign object, tight shoes, and toenails that are too long are some typical examples. These are all issues that can be prevented. Patients should avoid going barefoot, wear proper shoes that fit, and eliminate environmental factors that could lead to foot trauma.
  • Infections—resolving the first two problems will greatly reduce the chance of infection.
  • Smoking—people with diabetes who smoke increase their risk of diabetic foot complications. The best thing to do is quit.
  • Fungal toenails--see below

Fungal Toenails and Diabetes

Diabetic patients are at greater risk for developing a fungal nail infection due to lack of sensation in the feet. For example, wearing shoes that are too tight (whichtoenail fungus can cause ulcer in patients with diabetes may go unnoticed) can cause the nail to lift and letting in fungus. Once the nails are infected the fungus often spreads to the surrounding skin and can cause cracks and ulcers in the skin.

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).

Patients with diabetes and thickened fungal toenails, should obtain treatment to resolve this problem. Learn more about how we treat fungal toenails here.

Management of Diabetic Feet in Seattle

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.

Inspect your diabetic feet on a daily basisSelf-Exam and Other Recommendations

Click here for a complete list of Diabetic Foot Care Guidelines.

Am I Eligible for Diabetic 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 also recommend custom orthotics to help prevent protect your feet.


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.

More Information About Management of Diabetes

A person with diabetes should have a podiatrist who specializes in evaluating and treating diabetic feet. Complete the contact form on this page or call our office at 206-368-7000 to schedule an appointment with Dr. Berg.

Most new patients are seen within 1-2 week's time. During your initial visit, Dr. Berg will spend up to 30 minutes getting to know you, your podiatry complaints, and your goals so that he can recommend the treatment best meets your needs. Don’t wait—contact us today.

North Seattle Foot & Ankle Specialist Dr. Rion Berg offers compassionate podiatry care for all foot and ankle problems to those living in Seattle Washington and the surrounding areas. Call us today at 206-368-7000 for an immediate appointment or request an appointment online.

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