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Foot Complications

Problems affecting the feet are common in diabetes and can be disabling. Minor, preventable injuries may become serious and could lead to amputation. Understanding common foot problems, recognizing them, and knowing how to treat them can help you prevent the most serious complications.1

What types of foot complications can occur with type 2 diabetes?

A range of foot complications may occur with diabetes, including:2

  • Foot deformities
  • Ulcers ranging in depth from surface wounds to deep infections
  • Amputation

What are the risk factors for diabetic foot complications?

Several factors increase the risk of developing foot complications in type 2 diabetes.

Neuropathy

Neuropathy (nerve damage) is the loss of sensation in the feet and is an important predictor of foot complications. About half of all people with diabetes have neuropathy. Those with diabetic neuropathy may lose the ability to feel pain, increasing the risk of foot injury.1-3

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Neuropathy also causes loss of muscle balance. This can lead to deformities of the foot and impairment of small blood vessels in the skin that can cause the skin to weaken and become prone to injury.1-3

Foot deformity

Charcot foot is a severe complication of diabetes. It may result from neuropathy, leading to a gradual weakening of bones, joints, and soft tissues of the foot or ankle.4

Charcot foot usually begins with a sprain or break of the foot or ankle. Because of the nerve damage and lack of sensation caused by type 2 diabetes, the injured foot or ankle goes untreated. Over time, bone loss leads to changes in the structure of the foot when areas of the foot collapse, causing deformity.4

Decreased joint mobility, muscle wasting (atrophy), and reduced-fat padding also contribute to foot deformities and foot ulcers.5

Vascular disease

Vascular disease, known as peripheral vascular disease (PVD), is a disease of the blood vessels. When this occurs in the arteries, it is called peripheral artery disease (PAD). Vascular disease can result in poor blood circulation in the feet, leading to weakened skin. This contributes to the formation of ulcers, poor wound healing, and amputation.1

What can I do to lower my risk for foot complications?

If you have diabetes, and especially if you have diabetic neuropathy, there are several essential steps you can take to lower your risk for developing foot ulcers. High levels of blood sugar can result in the growth of some fungi and bacteria, contributing to a breakdown of the skin and complication of ulcers. Additional prevention includes:1-3,6

  • Ask your doctor for a referral to a podiatrist. This type of doctor specializes in treating the feet, ankles, and lower legs. This doctor may be especially helpful for those with nerve damage and for helping with nail care or performing surgery when needed.
  • Inspect your feet daily. Check underneath and between toes and look for breaks, blisters, swelling, or redness, especially at pressure areas on your foot. A mirror may help see the underside of your foot and your heel. If you cannot give yourself a thorough exam, ask a friend or family member for help.
  • Quit smoking. Smoking contributes to an increased risk for many health complications, including vascular disease and neuropathy, increasing the risk of foot complications.
  • Do not walk barefoot. Walking or exercising without shoes can increase the risk for cuts, blisters, and calluses that can develop into more severe problems.
  • Check the temperature of hot surfaces or water. Avoid exposing your feet to a heating pad, hot water bottles, or stepping into the tub without checking the temperature. If you have decreased sensation due to neuropathy, you can burn yourself without feeling it.
  • Trim your toenails to the shape of your toe and file to remove sharp edges. This can reduce the risk that your toenails will become in-grown or that they will cause a cut elsewhere on your foot.
  • Wear shoes that fit correctly. Your shoes should not be too tight. If you have a foot deformity, you may need customized shoes. Also, an insole (such as a viscoelastic insole) used in well-fitting shoes, can decrease pressure on sensitive areas.
  • Wear loose-fitting, cotton socks. Make sure you wear cotton socks that are not too tight and that you change them daily.
  • Wash your feet daily. Give your feet a daily bath in lukewarm water with a mild soap. Dry your feet by patting them gently and apply a moisturizing cream or lotion.

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Written by: Jonathan Simmons and Katie Murphy | Last reviewed: March 2021.