Diabetes is a condition in which your body's ability to produce or respond to insulin is impaired. When a person doesn't have enough insulin, sugar in their blood is unable to enter their cells and instead builds up. This can result in kidney damage, retinal damage, and permanent nerve damage.
That nerve damage directly affects your limbs and extremities–especially in your feet. In fact, the majority of amputations that were performed in 2019 were patients with physical damage from diabetes. Specifically, 71.4% of all amputees were diabetics. And of those amputations due to diabetes, the majority were of the patient’s foot.
This is why doctors and orthotics put such an emphasis on proper diabetic care and footwear. Diabetes doesn’t have to be a death sentence or a guarantee of amputation. In fact, with some simple life changes and care routines, you can usually prevent amputation and some of the worse neuropathy symptoms that are often associated.
This guide was put together to assist diabetic patients in properly caring for their feet. Understanding the causes and symptoms of diabetic neuropathy, as well as how to treat it, can aid in foot care and help you avoid foot ulcers, peripheral neuropathy, permanent nerve damage, and limb loss.
How Does Diabetes Link to Getting Your Feet Amputated?
If you have diabetes, then you might be facing a few complications in your feet. The foot complications that can arise from diabetes include nerve damage, ulcers, and infections. All of these are problems on their own, but when they go untreated, they can lead to serious health complications and–ultimately–amputation.
The two most common and dangerous afflictions that lead to foot amputation are diabetic neuropathy and peripheral vascular disease.
Diabetic neuropathy is one of the most common complications of uncontrolled diabetes. Diabetic neuropathy causes damage to the nerves in your feet that send messages back to your brain, allowing you to feel heat, cold, and pain in your feet.
The damage is caused by high blood glucose, which breaks down the cell walls in your nerves and keeps them from functioning properly. This is called “sensory diabetic neuropathy.”
It may not seem like a problem at first glance. Not feeling pain may seem like a relief, especially if you’re used to chronic nerve pain. But pain is the body’s way of protecting you from harm. If you can’t feel a cut on your foot, you don’t know to disinfect and bandage it, which can lead to infection.
Nerve damage can also make it difficult to control the muscles in your feet–moving something when you can't feel it is difficult. This increases your chances of twisting or spraining your ankle, as well as falling, which is especially dangerous for the elderly and disabled.
Diabetic neuropathy can cause you to walk with more pressure on your numb foot, leading to foot ulcers, calluses, and stress fractures.
When the nerves in your feet are damaged, you may experience tingling, numbness, or burning sensations. These warning symptoms should be taken very seriously. Talk to your orthotist or podiatrist immediately about any symptoms of neuropathy. They will check your feet and help you create a care plan to prevent further damage.
Peripheral Vascular Disease
In addition to nerve damage, diabetes can also affect the flow of blood to your limbs. Poor blood flow to your arms and legs is known as “peripheral vascular disease”.
Poor circulation makes it more difficult for your body to heal itself when it’s wounded. For instance, cuts and sores take much longer to heal up, which gives infection more time to set in.
If an infection develops in a slow-healing wound, you're more likely to develop ulcers and gangrene. The death of tissue due to a lack of blood flow is referred to as gangrene. It's also the leading cause of diabetic foot amputations.
Diabetic neuropathy and peripheral vascular disease are both risk factors that increase the likelihood of amputation of the foot. Diabetic patients must pay special attention to the condition and care of their feet to avoid amputation.
Common Foot Problems for Patients With Diabetes
If you have diabetes, it can directly affect the long-term condition and health of your feet. There are several common foot problems for diabetics, including:
- Dry skin
- Callus formation
- Athlete's foot
- Fungal infection
- Ingrown toenails
- Plantar warts
All of these conditions are linked with elevated blood sugar levels and medicine-induced changes in the skin. One way to prevent these conditions is to frequently check your feet for any signs of trouble. However, if you suspect any of these problems may be present on your feet, it's important to see a podiatrist as soon as possible.
One of the most common foot conditions in diabetics is dry skin. Diabetes causes dry skin because the high blood sugar levels prevent the natural oils in your body from functioning properly. Dry skin may seem like a minor inconvenience, but it’s a major problem for diabetics because it can lead to other, more serious problems like cracking, callus formation, and infection.
