Why Type 2 Diabetes Causes Foot Problems And What You Need to Know

Type 2 diabetes can cause many long-term complications. While most of these are mitigated by healthy control of your blood sugar levels, this can be hard to achieve. In addition, some people may not be diagnosed with this condition until elevated blood sugar has already done some damage.

One complication of type 2 diabetes is diabetic feet, which can cause serious issues if not properly identified and treated.

How can diabetes affect my feet?

Diabetes can cause a variety of foot problems, some of which are minor and others more significant. Managing your feet with type 2 diabetes is important and starts with understanding what causes the problems and how common they are.

What causes diabetic feet?

Diabetic feet are caused by two main factors:

1. Diabetic neuropathy is damage to the nerves caused by high blood sugar and high triglycerides. Specifically, the issues are caused by peripheral neuropathy, which causes your feet to become numb, potentially resulting in limited awareness of an otherwise minor injury. It can also cause pain, pins and needles, and other symptoms.

2. Reduced blood flow to the legs and feet (peripheral vascular disease) means that white blood cells may not be being carried to the feet in sufficient numbers, resulting in difficulty healing infections. It can also cause pain.

These factors together can cause serious problems. Neuropathy may result in you failing to notice a cut or scrape, and then reduced blood flow may cause an infection.

How common are diabetic feet?

About one-third to one-half of people with diabetes have peripheral neuropathy. In most cases, this affects only the feet or has a minor impact on the hands.

This makes complications involving the feet very common. In fact, anyone with diabetes should keep an eye out for foot problems, especially if there are problems controlling the condition.

How are diabetic feet diagnosed?

The phrase "diabetic feet" actually covers a wide range of foot complaints. If you have been diagnosed with peripheral neuropathy or peripheral vascular disease, or both, you are at a higher risk of developing various foot-related complications.

Having "diabetic feet" serves as an important reminder that you should practice good foot care to reduce your risk of further health concerns. 

Signs of diabetic feet

So, what signs should you be aware of to see if your diabetes is affecting your feet? Here are the symptoms to watch for:

• Changes in skin color on the foot. This is a sign of diabetic dermopathy, which is typically harmless on its own, but a sign that your blood sugar may not be under control.

• Swelling in the foot or ankle. This is caused by poor blood circulation leading to excess fluid building up in your feet and lower legs.

• Temperature changes in your feet. Peripheral neuropathy affects temperature regulation, and the temperature of the affected body part can rise, sometimes substantially. This raised temperature can make skin problems and ulcers more likely.

• Persistent sores on the feet. Sores that persist for an extended period of time indicate that your blood is not carrying enough white cells to the area to promote healing.

• Pain or tingling in the feet or ankles. This is a direct symptom of peripheral neuropathy, with the nerves malfunctioning and sending false signals.

If you are a diabetic and notice any of these symptoms, you should talk to your podiatrist about proper foot care to avoid significant complications.

Common foot problems with type 2 diabetes

Diabetic feet can lead to a number of health concerns and foot problems of varying severity, although all should be taken seriously.

Foot ulcers

About 15% of diabetics develop a foot ulcer, which is an open sore or wound typically on the underside of the foot. Diabetic foot ulcers can be serious. About six percent of the people who develop one have to be hospitalized. Diabetic foot ulcers can be so severe as to lead to amputation of the foot, typically because they have become infected.

Foot ulcers are preventable, but if you do develop one, it's important to seek treatment right away.

Foot infections

The loss of circulation can result in infections that are hard to treat. A small injury that would not be a problem for a healthy person can rapidly become infected, and loss of sensation can cause you not to notice said injury.

This can lead to an infection that simply does not heal.

Gangrene

Foot infections can eventually result in gangrene, which can end with the amputation of your foot or even part of your leg. Worldwide, diabetes is the leading cause of lower limb amputation. Without rapid treatment, which does typically mean amputation, gangrene can be fatal. Foot infections thus need to be treated promptly.

Diabetic calluses

Because you can't feel your feet properly, you are more likely to walk improperly, choose shoes that do not fit well, and otherwise put abnormal pressure on your feet.

This increases the risk of developing a callus. Calluses can turn into ulcers if you are not careful. The best way to avoid developing a callus is to carefully select shoes and understand that you may not feel discomfort from a shoe that fits poorly.

Charcot foot

Charcot foot is a rare complication of peripheral neuropathy. Your foot will become swollen, and then damage to joints and cartilage can cause the bones in your feet and toes to shift or even spontaneously break. Often this is triggered by some minor trauma, such as stubbing your toe on a rock.

This ultimately leads to your feet becoming deformed. A common form this takes is "rocker bottom," where the soles of your feet become convex. This deformity then leads to gait changes which can cause other problems. 

