The disease of diabetes affects multiple body systems that have an impact on our feet.

First, diabetes affects circulation. People who's blood sugar is elevated are more likely to develop blockages in their arteries. The blockages frequently develop in the small blood vessels that lead to the lower extremities. As a result the flow of blood to the feet becomes impaired.

We can get by with moderately reduced circulation to our feet as long as there are no other problems. However, once there is small injury, such as a cut or blister, there may not be enough circulation to heal the area. When the circulation of blood is impaired not enough oxygen is transported to the tissues.

The need for oxygen also increases significantly when there is an injury. As a result, small things can turn into big things because there's not enough circulation to heal the wound. A small cut or blister on the toe of a person with diabetes can therefore lead to a much larger wound because it is unable to heal properly.

People with diabetes also have increased difficulty fighting infections. This is because elevated blood sugars affect the ability of our white blood cells to destroy bacteria. This has a tremendous impact on the feet because there are a larger number of bacteria living on our feet than on other parts of our bodies.

Any type of wound on the foot is more likely to become infected in someone with diabetes.

When you combine the potential for bad circulation with the lack of appropriate white blood cell function even a small infection has the potential to spread and cause even more problems.

Diabetes also frequently affects the nerves of the feet. Having a high blood sugar essentially slowly kills the nerves over a period of time.  The higher the blood sugar the quicker the damage to the nerves.  Because the nerves are damaged someone with diabetes may not have enough sensation to know that there's a problem. 

Again, small issues, such as calluses or corns, can lead to more serious problems such as foot uclers. Someone with diabetes might step on something sharp and not feel it. Or their shoe may rub on their foot and cause the skin to break down and, again, they may not feel that there is a problem.

When you combine three problems of impaired circulation, inability to fight infection, and lack of sensation it's easy to see why those with diabetes tend to have more problems with their feet than those who do not. 

Simple problems that can affect anyone may be devastating for someone with diabetes.  Anyone with diabetes should seek immediate medical treatment for cuts, scrapes, blister, corns, calluses or any other foot problems. 

They should also follow a daily foot care regimen and check their feet daily for any problems they may not have noticed. Even in the absence of any problems they should see a podiatrist at least once a year to check the circulation and nerve function in their feet.

If you or somone you know has diabetes and has not had their feet checked in the last year, schedule an appointment with a podiatrist, and make them part of your diabetes medical management team.





Richard H. Graves, DPM
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Podiatrist, Sports Medicine Specialist
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