An estimated 15% of diabetics experience serious foot problems. They are the leading cause of hospitalizations for these patients. Research has demonstrated that following a strict preventive program can significantly reduce serious complications, including amputations.

Infections and Ulcers

People with diabetes are at risk for problems, particularly infections, resulting from blood vessel injury, which may be severe enough to cause ulcers in the legs and feet. Numbness from nerve damage, which is common in diabetes, makes this a significant problem, since the patient may not be aware of injuries. Even minor infections can develop into severe complications. In study of patients with type 2 diabetes, those at highest risk for foot ulcers were those who were less sensitive to sensation in the foot, who had a higher intake of alcohol, and who put more pressure on their feet.

Amputations

Extensive surgery may be required, and, in extreme cases, amputation may be necessary. Diabetes is responsible for more than half of all the lower limb amputations performed in the US each year and every year there are over 86,000 foot amputations due to this disease. According to a 2002 study, about one-quarter of these amputations are performed on the toe, nearly 6% are mid-foot, 38% below the knee, and 21.4% above the knee. The remaining 10% of amputations are performed on the hip, pelvis, knee, and other sites.

Charcot Foot

Charcot foot or Charcot joint (medically referred to as neuropathic arthropathy) is of particular note. Between 1% and 2.5% of people with diabetes suffer from this condition, which is caused by abnormalities in the nerves in the feet. This condition can numb the feet so that the sufferer does not feel pain at first and is not aware of injury. Instead of resting an injured foot or seeking medical help, the patient often continues to walk, causing further damage. Early changes appear like an infection, with the foot becoming swollen, red, and warm. A seriously affected foot can become deformed. The bones may crack, splinter, and erode, and the joints may shift, change shape, and become unstable.

Prevention of Foot Disorders in Diabetes

Preventive foot care could reduce the risk of amputation in people with diabetes by 44% to 85%. Some tips for preventing problems include the following:

• Patients should inspect their feet daily and watch for changes in color or texture, odor, and firm or hardened areas, which may indicate infection and potential ulcers.
• When washing the feet, the water should be warm (not hot) and the feet and areas between the toes should be thoroughly dried afterward. Check water temperature with the hand or a thermometer before stepping in.
• Moisturizer should be applied, but not between the toes.
• Corns and calluses should be gently pumiced and toenails trimmed short and the edges filed to avoid cutting adjacent toes.
• Patients should not use medicated pads or try to shave the corns or calluses themselves.
• Well-fitting footwear is very important. In a 2001 study, 30% of diabetic patients wore shoes that were too narrow. Patients should also avoid high heels, sandals, thongs, and going barefoot.
• Shoes should be changed often during the day.
• Wear socks, particularly with extra padding (which can be purchased).
• Seek footwear that reduces foot pressure. For example, custom-molded boots (e.g., Conformer Diabetic Boot) are designed to increase the surface area over which foot pressure is distributed. This reduces stress on the ulcers and allows them to heal. Researchers report pressure loads that are about a third lower than with standard casting technology. Special insoles (e.g., the Rocker insole) have also been designed to reduce pressure on the front of the foot, in one study by 48%.
• Patients should avoid tight stockings or any clothing that constricts the legs and feet.
• Foot pain, numbness, or tingling is worse at night; diphenhydramine (Benadryl) may help.
• A specialist in foot care should be consulted for any problems.