Diabetes can affect your feet

When you have diabetes you need to take very good care of your feet every day. If you do this then you can prevent serious complications.

Your feet are at risk because diabetes can cause damage to the nerves and the blood supply. The damage is more likely if:

  • You have had diabetes for a long time
  • Your blood glucose levels have been too high for an extended period
  • you smoke
  • you are inactive

There are two types of risk to feet, high risk and low risk. Knowing the risk and taking care of your feet can prevent serious problems even amputation. A doctor, podiatrist or Credentialled Diabetes Educator can carry out an easy and painless check on your feet to determine whether your feet havea low or high risk of developing more serious problems.

Low risk feet have normal sensation and good blood flow. However, it is important to know that low risk feet can become high risk feet without symptoms, so regular checks are still as important.

People who have had a foot ulcer or amputation in the past have high risk feet. Feet with calluses or deformaties like claw toes also have increased risk if poor feeling and/or decreased blood flow are also present.

If you have high risk feet you should have them checked by your docotr or a podiatrist every 3-6 months. In some cases you may be referred to a specialist or high risk foot clinic.

The booklet Healthy Feet are Happy Feet is available from Diabetes Australia and is written especially for people with high risk feet.

Nerve damage

Poor blood glucose control can cause nerve damage to feet. Symptoms include:

  • Numbness.
  • Coldness of the legs.
  • A tingling, pins-and-needles sensation in the feet.
  • Burning pains in the legs and feet, usually more noticeable in bed at night.

These symptoms can result in a loss of sensation in the feet which increases the risk of accidental damage because you can't feel any pain. An injury to the feet can develop into an ulcer on the bottom of the feet which can penetrate to the bone. This could lead to osteomyelitis and a chronic infection in the bones and joints. If an infection isn't treated at the earliest signs, this could result in ulceration (an infected open sore) and eventually amputation (removal of a toe, foot or limb).

Always seek urgent medical advice for even the mildest looking foot infection.

See your podiatrist, doctor or Credentialled Diabetes Educator if you have any of these symptom.

Blood supply

Poor blood glucose control can cause a reduced supply of blood to the feet. This makes people with diabetes more prone to infection following any injury that breaks into the skin. Signs of poor blood supply include:

  • Sharp leg cramps after walking short distances or up stairs.
  • Pain in the feet, even at rest (often in the early hours of the morning).
  • Feet feeling cold.
  • Feet looking a reddish-blue colour.
  • Cuts which are slow to heal.

See your podiatrist, doctor or Credentialled Diabetes Educator if you have any of these symptoms.

Checking your feet

You need to have your feet checked every year for low risk feet and every 3-6 months for high-risk feet. The check-up will include looking at the following:

  • Blood flow to the feet (circulation)
  • Feeling and reflexes (nerves)
  • Unusual foot shapes (including bunions, claw toes and hammer toes)
  • Toenails
  • Dryness, calluses, corns, cracks or infections.

People with diabetes who have misshapen feet and nerve damage are the more likely to develop:

  • ulcers from too much pressure over some areas of the feet; and
  • more corns and calluses due to too much pressure on one area. These can be avoided with some changes.

Seek your podiatrist’s help to remove calluses or corns before they become ulcers as these can become infected, risking amputation.

Caring for your feet

In addition to regular check ups with a podiatrist, you should also:

  • Seek more information about how to care for your feet from a podiatrist or Credentialled Diabetes Educator
  • Have your feet checked at least once a year by your doctor or other health professional
  • Know your feet well - wash, dry and check your feet every day. check for redness, swelling, cuts, pus discharge.
  • Cut your toenails straight across, not into the corners - and gently file any sharp edges. If you can't properly see or reach your feet to cut your toenails, ask someone to do it for you.
  • Moisturise your feet daily to avoid dry skin.
  • Never use over-the-counter corn cures.
  • Cover your feet with a clean sock or stocking without rough seams.
  • Don't wear tight socks or stockings.
  • Protect your feet in a shoe which fits well - the right length (a thumb width longer than your longest toe), width and depth - and has been checked for stones, pins, buttons or anything else which could cause damage.
  • Keep your feet away from direct heat, such as heaters, hot water bottles and electric blankets.
  • Get medical advice early if you notice any change or problem.

Injuries

If you find an injury including a cut, blister, sore, red area or open crack, immediately:

  • Wash and dry the area
  • Apply good antiseptic, e.g. Betadine
  • Cover with a sterile dressing, available from pharmacies.

If any injury does not improve within 24 hours, make an urgent appointment to see your doctor to avoid serious complications. Seek urgent medical advice for even the mildest foot infection, including any sore, open wound or crack which is oozing, contains pus or any type of discharge or which does not heal within a week.

Podiatry and more information

Podiatry is a field of healthcare devoted to the study and treatment of disorders of the foot, ankle and the knee, leg and hip, collectively known as the lower extremity.

Some area health services and local councils offer subsidised podiatry services. Phone your local hospital, council or community health centre to find out more.

 

Medicare may provide a rebate on podiatrist's fees. If you have a chronic condition and are referred by your doctor.

Department of Veteran Affairs (DVA) gold card holders are entitled to free podiatry services from private podiatrists. Private health funds cover some podiatry services.

The Podiatry Association in your state will help you to find a podiatrist with specialised knowledge about diabetes.

A doctor can refer people with diabetes and serious foot problems (such as ulcers or neuropathy) to high risk foot clinics.

Last Reviewed: 25 August 2011
Reproduced with the kind permission of Diabetes Australia.

References

Diabetes Australia. Diabetes and your feet. Last updated 25/8/2011. http://www.diabetesaustralia.com.au/en/Living-with-Diabetes/Mind--Body/Diabetes--Your-Feet (accessed Jan 2013).
Diabetes Australia

Diabetes Australia

Diabetes Australia was established in 1984 and is the national body for people affected by all types of diabetes and those at risk. Through leadership, prevention, management and research, Diabetes Australia is committed to reducing the impact of diabetes. We work in partnership with diabetes health professionals and educators, researchers and healthcare providers to minimise the impact of diabetes on the Australian community.