Diabetes and foot problems Mate huka me waewae

Diabetes can damage the nerves (diabetic neuropathy) and blood vessels supplying your feet. This can affect:

• the feeling in your feet (peripheral neuropathy)
• circulation in your feet (peripheral vascular disease).

These changes can lead to problems with your feet such as infections and foot ulcers.

Diabetic neuropathy

Peripheral vascular disease

You have a high risk of diabetic foot problems if:

• you have had ulcers before
• you have had an amputation
• you have lost some feeling in your feet
• you have reduced circulation in your feet
• you have hard skin on your feet and a foot deformity
• the shape of your feet has changed
• diabetes is damaging your vision
• you cannot look after your feet yourself
• you have end stage renal failure.

Early foot damage to your nerves or blood vessels may not cause any symptoms. If you have diabetes it is very important to:

• monitor your own feet every day
• get your feet checked at least once a year.

You can arrange a quick, non-invasive check of your feet with your healthcare provider or podiatrist. They will pick up signs of damage.

If you are getting symptoms, you may feel:

• pins and needles, burning or numbness in your feet.
• pain in your feet or legs.

Active foot ulcers

A foot ulcer is an open wound or sore that does not heal properly. Ulcers can deteriorate quickly and also get infected. This is called an active foot ulcer.

Foot ulcers

Ischaemia and gangrene

When your feet do not get enough blood supply (ishcaemia), the tissue can die. This is called gangrene and shows as:

• dry and shrivelled skin
• skin that is discoloured brown, purpleish-blue or black.

If you get severe foot disease, including gangrene, you may need to have your toes, foot or sometimes also part of your leg amputated.

Critical limb ischaemia

Severe infection

Sometimes an infection in your foot can become very severe or spread. An infection may be:

• a rapidly deteriorating ulcer
• a deep abscess
• spreading cellulitis (with redness and swelling).

Cellulitis

If you have an infection you may feel very unwell and have a fever. 

Acute Charcot foot

Sometimes nerve damage can cause the joints in your foot to deteriorate. The bones can weaken and may eventually fracture or collapse. This is known as charcot foot.

You may notice your foot is hot and swollen but it may not hurt at first. It can become intensely painful making it hard to walk.

Charcot foot — NHS Scotlandexternal link

To diagnose diabetes-related foot conditions, your healthcare provider or podiatrist 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 they find something of concern, they may arrange for you to have a scan or take a sample of skin (biopsy) to have it tested for infection.

Looking after your feet is the most important thing you can do to treat and prevent diabetic foot problems.

If you have poorly managed diabetes (high blood sugars) feet problems can deteriorate quickly.

Good control of your blood sugar levels will help support your feet to heal and prevent complications. You should also:

• not smoke
• eat well
• be physically active.

In most cases complications such as foot ulcers and amputation are preventable. If you notice any problems with your feet, you should seek help immediately from your healthcare provider.

If you get an infection in your feet, you will need quick treatment with antibiotics.

Infected foot ulcers also need to be treated with dressings.
Your healthcare provider may prescribe pain relief medication to treat pain in your feet.

You may also be referred to a specialist.

Look after your feet by:

• checking and caring for them every day
• wearing well-fitting footwear
• avoiding situations that put your feet at risk of injury
• managing your diabetes well
• seeing your healthcare provider or podiatrist for a foot check at least once a year.

You should also get regular checks for high blood pressure and high cholesterol, as these can affect the blood flow to your feet.

Check your feet

If you cannot check your feet yourself, ask someone to help you.

Check your feet every day for:

• blisters
• breaks in the skin
• any redness or other change in colour
• swelling.

When to get help

If you discover any breaks in the skin, minor cuts or blisters:

• cover the area with a sterile dressing
• if it does not start to heal within a few days, contact your podiatrist or other healthcare provider as soon as possible.

Daily foot care

Wash your feet every day.

• Use warm water and mild soap.
• You may not be able to feel hot or cold temperatures very well. Test the temperature of the water with your elbow or ask someone else to test it for you.
• Rinse your feet thoroughly. Do not soak your feet, as this may damage your skin.
• Dry them carefully, especially between your toes.

If your skin is dry, apply a moisturising cream every day. Avoid the areas between your toes.

Change your socks, stockings or tights every day. Choose ones without bulky seams and elasticised tops. Wearing socks inside your shoes helps protect your feet from friction and damage.

Wear socks if your feet are cold.

Always remove hot water bottles or heating pads from your bed before getting in.

Wear well-fitting shoes

It is important your shoes fit well. If the nerves in your feet are damaged (diabetic neuropathy) you can lose feeling in your feet. This can make it hard to know if your shoes are the wrong fit. You may not notice if your shoes are causing a blister or that you have a split in your skin.

Your podiatrist may advise you about your shoes and buying new shoes. You may be able to get prescription shoes.

Before you put on your shoes, check the bottom to make sure that nothing sharp has pierced the outer sole. Run your hand inside each shoe to check that no small objects such as small stones have fallen in.

If your podiatrist or orthotist (the person who makes the shoes) has supplied you with prescription shoes:

• follow the instructions they give you
• only wear your prescription shoes
• only remove insoles if your orthotist or podiatrist advises you to.

What not to do

• Do not cut your own toenails if you are at risk of injuring yourself. It is safer to file your nails or get your podiatrist to do it.
• Avoid exposing your feet to high or low temperatures. Do not sit with your feet in front of a fire or heater to warm them up — wear socks instead.
• Avoid walking barefoot, as you could stub your toes or stand on sharp objects.
• Do not wear badly fitting shoes.
• Do not burst blisters.
• Do not try to remove hard skin or corns yourself. Your podiatrist can provide treatment and advice.
• Do not use over-the-counter corn remedies, as they can damage your skin and cause ulcers.