Diabetes can be dangerous to your feet—even a small cut can produce serious consequences. Diabetes may cause nerve damage that takes away the feeling in your feet. Diabetes may also reduce blood flow to the feet, making it harder to heal an injury or resist infection. Because of these problems, you may not notice a foreign object in your shoe. As a result, you could develop a blister or a sore. This could lead to an infection or a nonhealing wound that could put you at risk for an amputation.

Diabetes-Related Foot and Leg Problems

• Infections and ulcers (sores) that don’t heal. An ulcer is a sore in the skin that may go all the way to the bone. Because of poor circulation and neuropathy in the feet, cuts or blisters can easily turn into ulcers that become infected and won’t heal. This is a common—and serious—complication of diabetes and can lead to a loss of your foot, your leg or your life.
• Corns and calluses. When neuropathy is present, you can’t tell if your shoes are causing pressure and producing corns or calluses. Corns and calluses must be properly treated or they can develop into ulcers.
• Dry, cracked skin. Poor circulation and neuropathy can make your skin dry. This may seem harmless, but dry skin can result in cracks that may become sores and can lead to infection.
• Nail disorders. Ingrown toenails (which curve into the skin on the sides of the nail) and fungal infections can go unnoticed because of loss of feeling. If they are not properly treated, they can lead to infection.
• Hammertoes and bunions. Nerve damage affecting muscles can cause muscle weakness and loss of tone in the feet, resulting in hammertoes and bunions. If left untreated, these deformities can cause ulcers.
• Charcot foot. This is a complex foot deformity. It develops as a result of loss of sensation and an undetected broken bone that leads to destruction of the soft tissue of the foot. Because of neuropathy, the pain of the fracture goes unnoticed and the patient continues to walk on the broken bone, making it worse. This disabling complication is so severe that surgery, and occasionally amputation, may become necessary.
• Poor blood flow. In diabetes, the blood vessels below the knee often become narrow and restrict blood flow. This prevents wounds from healing and may cause tissue death.

What Your Foot and Ankle Surgeon Can Do

Your foot and ankle surgeon can help wounds heal, preventing amputation. Many new surgical techniques are available to save feet and legs, including joint reconstruction and wound healing technologies. Getting regular foot checkups and seeking immediate help when you notice something can keep small problems from worsening. Your foot and ankle surgeon works together with other healthcare providers to prevent and treat complications from diabetes.

Your Proactive Measures

You play a vital role in reducing complications. Follow these guidelines and contact your foot and ankle surgeon if you notice any problems:

• Inspect your feet daily. If your eyesight is poor, have someone else do it for you. Inspect for:
  • Skin or nail problems: Look for cuts, scrapes, redness, drainage, swelling, bad odor, rash, discoloration, loss of hair on toes, injuries or nail changes (deformed, striped, yellowed or discolored, thickened or not growing).
  • Signs of fracture: If your foot is swollen, red or hot or has changed in size, shape or direction, see your foot and ankle surgeon immediately.
  • Don’t ignore leg pain. Pain in the leg that occurs at night or with a little activity could mean you have a blocked artery. Seek care immediately.
  • Bathe feet in lukewarm, never hot, water. Keep your feet clean by washing them daily. Use only lukewarm water—the temperature you would use on a newborn baby.
  • Be gentle when bathing your feet. Wash them using a soft washcloth or sponge. Dry by blotting or patting and carefully dry between the toes.
  • Moisturize your feet but not between your toes. Use a moisturizer daily to keep dry skinfrom itching or cracking. But don’t moisturize between the toes—that could encourage a fungal infection.
  • Nail cutting. If you have any nail problems, hard nails or reduced feeling in your feet, your toenails should be properly trimmed.
  • No “bathroom surgery.” Never trim calluses or corns yourself, and don’t use over-the-counter medicated pads.
  • Keep floors free of sharp objects. Make sure no needles, insulin syringes or other sharp objects are on the floor.
  • Don’t go barefoot. Not even at home! Always wear shoes or slippers. Wear shoes, indoors and outdoors.
  • Check shoes and socks. Shake out your shoes before putting them on. Make sure your socks aren’t bunched up.
  • Have your circulation and sense of feeling tested. Your foot and ankle surgeon will perform tests to see if you’ve lost any feeling or circulation.
  • Take care of your diabetes. Keep your blood sugar levels under control.
  • Don’t smoke. Smoking restricts blood flow in your feet.

When Is Amputation Necessary?

Even with preventive care and prompt treatment of infection and complications, there are instances when amputation is necessary to remove infected tissue, save a limb or even save a life.