Diabetes is a disease that can affect every single part of the body, in many different ways. People with diabetes (both Type I and 2), have a high risk of many changes happening to their feet. These changes, if not prevented, or managed correctly, are the reason people with diabetes have a higher risk of a special kind of chronic foot wound called an ulcer, infection, hospitalization, and amputation. This a friendly reminder that diabetics should have a podiatrist or a food doctor as a part of their healthcare team, and be seeing that podiatrist on a regular schedule. Diabetic patients should never hesitate to call their podiatrist immediately if they notice any new wounds, calluses, or blisters on their feet. These are the top 9 most common diabetic feet issues.
1. Nail problems
Nail problems or changes to the nail are commonly seen diabetic feet issue. The toenails, especially in people with diabetes do change for several reasons, One reason is that with diabetes, your immune system can become weaker, making a person more prone to any kind of infection, nail fungus included. This weakened immune system also makes it harder to fight infections. Being immunocompromised due to being diabetic can cause other infections for toenails including bacteria and yeast. Diabetes can damage the kidneys as well, leading to chronic kidney disease. Chronic kidney disease or CKD can cause changes to the toenails as well, like pincer nails .
Swelling, or the medical term, edema, is another common diabetic feet issue. Outside of an infection or a blood clot, the most common reason for swelling in the legs and feet of someone with diabetes is PVD or Peripheral Vascular Disease. In PVD, veins in your legs do not work as well as they once did. Fluid backs up in your legs and feet, which can cause swelling. In extreme cases, the swelling gets so bad that the skin stretches too much, breaks open, and ulcers are seen on the legs and feet.
3. Peripheral Arterial Disease
Peripheral Arterial Disease or PAD unfortunately seen in many diabetics. as well. Diabetes can attack the arteries (a type of blood vessel) and causes plaque buildup inside the artery itself, known as atherosclerosis. Calcium deposits can also build up inside the the walls of arteries of diabetics. Whether it's plaque or calcium, both of these issues harden arteries, make them less flexible, and make it much harder for blood to reach the legs and feet. This leads to poor circulation or blood flow. Poor blood flow due to PAD increases your risks of chronic wounds or ulcers, gangrene, and amputation.
Neuropathy is the name given to a special kind of nerve damage. Diabetic neuropathy is nerve damage due to diabetes. When blood sugars are high, one of the systems in the body that is attacked is the nervous system, specifically the nerves. Diabetic neuropathy typically starts in the feet. People with diabetic neuropathy describe numbness, tingling, or pain in their feet. If your blood sugar is not kept under control and at healthy levels, neuropathy can get worse and spread eventually up the legs, and even to the hands. The loss of feeling in the feet makes people with diabetes at high risk for foot ulcers as well. Diabetic neuropathy can weaken the muscles in the feet and legs, this increases the risk of falling as well. This unfortunately is a diabetic feet issue that also increases your risk of foot amputation.
5. Hammer toes, and other toe deformities
Hammer toes, mallet toes, and claw toes are all different types of toe deformities. Diabetic neuropathy discussed above, can weaken the muscles in the toes, feet, and legs. Toes remaining straight is a delicate balance between these muscle groups, and once that balance is thrown off by weak muscles, toe deformities can be seen. To learn more about hammer toes, click here.
6. Dry skin
Another effect of neuropathy in people with diabetes is dry skin. Sweat and oil glands in your feet are controlled by nerves. If you suffer from diabetic neuropathy, one effect of this is that your feet will not make enough sweat and or oil to keep your skin moisturized and hydrated, This can lead to very dry skin, and cracks in the skin, especially on the heels. This is a unique, but yet common diabetic foot problem. These cracks can eventually cause openings in healthy skin and lead to ulcers as well. To learn more from me about how to best manage dry skin from diabetes, click here.
7. Foot Ulcers
A foot ulcer is a type of chronic wound. A chronic wound is a wound that takes longer than normal to heal. This could be weeks, months, or even years. Diabetics are at a higher risk for foot ulcers due to poor circulation from PAD, as well as neuropathy from high blood sugars. When a wound happens in the foot of a diabetic, it can be difficult to heal because of these factors. Click here to read my post all about foot ulcer prevention in the diabetic,
8. Corns and calluses
Corns and calluses are commonly seen on the feet of diabetics for several reasons. Due to the dry skin from diabetic neuropathy, calluses can build up on the feet. Also, the feet of diabetics often will change shape due to neuropathy and the weakening of muscles in the feet. This new foot type changes how the foot hits the ground when standing or walking. In order for the body to protect these areas from this new increased pressure, a callus is made. Corns are similar to calluses, but they are more commonly found over the joints of toes, between toes, or at the tips of toes. Sometimes corns can be found on the soles of the feet. There is also a central core to a corn which makes them particularly painful. People with corns for example on the bottom of their feet describe the feeling like "walking on a rock". I have another blog post that deep dives on everything seed corn-related here.
9. Charcot foot
In my opinion, one of the most heartbreaking diabetic feet issues is Charcot foot. Charcot is actually a rarer condition than those listed above but is something that can affect diabetics. I wanted to include it in this list so that people with diabetes are aware. Charcot is a condition that affects less than 10% of diabetics. Due to diabetic neuropathy and or PAD, the bones in the foot will start to become soft, eventually completely break down, and harden again into a new shape. This condition completely changes the shape of a normal foot. People with severe Charcot can end up with what is called a "rocker bottom foot" This foot shape makes it very difficult to walk, or to wear shoes. This foot shape also usually comes with chronic ulcers due to the new pressure areas on the feet. To read one of my posts all about Charcot foot, and if it's reversible, click here.
Schedule Your Appointment At Direct Podiatry Arizona
Do you have diabetes, and are looking for a foot doctor in the Phoenix area? My name is Dr. Tarr, and I'm the owner of Direct Podiatry Arizona in Tempe. If you are interested in making an appointment, click the link here.