Diabetic Complications and Amputation Prevention
What is diabetes?
It’s true that many medical conditions have absolutely nothing to do
with the foot. Colds, for instance, are not particularly related to
podiatric care. (Unless, of course, you’re sneezing so hard that you
accidentally stumble into the corner of the table and break your
toe.) However, some diseases or medical conditions are linked
closely with the feet, and diabetes is most definitely one of these
Diabetes is a disease in which your body is either (in the case of
Type I diabetes) unable to produce insulin (a hormone that helps the
body process sugar), or your tissues don’t respond to the insulin
that’s produced (in the case of Type II diabetes). This leads to too
much sugar in the blood, which, in turn, can damage blood vessels,
nerves, kidneys, the heart, the eyes, and the feet. It’s estimated
that about 24 million people in the U.S. alone suffer from diabetes,
and up to a quarter of that number may be unaware that they have
Because diabetes can be so damaging to your overall health, you
should talk with your doctor right away if you start to experience
any symptoms. Common signs of diabetes include an increase in
thirst, urination, extreme hunger, fatigue, unexplained loss of
weight (although often a cause to celebrate, this weight loss is not
normal and may be dangerous), a tingling sensation or loss of
feeling (numbness) in your extremities (hands and feet), blurry
vision, or wounds that are slow to heal.
If you have diabetes, don’t deny it. Ignoring the problem can lead
to your health spiraling completely out of control. Whereas being
aware of your diabetes, keeping close tabs on your blood sugar
level, and managing any problems that arise can prevent severe
complications and extend your life. However, acknowledging you have
diabetes doesn’t mean you have to resign yourself to losing limbs or
having a huge host of problems. There are many things you can do to
prevent complications from developing, and thus protect the health
of your foot, and your life.
Possible foot complications
Diabetes can cause two serious problems that are closely linked to
foot health: nerve damage and damage to the blood vessels. Nerve
damage (also known as diabetic peripheral neuropathy) might mean
that you won’t notice when your foot becomes injured, so you
continue to walk on it or fail to get it treated, which will cause
further damage. Circulation problems mean that diabetics will be
slow to heal from injuries or infections. Feet are particularly
susceptible to circulation issues, since they’re about as far from
the heart as your body gets, and blood coming from your feet has to
fight against gravity to get back up to the heart. So, in short, if
you get even a small cut or irritation on your foot, it can develop
into serious trouble. In fact, it can even lead to infection and
eventual tissue death.
Some possible complications that can arise from diabetes are listed
below. Please remember: this information isn’t intended to terrify
you and make you retreat into a dark room where you never put your
feet on the ground again. However, it’s very, very important to
understand the seriousness of diabetic complications so that you
take the time and effort to resolve problems early before they
- Ulcers – This is a particularly common complication from
diabetes. Basically, ulcers form from areas of the skin that are
under pressure, injured (such as with a small cut) or otherwise
irritated. Because of nerve damage, people with diabetes can’t
always feel this irritation developing. Without any changes made to
protect this irritated skin, (such as switching shoes, padding the
area, etc.), it may eventually break down completely, leaving an
open sore: an ulcer. Unfortunately, because people with diabetes
also have trouble healing (due to circulation issues), these ulcers
are slow to heal and can easily become infected. They may eventually
become so bad that it’s necessary to remove a portion of the foot,
the entire foot, or even your leg. In some very serious
circumstances, ulcers can even become life-threatening.
- Corns and Calluses – Corns and calluses aren’t experienced by
diabetics alone. They form when skin is under unusual pressure from
shoes, or may form as a result of a deformity in the foot. However,
diabetics may be particularly susceptible to these foot problems,
since (again, because of nerve damage) noticing when shoes or other
things are irritating the foot is somewhat difficult. Without proper
treatment, it’s easy for corns and calluses to turn into ulcers, so
getting these problems treated early is essential.
- Hammertoes and Bunions – Neuropathy (nerve damage) doesn’t just
affect your ability to feel things through your skin. Remember that
it’s nerves (transmitting signals from your brain) that causes your
muscles to move. So, damage to these nerves can also cause your
muscles to get weaker or have a change in tone. Hammertoes or
bunions may result, which, in turn, can lead to ulcers as your foot
begins to experience pressure in unusual areas.
- Dry Skin – Oddly enough, both a lack of proper circulation and
nerve damage can make the skin of your feet dry and cracked. Now,
dry feet may not seem like a particularly serious condition, but
left untreated, the skin can crack, which can lead to infection
and… you guessed it… possible amputation.
- Nail Problems – Ingrown toenails and fungal infections of the
nail are, again, not restricted to those with diabetes.
Unfortunately, people with diabetes may not notice these problems
(yup-once again due to nerve damage) and so infection may
- Charcot Foot – Charcot foot is a very serious diabetic
complication. Imagine breaking a bone in your foot (sometimes only a
very small fracture) and then continuing to walk on it. For a long
time. That’s a really ugly image, right? This is what happens with
Charcot foot. Because of nerve damage (that ever-present diabetic
threat), someone with diabetes may not be aware that they’ve
developed a fracture. Where someone with fully operational nerves
may be moaning and crying and staying off the foot, a diabetic might
blithely walk along, not noticing the damage they’re continuing to
cause by putting weight on it. Eventually, the soft tissue of the
foot are destroyed, bones are seriously damaged, and surgery or even
amputation may become the only option.