For example, if the skin on your feet becomes so dry that it cracks, your foot may develop an open wound. If the infection spreads, you could develop foot ulcers or even gangrene, both of which can lead to amputation if left untreated.
The best way to combat dry skin is to use moisturizing soaps and lotions. This conditions your skin and prevents cracking, protecting you from infection. Talk to your doctor or orthotist about the right skincare products for you.
A callus is a thick, hardened layer of skin that forms on the more sensitive parts of our bodies that come into contact with the ground or other hard surfaces frequently. The hands and feet are the most common places for calluses to develop. Your body's natural reaction to repetitive motion is callusing, which thickens and hardens the skin to protect you from future scratches, bruises, and cuts.
In diabetics, the most common cause of calluses on the feet is an uneven distribution of weight. If you suffer from neuropathy and numbness, you can’t always feel how much weight and stress you’re putting on your feet.
Calluses can also be caused by improperly fitted shoes. If you are experiencing swelling, blisters, or other foot problems that could cause your shoes to fit differently, you may find calluses beginning to form.
Calluses are your body's way of protecting your skin from harm, but for diabetics, they can quickly become a serious health issue. Ingrown toenails and infection can occur if calluses form around your toenails. That infection can progress to gangrene or a bacterial infection known as staph if it goes unnoticed and/or untreated.
Talk to your orthotist about how to deal with your foot calluses. They will likely recommend a care routine similar to this one:
- Wash your hands with soap and water before handling the callus.
- Use a pumice stone or emery board to gently file away the callus. Be careful not to cut yourself on the sharp edges of the callus.
- Rub antibiotic cream over the area three times per day for five days, then continue applying it once per day until the callus is gone.
- Acetone works as an effective home remedy for some people. Rub some acetone on your calluses twice per day for two weeks until they disappear.
- Apply an antibiotic ointment suck as Bacitracin on the area twice per day for ten days, then continue applying it once daily until the calluses are gone.
Corns are a type of callus that forms over a bony prominence. They usually form on the toes, the balls of the feet, and the heels. The reason for this is because these areas have more bony prominences, which rub against shoes and cause friction. Corns can be prevented by wearing footwear that provides good arch support and distributing pressure evenly across your foot.
Corns are more likely to develop in people who have flat feet or high arches because they walk with more friction. Corns form when you wear tight-fitting shoes like sneakers, high heels, or boots for an extended period of time without allowing your feet to rest. To give different areas of your feet a break, try switching out types of footwear regularly. If you wore heels yesterday, for example, try sandals or sneakers today.
The best way to treat a corn is by using corn pads or creams, which will help relieve the pain and reduce inflammation. You can also lightly go over rough and built-up
areas with a pumice stone after your bath or shower. But talk to your doctor or orthotic specialist before you use either of these remedies. For some diabetics, this could lead to an infection caused by poor circulation.
Old wives’ tales and remedies say that you can get rid of a corn by popping it. But you should never pop a corn–especially if you’re diabetic. Corns are made up of several layers of skin cells and tissue. If you pop it, you’ll damage these layers of skin, which can lead to infection. And every infection increases your risk of amputation significantly.
Athlete's foot, also known as tinea pedis, is a fungal infection. The fungus that causes this condition thrives in moist environments such as wet socks and shoes. It can be passed from person-to-person or through contact with contaminated surfaces. Athletes' foot is contagious and can affect the skin of the feet, toes, and soles.
It can cause ulcers, blisters, and cracking on the feet and ankles if not treated. Athletes' feet can also cause itchiness and burning sensations.
If germs get into your foot through cracks or open sores, you're more likely to get an infection that leads to amputation.
Luckily, Athlete’s foot is extremely easy to treat in the early stages. The first step in treating Athlete’s foot is to clean your feet. This will help prevent the infection from spreading any further. The best way to clean your feet is to wash them with soap and water. You should also dry your feet thoroughly after washing them. It's important to make sure all the skin on your feet is completely dry before putting on socks or shoes.
There are dozens of over-the-counter anti-fungal creams and powders to help reduce symptoms and kill the fungus. They contain ingredients like clotrimazole, miconazole, or tolnaftate. These products should be applied to the areas of skin that are affected by Athlete's foot and should be left on for 5-8 hours before washing off.
