Diabetic Foot Problems: Common But Preventable

July 25, 2024

A woman's hands caressing her two feet in pain

People with diabetes often have reduced sensation and poor blood circulation in their feet. As a result, a small cut or blister can lead to big problems. Left untreated, the abrasion can turn into an ulcer, increasing the risk for infection and, in severe cases, amputation.

University Hospitals podiatrist Craig Frey, DPM, shares why people with diabetes should take extra care of their feet.

How Diabetes Affects the Feet

Over time, high blood sugar levels can lead to neuropathy, a condition that damages the nerves and the ability to feel pain. High blood sugar also interferes with the body’s healing process.

“Most people present with foot ulcers after they notice blood in their sock or in bed, or they notice an odor from infection,” says Dr. Frey, Director of University Hospitals Podiatric Medical and Surgical Services. “It usually starts from pressure or trauma to the foot and the underlying diabetes interferes with the ability to heal.”

“About 15 to 25 percent will develop a diabetic foot ulcer sometime in their life. The risk of amputation among people who develop an ulcer is around 50 percent.”

Jillian Fetzner, CNP, program director for Diabetes Clinical Care Improvement in the University Hospitals Diabetes and Metabolic Care Center, says patients need to be educated early on about the consequences of uncontrolled blood sugar.

“Some of the patients are young and, for many reasons, they may not adequately manage their diabetes,” says Fetzner. “Down the road, they may not be able to feel their feet or stand for long periods of time. Some people with diabetes can’t drive because they can’t feel the pedals.”

“Knowledge is power. When people with diabetes understand the potential effects on the body, we can help prevent these complications that affect daily living.”

Who Is at Risk

Anybody with diabetes or uncontrolled blood sugar is at risk for neuropathy. Other factors that put patients at higher risk for foot ulcers and lower-limb amputations include:

Smoking
Poor diet
Obesity
Sedentary lifestyle
Uncontrolled high blood pressure

Many people of color face financial barriers to care and have a higher risk of diabetes-related amputation. “Patients might not get regular medical visits or they can’t afford insulin,” says Fetzner. “We have a lot of patients rationing their insulin, which is going to affect their blood sugar and their risk of developing complications.”

Preventing Diabetic Foot Complications

It’s critical that people with diabetes get regular foot screenings and seek medical care at the first sign of a problem, says Dr. Frey. He also recommends the following:

Inspect your feet daily or ask someone else to do it.
Wash and dry feet daily.
Wear appropriate shoes and socks. Avoid going barefoot.
Get regular exercise (under a doctor’s guidance) for cardiovascular health, which helps with blood flow, weight loss and blood-sugar control.
Trim toenails straight across or have someone do it for you.

People at higher risk should have a podiatrist cut their nails. “We trim them because they’re at risk of getting a cut and not realizing it when trimming their nails by themselves,” says Dr. Frey. “Also, we’re performing a foot screening to look for changes every time they come in,” he says. Medicare and private insurance typically cover a nail trim every 62 days for qualifying patients.

People should also take care when walking outside barefoot. “During the summer especially, you can’t differentiate between temperatures,” says Dr. Frey. “People walk out of the pool and the pavement is hot, but they don’t feel it. It also happens when it’s cold out and patients put their feet too close to space heaters. We get a lot of burns that result in amputation from that.”

“It’s a lot easier to prevent problems than to treat problems,” says Dr. Frey. “A lot of patients delay seeking medical care for foot problems. If something doesn’t look right, we want patients to come in right away. The more time with an open wound, the higher risk of infection or amputation.”