What you can do
Now, lest you think life with diabetes is all doom and gloom and
foot problems, please remember that it’s entirely possible to take
good care of yourself, your diabetes, and your feet. Catching
problems early (and preventing problems entirely where possible) are
crucial in preventing future complications. So, here are a few
things you can do:
- Keep blood sugar level in target range – Your primary care physician
can assist you with this, but it’s vital that you monitor your blood
sugar level closely between visits. Remember that it’s problems with
your blood sugar level that can cause the damage to blood vessels
and nerves that can be so detrimental to your overall health (and
your feet in particular). Keeping that level in check can prevent a
whole host of other problems.
- Daily foot inspections – Inspecting your foot daily may not
sound like the most exciting use of your time, but such inspections
are essential in finding problems to your foot early on,
particularly if you have nerve damage. (If it helps to make it seem
less boring, you can begin your inspections by donning a Sherlock
Holmes type of cap, putting a pipe (an unlit one, of course) firmly
between your teeth and using a wonderfully large magnifying glass.)
If you can’t see your foot well, or if you have trouble reaching it,
have a friend or family member assist you, or use a mirror (the
magnifying ones are best) to check those hard-to-see places (like
the bottom of your foot). (You can also use the mirror to tell
yourself what a wonderful person you are, and compliment yourself on
your excellent self-care of your feet.)
- Pay particular attention to the soles of your foot and
between your toes, since this is where problems can often
- Check your skin for any sign of irritation or injury. Look for
scrapes or cuts (however small), blisters, rashes, signs of
infection like redness, swelling, drainage, or a bad smell, or
possibly changes in skin color, or loss of hair on your foot or
- Check your nails for problems. Do they look yellowed or have
other changes in color? Are they thickened, deformed, striped, or
just not growing?
- Look for signs that you may have fractured your foot. Check your
foot overall for redness, see if it’s warm or hot to the touch,
swollen, or has changed in size, shape or direction.
- If you notice any of the above on your feet, see your podiatrist
as soon as possible. Don’t assume that the problem will go away on
its own, and don’t try to just wait it out. Getting problems treated
early is a MUST in diabetic foot care. Doing so can significantly
reduce your chance of developing a severe complication.
- Set a specific time for your foot inspection every day, just to
be sure you don’t forget.
- Pay particular attention to the soles of your foot and
- Clean your feet – Wash your feet every day with lukewarm water
and mild soap. (You can even make this part of your foot inspection
regimen, if you like.) Be sure to test the water temperature with
your hand (or elbow if your hand doesn’t have great sensation
either) just to make sure it isn’t too hot, or have someone test the
water for you. Dry your feet thoroughly but gently using a soft
towel, paying particular attention to the skin between your toes.
You can use talcum powder (aka baby powder) to wick moisture away
from your skin, but be sure to get rid of any residue, particularly
between your toes. Don’t soak your feet unless your podiatrist
advises you to do so.
- Use proper shoes – Because they may expose your feet to harm,
cause significant pressure, or may position your foot unnaturally,
it’s important to avoid wearing certain types of shoes, such as
sandals (especially those with a thong between the toes), slippers,
and shoes with high heels. Instead, wear comfortable, well-fitting
shoes with soft leather uppers that can mold to the shape of your
feet. (Running or walking shoes may fit the bill nicely.) Wear socks
with your shoes, but avoid socks or stockings with seams in them,
since this can cause irritation (and potentially an ulcer). (You can
ask your podiatrist about special shoes and socks designed for
diabetic patients.) Always check the insides of your shoes before
wearing them and after taking them off, making sure that the lining
of the shoe is smooth and that there are no foreign objects (like
rocks or (shudder) spiders) inside.
- Lubricate dry skin – Apply a thin film of moisturizer (Cetaphil
cream is recommended) to the soles of your feet while they’re still
wet. Avoid getting the cream between your toes, since this can
foster a fungal infection.
- Trim nails – Cut your nails straight across. Rounding corners
down can lead to ingrown toenails, which can become infected.
Keeping your nails properly trimmed can also reduce pressure within
your shoe and help you avoid other complications.
- Lose weight – This one may make you groan a bit. And you may not
be overweight. But the truth is that an overwhelming majority of
diabetic patients are also not at a healthy weight. While improving
your health in general, weight loss can also take pressure off your
feet, thus preventing future problems. Weight loss plans should
always be discussed with your doctor, particularly if you are
- Exercise – Along with reducing weight, exercise can help improve
circulation and condition your feet. Walking is often the best
exercise for diabetics. However, you should consult with your
primary care physician as well as your podiatrist before adopting an
exercise regimen. (Also, be sure to ask your podiatrist about the
best kind of shoes to wear while exercising. He or she is sure to
have some good ideas.)