Some people may recommend that you try using yeast infection treatments or acetic acid products. However, these treatments are not recommended for people with diabetes since they can cause blood sugar levels to drop too low.
Keep your feet dry to avoid getting Athlete's foot in the first place. Wearing breathable shoes and socks, drying off your feet after swimming in a public pool, and changing out wet socks or shoes immediately after exercise are all ways to achieve this. If you have a history of Athlete's foot, check your feet every day for signs of the fungus. Showering daily can also help to reduce the risk of contracting this illness.
Fungal nail infections are a common foot malady. These infections occur when fungi such as dermatophytes and yeasts grow on the skin and cause an infection underneath the toenails. The most common symptoms of this condition include:
- Discoloration of the nails
- Cracks and scales on the surface of the nails
- Pain when wearing shoes or lotions
- Thickened nails
- Nail deformities
Primary causes of fungal nail infections are a lack of proper foot hygiene, wearing shoes without socks, and exposing your feet to the water. Other causes include using an electric nail clipper and using a nail grinder. Fungal infections can also be caused by having a weakened immune system or being on certain medications, such as those prescribed for diabetes.
Keeping your feet and nails clean is an easy way to avoid a fungal infection. You should also take a shower before and after working out so that you remove sweat, dirt, and grime from your skin.
Instead of going barefoot, wear flip-flops or sandals with socks to avoid infections in the future. This will help to reduce friction on the skin of your foot, lowering your risk of infection.
If you're experiencing any of the symptoms listed above, consult your doctor or an orthotist to determine the best course of action. They may prescribe an anti-fungal cream with a prescription strength as well as preventative measures.
Blistering is caused by friction between the sock and shoe fabric from rubbing against a rough patch on the foot. This friction causes fluid to build up, which creates an opening for bacteria to enter and create an infection.
It’s important that you try not to pop any blisters that appear on your feet. Remember, any open wounds on your feet increase the risk of infection and, therefore, amputation. Instead, treat blisters with antibacterial cream and wrap them in soft, clean bandages to protect your skin and prevent infection.
To prevent blisters in the first place, make sure you’re wearing shoes and socks that
fit properly. You should also avoid activities that routinely cause blisters, such as walking in heels or running long distances. Try modified forms of your favorite activities to protect your feet.
Bunions are a type of bump that can form on the ball of the foot. They usually develop when there is too much pressure on the first and second toes, forcing them to push against each other, leading to pain, inflammation, and deformity. This makes walking uncomfortable, causes pain on the inside of your ankle, and often requires surgical removal of the toes or surgery to reposition them.
Bunions are commonly caused by over-pronation or repetitive foot movements. Bunions, if left untreated, can cause changes in your gait, causing pain and discomfort during physical activity.
If you are a diabetic and suffer from neuropathy or numbness in the feet, make sure you perform a regular self-examination on your feet for signs of bunions. If left untreated, they can result in extreme deformity of the feet and even infection.
Bunions are very common in adults, especially women who wear high-heeled shoes for extended periods. Bunions can occur to anyone at any age, but they are most common in people between 50-60 years old. The reason for this is that as we get older, our joints start to lose their ability to rotate, which leads to excess pressure on the big toe.
Wearing comfortable shoes with enough room for the toes is the most effective way to avoid bunions. Insoles should be used to support your arches, and you should avoid wearing shoes that are too tight or too loose.
If you’ve already developed bunions, it’s important to seek the advice of an experienced orthotic specialist. Orthotics can help decrease pressure on the big toe by redistributing the weight of the foot over a larger surface area. Talk to your doctor about how custom orthotics can help relieve the pain of your bunions and prevent them from becoming worse.
A foot ulcer is a painful, open sore on the bottom of the foot or the sides of the heel. People with poor circulation, diabetes, or peripheral vascular disease are at a higher risk of developing them.
Ulcers are most common in people who have some form of neuropathy, which causes numbness in the feet, which can mask the pain of a cut, scrape, or scratch.
As you continue to walk on the scrape or cut, the friction pulls at the wound, and ulcers develop. They can also be caused by the constant rubbing of ill-fitting shoes and socks.
