- Diabetic foot is a serious, common condition that affects about half of those with diabetes.
- Key symptoms of diabetic foot include tingling and numbness in the feet, calluses, and peeling skin.
- There's no cure but you can avoid ulcers and amputation with proper foot care and regular exams.
- Visit Insider's Health Reference library for more advice.
The condition diabetic foot affects about half of people with diabetes. It's a type of peripheral neuropathy, where certain nerves in the body are damaged, triggering numbness, tingling, pain, or loss of sensation.
In this case, symptoms occur in the feet leading to poor blood circulation, which causes wounds to heal slower and can trigger changes in the shape of the feet and toes.
"This can be a serious condition, because peripheral neuropathy can lead to increased falls, cause pain, and lead to decreased quality of life," says Kevin Springer, DPM, a podiatrist at The Ohio State University Wexner Medical Center.
"People tend to wait too long," says David Alper, DPM, a retired podiatrist and member of the American Diabetes Association's (ADA) Northeast Leadership Board.
It's important that those with diabetes and their loved ones understand the signs and symptoms of diabetic foot and get treatment as soon as the condition appears.
Causes of diabetic foot
Although diabetic foot is common, doctors are still working to figure out exactly why it happens.
"What is actually occurring is quite complicated and is not entirely known," says Springer.
There are a few factors at play: high blood sugar, a primary symptom of poorly controlled diabetes, can cause circulation problems, as the blood vessels become inflamed and the arteries narrow. And arteries in the legs and feet are particularly vulnerable to poor circulation.
If wounds occur in the feet, they're slow to heal because adequate blood flow is needed for tissue to heal, says Alper. These wounds can become infected, leading to serious complications like diabetic ulcers, a leading cause for amputations.
At the same time, diabetes can cause neuropathy, or nerve damage, which is also most likely to occur in the feet. This can make it difficult for people to feel pressure or pain in their feet, so wounds can progress without being noticed, increasing risk for infection and complications that may require amputation, Alper says.
Although all diabetics can develop diabetic foot, you are most at risk if you:
- Have poorly-controlled blood sugar or a higher A1C
- Are older than 40
- Are overweight
- Have high blood pressure and cholesterol
- Risk factors for vascular disease: smoking, history of coronary artery disease, history of stroke
Signs and symptoms
Recognizing the early signs of diabetic foot is essential, but can be difficult.
"The earliest warning signs can be vague and go unnoticed," since they are subtle and not easy to feel due to nerve damage, says Springer.
Early symptoms are often more noticeable at night, Springer says. They usually appear in both feet and can include:
- Dry, peeling skin, which is a sign of poor circulation.
- A tingling or "pins and needles" sensation in the feet
- Calluses because the feet are under pressure. Don't try to remove the calluses yourself — let a doctor do it to minimize infection risk.
- Loss of sensation, beginning in the toes and moving up the foot
- Reddened skin, particularly on a bony area of the foot
- Burning sensation in the foot
Although early signs might seem harmless, they're important to discuss with your doctor at your next appointment. If that's far away, it's best to call and let your doctor know you're seeing changes.
"Early intervention can prevent so many issues, or at least keep them from becoming severe," says Alper.
If diabetic foot is not treated, you may notice more severe symptoms including:
- Thickened, yellow toe nails
- Loss of sensitivity to hot or cold temperatures
- Pain or cramping in the feet or legs during exercise
- Change in the skin color or temperature
- Fungal infections, including athlete's foot, particularly between the toes
- Blisters, cuts or sores that don't heal within a few days.
There's no way to get rid of diabetic foot, but treatment is still important.
"The goals of treatment are to reduce pain, slow the progression, and manage and hopefully prevent complications," says Springer.
The most severe complication is the development of open wounds known as diabetic foot ulcers. These are prone to infection, and can be cause for amputation. About 15% of people with diabetes will experience a foot ulcer, and 14%-25% of those will need an amputation.
If you notice symptoms of diabetic foot, you may want to work with several doctors including your PCP, a nutritionist, as well as a podiatrist. Together, these doctors will counsel you about treatments, which may include:
- Better controlling your blood sugar
- Changing your shoes and using inserts or braces to lessen pressure on certain areas of the foot. Or your doctor can fit you for specially designed diabetic shoes, which most health insurance plans should cover.
- Treating open wounds
- Removing dead tissue, like calluses
In severe cases, diabetic foot can lead to amputation. However, this can be avoided with proactive care. Moreover it's important to point out that fear of amputation should never delay you from getting care and will likely help you avoid amputation altogether.
"The best way to prevent or at least delay diabetic neuropathy is to closely manage one's blood sugar," says Springer.
To prevent diabetic foot, people with diabetes should follow basic diabetes management, including:
- Quit smoking, since smoking can reduce blood flow to the feet.
- Eat more fruits and vegetables, while avoiding salt and sugar
- Exercise daily. Even ten minutes of walking can make a difference.
In addition, those with diabetes should practice daily foot care, which includes:
- Washing and drying the feet thoroughly every day, including between the toes.
- Moisturizing feet daily, but not moisturizing between the toes.
- Keeping toenails trimmed low in a straight line.
- Wearing moisture-wicking socks and shoes that do not rub.
- Checking feet daily for cuts, blisters, red spots or other signs of distress.
- Wearing shoes always, even indoors, and checking for obstructions like small rocks before putting them on.
- Not soaking the feet.
- Elevate the feet when sitting, and wiggle your toes to encourage blood flow.
"This really does not differ from advice for general good foot health, it just becomes more important with the presence of diabetes," Alper says.
As part of your standard diabetes care, your physician should do a diabetic foot exam at least once a year to detect any signs of neuropathy.
Diabetic foot is common and can have dire consequences, including amputation. But noticing the signs early and being proactive about foot care can keep you healthy.
"Prevention of complications due to diabetic peripheral neuropathy is of the utmost importance," says Springer. "However, if any complications do arise, it is important to be evaluated as soon as possible by the provider managing your diabetes or by a podiatrist."
Foot care doesn't have to be complicated, but does require daily attention, says Alper.
"Look. React. Prevent. And control your blood sugars," says Alper. "Most issues, including amputations, are preventable by following those four steps."