Diabetic Foot Problems

Arlington Foot & Ankle Center

Ben Pearl, D.P.M., F.A.C.F.A.S.

N.I.H. Consultant

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What are diabetic foot problems?
Foot problems are the leading cause of hospitalization for the 16 million people in the U.S.A. who have diabetes. It is estimated that 15% of all diabetics will develop a serious foot problem at some time in their lives. Nervous system impairment (neuropathy) is one of these serious complications and results in loss of feeling in your feet and hands. This problem affects about 70% of people with diabetes. This is a serious problem for several reasons:

First, as opposed to your hands, your feet are hidden inside your shoes and socks and easily forgotten since they are out of view and often not looked at by your family doctor or endocrinologist during office visits. When you can't feel your feet you may purchase shoes that are too small and tight for your feet and socks that have wrinkles or creases in them. This can result in too much pressure on your feet and create corns and callouses, which, if not treated properly, can cause an open sore that can become infected.

Second, neuropathy not only damages the nerves that give your feet sensation but also the ones that control the muscles in your legs and feet. When these muscles are affected the foot begins to develop problems such as bunions, hammer and claw toes, stiff high-arched feet, or even a completely flat foot called a "Charcot" deformity.

Finally, neuropathy can affect the nerves that normally allow your feet to sweat and stay soft and supple. When this happens, your feet are much more likely to dry out and develop cracks in the skin called "fissures" which if not treated properly can can an open sore that can become infected.

What are the symptoms?
Unfortunately, you may not notice any symptoms until you develop an open sore. However, the presence of burning and tingling in your feet and toes are a sign of developing neuropathy and should be evaluated. The presence of corns and callouses, bunions, hammer and claw toes, and any other changes in the shape of your feet and toes should be a sign that something is wrong and be evaluated by your podiatric physician. Obviously, any area that is red and/or swollen, any bloody stains on your socks, or an open sore should be evaluated by your podiatric physician immediately to prevent serious complications.

What are the treatment options?
Treatment options depend on the symptoms you have and any associated foot and toe deformities present. The neuropathy is best treated by maintaining your blood sugar levels within the range that your family doctor or endocrinologist developed for you. If this does not help, the are a number of prescription medications that can be used to lessen the symptoms you have. If any structural problem exists in your feet, you should buy shoes that are made of soft, natural, breathable materials (leather, suede) which offer good soft support to the arches and plenty of room for the toes. It is best to buy your shoes at the end of the day when your feet are at their largest so that you don't buy shoes that are too tight. Purchase socks that are made of soft, breathable cotton and have no seams in them to avoid too much pressure on the tips of your toes. Inspect your shoes for any sharp seams or pressure spots and make sure that nothing has been misplaced inside your shoes (like car keys). Evaluate the bottom of your feet and in between your toes daily. If you can not reach your feet use a hand mirror to view these areas or have a family member help. Do not use "medicated" pads or "corn removing" products since they contain a strong acid which does not know the difference between good and bad skin and can create a chemical burn or even an open sore and infection. Also, do not trim your own callouses since you may go too deep, cause bleeding, and possibly even an open sore or infection.