How Does Diabetes Affect Your Feet? [Updated 2024]

Diabetes and Your Feet

You’ve probably heard that diabetes can have an affect on feet. 

But did you know there are over 4,400 leg/foot amputations in Australia each year linked to diabetes.

These are ALL preventable with early detection and care.

In this article I am going to look at:

Why Does Diabetes Affect Feet?

Diabetes is a group of different conditions characterised by the body being unable to convert blood glucose, (type of sugar in the blood), allowing blood sugar levels to vary greatly. 

Uncontrolled glucose builds up in the blood leading to high blood glucose levels which cause the health problems linked to diabetes. 

You may already check your sugar levels (BGLs – Blood Glucose Levels) a few times per day, and your doctor may do a check of your HbA1c every six months.

Blood checks are crucial to know that your diabetes is being managed well.

The more frequently you have high blood glucose levels – the quicker you will develop complications of diabetes.

Diabetes can cause immediate and long term damage to the body’s soft tissues, typically affecting the nerves and blood vessels. 

People with uncontrolled glucose levels are at risk of developing serious foot conditions that can involve ulcerations which then can sometimes lead to amputation. 

A diagram showing the affects on different body parts of diabetes

You can reduce the risk of complications by managing your blood sugar levels through a well-planned diet intake and daily exercise regime.

You may need to be on oral medications or injections (e.g. Ozempic), or you may be on daily insulin. Your doctor will advise you on this.

Proper podiatry care has been shown to be beneficial in managing foot health in patients with diabetes. 

Your Podiatrist will regularly assess the sensation and blood flow in your feet.

Knowing the status of your feet can help to prevent serious diabetic foot complications.

Preventing Diabetic Foot Complications or PROTECT, DETECT, REPORT.

Prevention is better than a cure! 

Let’s look at some very simple steps that you can take to prevent diabetic foot complications.

Control Your BGLs

Control your blood Glucose Levels as best you can. If you find that your BGLs aren’t as well controlled as possible, talk to your doctor and diabetes educator to see if there is more that you can do.

PROTECT

Protect your feet!

I can’t say this one enough. Not adequately protecting your feet is one of the biggest causes of problems.

If you have peripheral neuropathy, you need to be in protective footwear all the time. At home and when outside. There are many dangers around the house including shards of glass from previous breakages, sewing needles etc.

If you are going on grass, dirt, sand etc., you will need fully enclosed footwear. Sticks, stones, glass, spiders and many other nasties are potential threats everywhere. 

DETECT

Detect any problems. Check your feet everyday.

If you can’t bend to see the bottoms of your feet you can either ask a relative to check them for you, or use a mirror.

Massaging your feet can help reduce pain

Look for any signs of broken skin like scratches or sores or any fluids like blood or pus.

REPORT

Report any problems quickly. 

If you can see any signs that your skin as been broken, clean and dress the area and get to the doctor in the next 24 hours. If you see any signs of infection – get to a doctor on the same day, or go to the hospital. 

Signs of an infection include: swelling, redness, heat, pus and a fever.
N.B. If you see a distinct red line going up your foot or leg – get to a hospital. This is a sign that you have an advancing infection that is now in your lymph vessels (Lymphangitis).

The Benefits a Podiatry Diabetic Foot Check:

  • Measuring blood flow using a doppler ultrasound,
  • Assessing the protective sensation in your feet (nerves),
  • Checking and treating toenails
  • Checking and treating dry feet, calluses, corns, cracks or infections,
  • Assessing the presence of and managing any wounds/ulcers,
  • Advice on appropriate footwear,
  • Education on preventing ulcerations and further complications.

Let Dynamic Podiatry Keep Your Feet Healthy

At Dynamic Podiatry we use technology and our experience and expertise to monitor and manage your feet.

Low risk patients should visit at least every twelve months, and patients with higher risk statuses will need to visit more frequently to avoid complications.

Podiatrist Laura strapping a foot

We also offer regular nail and skin care to prevent thick or ingrown nails, corns and callouses from becoming an issue.

 

We use doppler ultrasound and PPG (photoplethysmography) to check blood flow and big toe blood pressures, and monofilaments and tuning forks to check your sensation.

Some patients with diabetes will require custom shoe inserts to offload high pressure areas and prevent ulceration.

Below we go into deeper detail about different conditions and management.

Peripheral Neuropathy in Diabetic Feet

Peripheral neuropathy occurs when the nerves in your feet or hands are damaged and the sensations they send to your brain are altered.

This can be particularly dangerous if the protective sensation is affected.

Pain is for our protection. If you can’t feel pain, you won’t know if your skin is being broken or damage and infection is likely to follow.

Threats can come from something sharp or hot that you stand on like a hot road or some broken glass.

