Diabetes May Cause Foot Problems

Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus, affecting the nerves, typically in the feet. It is seen in about 50 percent of patients with diabetes and contributes up to 27 percent of the direct medical costs associated with diabetes. Many people with diabetic neuropathy may have no obvious symptoms. However, some will develop pain requiring treatment. Estimates of painful neuropathy vary and are difficult to determine precisely because of differing definitions of neuropathy, differing diagnostic criteria for this type of neuropathy, and the specific people being included in studies defining neuropathy. Approximately 11 to 26 percent of people with diabetic neuropathy experience chronic pain.

Painful neuropathy can develop over time due to a lack of feeling or numbness that can place one at risk for burns, injuries, foot ulceration and amputations. Painful neuropathy symptoms are often described as “paresthesias”[ [par-uhs-thee-zhuhs] - tingling sensations similar to when you have crossed your legs and then your foot feels like it has “fallen asleep.” Painful neuropathy can also be felt as a burning-type pain usually first felt in the feet and lower extremities, progressing to the hands. People with painful neuropathy frequently experience depression, problems with sleep, and interference with activities of daily living and quality of life. Feet are particularly at risk of being affected by neuropathy, as well as being affected by circulation changes, so taking care of your feet on a daily basis by looking at them and having any persisting changes in skin appearance checked by your doctor should be a very important part of your self-care when you have diabetes.

HOW TO PREVENT FOOT PROBLEMS

You can prevent foot problems by controlling your blood sugar (glucose). High blood sugars can affect the small blood vessels leading to damage of the nerves in your feet.

HERE ARE OTHER WAYS TO PROTECT YOUR FEET :

  • Wash your feet daily but do not use hot water or soak your feet because this may soften the skin and make it easier to get a tear in your skin that may lead to infection. After you wash your feet, dry them well -- especially in between the toes -- and apply lotion to areas of dry skin, but not in between your toes.
  • It is best not to use a clipper or scissors to cut your toenails because you may cut yourself and get an infection. File your toenails following the shape of your toes.
  • Wear good fitting shoes (no open toes), and socks, that support your feet and are comfortable from day number one.
  • Do not go barefoot. For example, if you have numbness in your feet and you are walking on the beach and step on a shell, you may cut your foot and not feel it, and an infection may set in.
  • Always tip your shoes over before you put them on to remove any pebbles or other objects that may be inside the shoes.
  • Wear a clean pair of socks everyday that are free from seams and do not fit tightly.
  • Smoking can cause decreased blood flow in your feet, so if you smoke, you should stop.
  • Check feet daily and look for signs of infection which may include redness, swelling, drainage or cuts that do not heal, and notify your provider right away.
  • If you have difficulty seeing your feet or reaching down to check your feet, you can use a mirror with a long handle to see the bottom of your feet or ask someone to check your feet for you.
  • Take care of cuts and scratches, and call your doctor right away if you have cuts that do not heal. Protect your feet from heat, and get your blood glucose in control.

FOOT EXAM BY A PROFESSIONAL

Your doctor should do a foot exam at least once a year or more often if you have neuropathy, poor circulation, foot infections, or if you smoke. Taking your shoes and socks off in the exam room will help remind your doctor to do this exam. The foot exam includes checking the sensation (feeling) in your feet with a monofilament, which is a small piece of plastic or a tuning fork. The goal is to check that you have sensation in your feet and no signs of infection. Your doctor may want you to go to a foot doctor (podiatrist) to trim your toenails, or remove corns or calluses.

WHY IS IT IMPORTANT TO GET TREATMENT FOR DIABETIC PERIPHERAL NEUROPATHY?

Painful diabetic peripheral neuropathy is a common complication of diabetes mellitus and can have serious consequences with a significant impact on quality of life. About a third of patients with long-standing diabetes have diabetic neuropathy, of which about two-thirds report it affected their quality of life. If you have numbness, tingling or pain in your extremities, it is important you discuss this with your healthcare provider and seek appropriate treatment.

Dr. Latha Dulipsingh is an endocrinologist and Medical Director of the Joslin Diabetes Center affiliate at The Hospital of Central Connecticut and Endocrine and Bone Health Center. She is a Diplomate of the American Board of Endocrinology and Metabolism and American Board of Internal Medicine and a Fellow of the American College of Physicians and the American College of Endocrinology. She also serves as Associate Professor of Medicine, University of Connecticut Health Center. Dr. Dulipsingh currently sees patients 18 years and older for endocrine disorders.

Ms. Susan Zailskas is supervisor of the Metabolic Research Center and a Certified Diabetes Educator at The Hospital of Central Connecticut Joslin affiliate. She is involved in clinical research, patient education and direct patient care.