Charcot foot is progressive and needs to be treated, typically by staying off the foot completely (in a cast) for a few weeks and then using protective weight-bearing with a brace or special shoes.

Bunions

A bunion is a bony lump on the inside of the foot at the base of the big toe. Anyone can get bunions, with the most common cause being ill-fitting shoes (particularly pointed-toe footwear, making bunions more common in women). 

Diabetics are more likely to get bunions for various reasons. For one thing, your feet can swell, resulting in your shoes no longer fitting properly. Not feeling pain may mean you don't notice the bunion. Bunions often have to be surgically removed, although conservative treatment includes choosing better shoes.

Hammertoes

About half of all diabetics have some kind of foot deformity. One of the most common is a hammertoe, which is a contraction of the toe at a joint, causing it to stay permanently flexed. People with long toes are more at risk.

Diabetes causes hammertoe by affecting your nerves and muscles, causing muscular imbalance. This can result in the muscles on the inside of your toe pulling more strongly than those on the outside (the extensors). Hammertoe can be treated conservatively with special insoles or orthotics or, if severe, with surgical intervention.

Fungal infection of nails

It's common for the toenails to be infected with fungus, which causes the nail to thicken, weaken, and become discolored. People with diabetes are more likely to get fungal infections because of their weak immune systems. In most cases, these infections are treated with oral antifungal pills. In some cases, your doctor may remove the infected nail, which will then regrow.

As you can see, some diabetic foot problems are annoying, whereas some are potentially life-changing. Becoming permanently disabled is a real risk if you don't practice proper foot care. However, if you focus on managing your condition and doing self-care for your feet, these complications are preventable.

Ways to manage diabetic feet

The best way to avoid all of these problems is to properly care for your feet. So, how should you manage your feet to keep them as healthy as possible? Here are some things you should do:

1. Check your feet daily for any changes, cuts, or the like. Get a mirror, and make sure to check the bottom of your feet and between your toes.

2. Wash your feet every day, but don't soak them. Wash in warm but not hot water. Dry your feet thoroughly, especially between your toes.

3. Use a moisturizer to reduce the dryness of your skin.

4. Keep your toenails short and trim them straight across. If you have a significant loss of sensation or if your body shape makes seeing your toes difficult, you should get your podiatrist to cut your toenails. People with ingrown nails and similar issues should have a medical professional cut their nails.

5. Do not share nail tools with another person. If you go to a salon, bring your own nail tools and make sure that the salon knows you are at higher risk of infection.

6. Do not cut corns or calluses. Talk to your doctor, who may recommend using a pumice stone. Do not use callus removers. All of these can damage your skin and put you at risk of infection

7. Wear closed-toed shoes and socks at all times. Don't go barefoot, even in your own home. Don't wear sandals. Remember that a minor foot injury can cause real problems. If you don't want to track dirt into the house, change to slippers or house shoes.

8. Choose well-fitting shoes. Do not wear high heels, which can make many foot problems worse. Avoid vinyl or plastic shoes, which are less likely to stretch. Your best daily wear shoes are walking shoes or athletic shoes. Your podiatrist may prescribe special shoes or inserts/orthotics. Be careful when breaking in new shoes.

9. If you are in a hot area and wearing shoes that don't cover the entire top of your foot, put sunscreen on that area. You might not notice a mild sunburn.

10. Put your feet up when sitting. Use a footstool or recliner. This helps improve circulation.

11. Do not put your feet too close to radiant heaters, as this can also dry your skin.

12. Wiggle your toes at intervals to increase circulation.

13. Exercising slows the progress of diabetic neuropathy. Choose low-impact cardio exercise which is easy on your feet, such as swimming or cycling and/or seated weight training. Yoga can be particularly helpful.

14. If you smoke, talk to your doctor about a cessation program. Smoking also reduces your circulation.

15. If you do find a cut on your foot, see your doctor right away as it can easily turn into an ulcer.

16. Get regular checkups with your podiatrist.

17. Work on managing your blood sugar. The better you keep your blood sugar under control, the healthier your feet will be.

When to see a doctor

Any significant changes to the appearance of your feet should be taken seriously. As some of these complications put you at risk for a foot amputation, you should see a doctor any time you notice unusual changes to your feet, especially if you have type 2 diabetes. This includes ingrown nails, cracked skin, or cuts or scrapes that don't appear to be healing well.

You should have your feet checked at every appointment, regardless of what you are there for, and see your podiatrist as recommended in your treatment plan.

The lowdown

Many people with diabetes develop problems with their feet. Some of these issues are minor and annoying, but others can be life-threatening or result in amputation and permanent disability. 

Because of this, you should keep your feet clean, check them regularly, and talk to your doctor if you notice any unusual changes. Keeping your diabetes under control can prevent most of these complications, and wearing well-fitting shoes also goes a long way toward keeping your feet healthy.