Foot Complications

Complications affecting the feet: an introduction

Problems affecting the feet are common in diabetes and can be a source of significant disability. A person with either type 1 or 2 diabetes stands a 25% chance of developing a foot ulcer at some point in the course of their life. Many serious foot complications, including those leading to amputation, start as minor, preventable injuries. This fact bears out the importance of the daily foot examination. If you have diabetes, you should get in the habit of regularly giving yourself a careful foot examination to check for small cuts, blisters, and other changes in skin.1

What types of foot complications can occur with diabetes?

A range of foot complications are associated with diabetes. These include fungal infection (sometimes called athlete’s foot), calluses, foot deformities such as bunions, and ulcers ranging in depth from a surface wound to a deep infection.

What are risk factors for diabetic foot complications?

There are several factors that increase risk for developing foot ulcers that can lead to amputation. These include1,2:

  • Neuropathy (the loss of sensation in the feet, increasing susceptibility for injury)
  • Deformity of the feet
  • Vascular disease. Vascular disease (peripheral artery disease) can result in poor blood circulation in the feet, leading to weakened skin, which contributes to formation of ulcers and impairment of wound healing.

Neuropathy is particularly important as a predictor of foot complications. It is present in approximately 8 out of 10 people who develop foot ulcers. In addition to causing loss of sensation and perception of pressure that can lead to injury, neuropathy also causes loss of muscle balance, leading 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

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 important steps that you can take to lower your risk for developing foot ulcers. First and foremost, you should make sure your blood sugar is in good control. High levels of blood sugar can result in growth of some fungi and bacteria, which can contribute to a breakdown of the skin and complication of ulcers. In addition to controlling your blood sugar, you should1,2:

  • Quit smoking. Smoking contributes to increased risk for many health complications, including vascular disease and neuropathy, that can increase risk of foot complications.
  • Do not walk barefoot. Walking (or exercising) without the proper foot protection can increase risk for cuts, blisters, and calluses that can develop into more serious problems.
  • Avoid exposing your feet to a heating pad, hot water bottles, or stepping into the tub without checking the temperature. If you have diminished sensation due to neuropathy, you can easily burn yourself without being aware.
  • 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.
  • Inspect your feet daily. Examine underneath and between toes and look for breaks, blisters, swelling, or redness, especially at pressure areas on your foot. A mirror may be helpful in seeing the underside of your foot and your heel. If you are not able to give yourself a thorough exam, ask a friend or family member for help.
  • Make sure your shoes fit properly. Your shoes should not be too tight. If you have a foot deformity, you may need customized shoes. In addition, 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 on a daily basis.
  • 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.
Written by: Jonathan Simmons | Last reviewed: May 2014.
View References