- Promote circulation to your foot – You can help blood flow more
easily to your foot by putting up your feet while sitting. (Putting
up your feet while standing isn’t likely to work well.) You can also
try little foot exercises like wiggling your toes and moving your
foot up and down at the ankle for five minutes at a time. Try doing
this about two or three times a day.
- See your podiatrist – See your podiatrist at least twice a year,
and be sure to tell him or her that you have diabetes. See your
podiatrist immediately if you notice any blisters, punctures, pain
in your feet or legs (leg pain may be a sign of a blocked artery),
change in skin or nail color, loss of sensation, or if there’s an
area of your foot with increased or decreased temperature.
What you should NOT do
Just as you should do certain things when you have diabetes, there’s also a list of things you should avoid.
- DON’T go barefoot – Whether in your house or out of it, your
feet may encounter things on the ground that cause damage, like
small plastic toys, bits of glass, nails, or very sharp rocks.
(Although you should also keep your floors free of these potentially
dangerous bits of things.) Because you may not notice when you step
on something like this, (and thus damage your foot as you continue
to walk on your injury), you can avoid the problem entirely by
wearing shoes (WITH socks) pretty much all the time. Except in bed.
Your feet are usually pretty safe there. (Although you can wear
socks in bed for warmth.)
- DON’T put tight things around your legs – Foot or leg-wear like
garters or knee-high stockings (or elastics to hold UP the
stockings) can reduce circulation to your foot, thus exacerbating
your bloodflow problems. Panty girdles, thigh highs, and even
sometimes men’s socks can also be problematic if the elastic is too
- DON’T expose feet to extreme heat/cold – Again, because of nerve
problems, you may not be able to feel when the skin of your foot is
too hot or too cold, and thus be unaware when extreme heat or cold
causes damage. In order to avoid problems, don’t walk on hot
pavement, never use a hot water bottle or heating pad on your feet
(wear socks instead if your feet are cold), be careful of car
heaters on road trips, and don’t put ice on your feet if they feel
hot. Also, apply sunscreen to your feet to avoid sunburn.
- DON’T cut corns or calluses yourself – If you try to perform
“bathroom surgery” on your corns or calluses, you run the risk of
cutting too much off, or getting an infection. If you need them
removed, your podiatrist is very skilled at taking corns and
calluses off. He or she can also instruct you how to work on
calluses (the ones that aren’t too thick) using pumice stones or
emery boards, but only if you promise to follow their instructions
carefully. NEVER use medicated callus or corn removers, since these
can eat into healthy skin and cause infections.
- DON’T use commercial foot supports – Your podiatrist may wish to
prescribe orthotics for your use, but avoid over-the-counter arch
supports or foot pads.
- DON’T smoke – Smoking can further reduce your circulation,
causing even more complications with healing. Quit smoking as soon
as possible to avoid these complications.
- DON’T drink excessively – Just as smoking can further damage
your circulation, so alcohol can speed up the damage to your nerves
already caused by neuropathy. This increases the likelihood that
you’ll be unable to detect injury or other problems with your foot.
Avoid drinking in excess.
- DON’T cross your legs – Crossing your legs while sitting (or
even lying down) can compromise the circulation in your legs and
feet. You may look great while doing it, but remember that it’s your
health that’s most important, not your appearance. (Yes. Despite
what the fashion industry may tell you.)
What your doctor can do
If you have diabetes, you need an entire team of specially trained
physicians to assist you in caring for your body. Your primary care
physician is one team member, and can help you to manage your blood
sugar levels, among other things. Ophthalmologists will help you
manage your eyesight, and your podiatrist will help you with your
ever-important foot care.
Seeing your podiatrist regularly (again, at least twice a year) for
foot inspections will help prevent foot problems from turning into
disasters. Your podiatrist is trained to detect issues in their
beginning stages. However, you can help him or her out by performing
daily checkups. Again, it’s essential that you see your podiatrist
immediately if you notice any blisters, bruising or bleeding around
your calluses, puncture wounds, sores, ingrown nails, ulcers
(especially when there’s redness around the ulcer), loss of
sensation or an area of increased or decreased temperature.
No one is happy about an amputation. In fact, your podiatrist will
do everything possible to prevent it. Fortunately, many techniques
have been developed to aid diabetics in the healing process. Your
podiatrist is an expert in healing wounds, and will use all the
tools at his or her disposal to assist in the healing process.
Surgery may also be an option, depending on your overall
condition, and the condition of your foot.
Sometimes Amputation is necessary
Unfortunately, despite your best efforts and the best efforts of
your podiatrist, amputation is sometimes necessary in order to curb
infection before it spreads to the rest of the limb, or to the body
as a whole. Such amputations might be the best way to save your limb
or your life. Your podiatrist will discuss your options with you if
this step becomes necessary.
Always remember though: amputation is a last-step resort. In most
cases, it can be prevented by regular screenings with your doctor,
proper management of your diabetes, and daily self-checks. Early
recognition of problems and immediate treatment are essential in
preventing serious complications. So, in short, stay on top of your
diabetes, and it’s much less likely to bowl you over.
Call 719-543-2476 today to schedule your appointment!