Circulation
Foot problems in diabetes can be caused by damage to both large and small blood vessels, which is much more common in diabetes. Foot problems, including nerve damage or peripheral neuropathy, usually begin with vascular disease. Damage to small blood vessels, in particular, appears to be the major cause of nerve damage that results in loss of feeling, or worse pain and burning sensations that bother the feet and legs. Once nerve damage progresses, it triggers loss of motor control and the abnormal gait that results in ulcers and amputations.
Preventing foot problems in diabetes begins by preventing the loss of circulation that will result in serious nerve damage. This is relatively easy today if the risks for circulatory problems are recognized early. Keeping the blood pressure below 130/80 is essential for reducing damage to blood vessel walls. Preventing plaque formation is also critical. This is done with medications the lower triglycerides and raise HDL, such as gemfibrozil and niacin, and those that lower LDL and make it lighter, such as the statins.
Blood vessel walls can also be protected with certain blood pressure meds called ACE inhibitors. Blood flow may be improved with high dose vitamin E, although 1200 mg to 1500 mg a day is usually required for this effect.
Signs Of Blood Vessel Problems In The Feet:
- absence of foot pulses
- a pale color of the foot when it is raised
- feet that feel cold
- pain at rest
- pain at night relieved by hanging the feet over the side of the bed
- thin appearing skin
- loss of hair from the toes and feet
- shiny skin
- blue color of the toes
- reddish color of the feet
- ulcers that don’t heal
- a foot infection that is hard to heal
Although amputations are 15 times as common with diabetes, about half can be prevented with simple steps that protect the feet:
Nerve Damage
Unfortunately, about 60 to 70 percent of people with diabetes already have at least a mild form of nerve damage. Damage appears to be largely caused by damaged circulation, but can also be worsened by direct damage to the nerves caused by high blood sugars.
There are three types of nerve damage in diabetes: sensory, motor, and autonomic.
Ways in which nerve damage may appear:
- loss of sweating which can cause dry skin, cracks in the skin, and callous buildup
- pain, tingling, burning, and numbness that starts in the feet and slowly progresses up the calves
- loss of tendon reflex and sense of vibration to a tuning fork
- inability to detect excessive heat such as in a bath or heating pad
- inability to detect objects in shoes, like rocks, paper clips, safety pins, tacks, or coins, leading to injury, infection, and an ulcer
- weakness in small muscles of the foot that cause the toes to claw, and in later stages causes foot drop
- ulcers occur after feeling is lost, combined with an abnormal gait and foot deformities (once you can’t feel the ground, you can’t walk right)
How to care for feet in trouble
Preventing trauma is the best way to prevent amputation. Properly fitted shoes are essential, with tennis shoes being ideal whenever possible. Plastisol shoe inserts are ideal for many shoes. If foot deformities such as hammertoes are present, orthopedic shoes should be obtained immediately to reduce callus formation.
Reduce your risk of amputation with these simple steps:
- use your eyes and hands daily to sense existing or potential damage to your feet
- keep a mirror on the floor near your bed to conveniently look at the bottom of your feet for redness, sores and cracks in the skin
- bacteria love cracks and crevices in the skin — keep lanolin or other moisturizing lotion handy and use it regularly
- never walk barefooted even to the bathroom
- avoid open shoes like the plague
- thick socks are great
- tennis shoes and suede shoes are least likely to create foot problems
- never wear new shoes more than an hour before checking for red pressure spots and early blisters — new shoes need to be fitted before purchase — great looking shoes will later look stupid if they cause an amputation.
- always feel inside your shoes before putting your feet into them
- corns and calluses need to be treated early — these deformities present the same danger as having a rock in your shoe that causes repeated trauma to one area of the foot
- wash and dry your feet thoroughly each day — keeps bacteria counts down
- keep a close eye and nose out for athlete’s foot, especially between the 4th and 5th toes — if present, use Tinactin or other powder insid all socks and shoes, and Micotin spray between the toes till gone, and repeat treatment as soon as it reappears (athlete’s foot can crack the skin between the toes and this offer triggers the infection that leads to the later amputation)
- don’t reduce your blood flow by crossing your legs
- trim your toenails straight across — ingrown toenails are another frequent trigger for infections and ulcers
- if you have any existing foot problems or deformities, be sure you see your podiatrist regularly
Additional Foot Information
HealthiBetic carries a therapeutic foot cream that helps circulation and more
Menzie-Med has foot care tips and helpful foot care products
Express Footcare carries insoles, socks, toe and skincare items, and helpful advice.
The Podiatry Channel also has information on Charcot Foot, its causes and symptoms
NIDDK has a wealth of information on How To Prevent An Amputation
Feet For Life has foot care tips and how to treat a number of common foot problems
Nail Fungus Information – Online resource for information on fungal nail infections.