It can also be repeated pressure in a bony area that can cause the skin to more slowly break down – this results in a pressure ulcer.

A neuropathic ulcer on the bottom of the ball of a foot.

A break in the skin is prone to infection if it is not properly cleaned and dressed which won’t happen if you don’t know there is a problem.

Peripheral neuropathy can also affect your balance and proprioceptive feedback and make you much more likely to have a fall.

To read more about preventing falls click here.

 

Vascular Insufficiency in Diabetic Feet

The vascular or blood supply system is mainly broken up into two main systems: the arterial system which takes blood to the feet; and the venous system which drains blood back to the heart.

Arterial Insufficiency in Diabetic Feet

The arterial system takes blood from the heart out to all the tissues in the body including the brain, vital organs, and of course the muscles of the body including the feet and legs. 

Increased glucose in the blood stream to lead to calcification of the walls of arteries and blockages which prevent strong blood flow.

If there is not enough blood flowing into the feet and legs, the result can be a loss or death of tissue including muscle, skin and many other essential parts.

You may notice weakness in your legs or an inability to walk very far.

MPeople often experience pain in their calves when they are walking, when they are in bed, or when they are sitting at rest.

This pain is called claudication and is caused by a lack of blood supply to the calf muscles. 

It will stop many people from walking any further once the pain starts.

 

The distance you can walk without the pain stopping you is called your claudication distance. 

If this is affecting you, measure how far you can walk before the pain stops you, and let your podiatrist and doctor know this distance.

Daily activity and pushing yourself a little further can actually stimulate growth of new arteries and improve the blood flow to your feet and legs.

Always check with your doctor before deciding to do more exercise.

PPG - Crucial Testing of Your Blood Flow

To the right is a photo of me using a PPG or plethysphotomography to test the blood pressure in the big toe.

Yes, blood pressure of the big toe!

A podiatrist is performing a test of a patient's blood flow

We do this test because Hallux (Big Toe) Blood Pressure is a very good predictor of the strength and pressure of flow throughout your limb.

The “normal range” your Toe Pressure is above 70mmHg. Below 70mmHg is mild ischaemia.

Note: This is the systolic pressure, which is the high number when they test the blood pressure in your arm.

We are interested in your pressure being HIGH enough, rather than LOW enough.

The Toe Pressure of the average healthy young person is around 120mmHg, similar to the healthy systolic pressure of the arm.

Arteries tend to calcify as we age, and plaques can build up in the lumen (space inside an artery), which can cause the amount of blood flow to drop.

Thankfully keeping as active as you can be including walking, eating a healthy diet, and controlling your BGLs can improve your Hallux Toe Pressure.

Venous Insufficiency in Diabetic Feet

The venous system can also be compromised as we get older, and can be worse in people with diabetes.

Problems occur with both the flow of blood in the veins and with the valves that prevent the blood from flowing back down to our feet.

This can result in certain tell-tale signs including:

  • Oedema (swelling) in the feet and ankles,
  • Haemosiderosis – a darkening of the skin on the lower half of the legs, 
  • Varicose veins – very prominent and often twisted veins in our legs,
  • Telangectasia – “spider veins” tiny little veins or venules (smallest veins) which become visibly red or blue.
  • Atrophe Blanche – small white areas on the skin often in the middle of heamosiderosis.
  • Venous Dermatitis – peeling of the skin and irritation caused by a lack of good blood supply to the skin.
A leg with severe venous compromise pointing out the signs
All of these signs are caused by blood remaining in the legs and feet for too long and if they get severe enough, can lead to death and ulceration of the skin.
 
Venous ulcers often take a very long time to heal. 
 

They require 2-3 visits to the doctor’s surgery per week to get them redressed and also need to be kept clean and dry at all times.

You can imagine the inconvenience this poses for a patient not to mention the constant risk of infection.

Conclusion

Diabetic foot complications are a huge health issue that cause impaired life and even death in some circumstances.

Thankfully they are fully preventable. 

If you work with your health team including your family doctor, endocrinologist, diabetes educator, nutritionist and podiatrist you can live a long and meaningful life free of diabetic foot complications.

Controlling your BGLs, protecting your feet, checking for any problems, and reporting them as quickly as possible gives you the best chance of success.

If you would like any further information on managing diabetes for you or a loved one you can also contact Diabetes Australia on 1800 177 055 or visit their website https://www.diabetesaustralia.com.au/

 

For help managing your feet with diabetes contact the friendly staff at Dynamic Podiatry on 33518878 or book online using the button below.

The team at Dynamic Podiatry L-R Sarah, Matt, and Michaela
The Dynamic Podiatry logo orange and navy with a foot in the "D"