Symptoms of a foot ulcer include swelling and redness, pain around the toe area, shooting pain when walking or standing, tenderness, and discoloration of the skin. If you are in enough pain to interfere with your ability to walk or stand, seek medical attention immediately.
Proper foot care is important to prevent foot ulcers from occurring. If you want to prevent foot ulcers from happening, follow these tips:
- Wear shoes that are appropriate for the activity
- Don’t stand for long periods of time
- Take proper breaks during activities
- Don’t wear shoes that lack proper support or ventilation
Wearing proper shoes and socks is another way to avoid foot ulcers. Wear shoes with thick soles and good arch support to keep your feet dry. Socks should be thick enough to prevent them from slipping down into the shoe as you walk upstairs.
Wear comfortable shoes that stay on your feet to avoid blisters and friction burns caused by rubbing against other objects inside your shoes. This will aid in the prevention of foot ulcers.
Treatment can vary depending on the severity of the ulcer. Mild cases are treated by soaking the foot in a solution of water, milk, and salt. This will draw out any bacteria that is causing the ulcer. In more severe cases, you can apply a topical antibiotic ointment or medication to the ulcer. If it continues to worsen, you may need to visit a doctor for treatment or surgery.
An important part of treatment is ensuring that your foot has proper circulation. If you injure yourself, make sure your foot stays elevated for about an hour to allow natural blood flow to return to normal levels.
Hammertoes are foot deformities caused by the growth of the bones in the toes at different rates. It's most common in people who have flat feet. Because flat feet are a genetic trait, hammertoes are likely to run in families.
Hammertoe can also be caused by wearing shoes that are too small to properly accommodate your toes. Women who wear high heels regularly are at a much higher risk of developing hammertoe later on in their lives.
Pain, redness, tenderness, swelling, and a reduced range of motion are all symptoms of hammertoes. Symptoms may include sensitivity to pressure on the foot, as well as walking or running difficulties.
Some people may experience itching or burning from the bottom of the toes up to the arch of the foot and heel. This can lead to an uneven gait, resulting in a higher risk for blisters, calluses, and sores–all of which increase the risk of infection and foot amputation.
It is important to treat hammertoes early because they can cause permanent damage if left untreated for too long.
To Treat Hammertoes
- Apply ice to the affected foot for 15-20 minutes alternating with the other foot, three times a day.
- Elevate your feet above your heart by using a rolled-up towel or firm pillow under each foot when you are sitting.
- Use a pumice stone to gently dry the area around the toes and gently rub it over the corns and calluses on your toes.
- Flush out any debris in your feet with warm water, saline, or a vinegar solution (1/2 cup of vinegar to 1 gallon of water).
- Apply an over-the-counter pain medication like ibuprofen or acetaminophen topically to reduce swelling and discomfort..
To Prevent Hammertoes
Hammertoes tend to develop in people who have flat feet. Therefore, the best way to prevent hammertoe is to invest in custom orthotics. This will help correct the alignment of the bones and help prevent injuries and deformities.
Wearing shoes with good arch support is another preventative measure. Shoes with high-quality arch supports can help relieve hammertoe pain and other issues. You should also make sure your shoes are properly fitted with an orthotic and that you wear them while exercising.
If you have hammertoes, getting regularly massaging your toes may help ease some of the discomforts. This can be done by using reflexology or conventional massage techniques.
When the edges of your nails grow back into the skin of your toe, it is called an “ingrown toenail”. Besides being painful and unsightly, ingrown toenails also often lead to swelling, drainage, and infection.
Common causes of ingrown nails include:
- Improper trimming
- Cuticle trauma
- Dry skin and nail bed inflammation
- Poor hygiene
- Unsafe footwear
- Excessive weight gain/loss
- Medical conditions such as diabetes or other illnesses that cause poor blood circulation in your legs and feet
Treatment for an ingrown toenail includes soaking your foot in hot water, using over-the-counter medications like ibuprofen or acetaminophen, and in some cases, surgical removal.
Soaking your foot in hot water is the first step in treating an ingrown toenail. For a week, soak your foot for fifteen minutes every day. This makes it easier for the nail to pop out on its own. If it doesn't peel away on its own, you can try over-the-counter medications or surgical removal.
You can use over-the-counter medications like ibuprofen or acetaminophen to relieve the pain and itching associated with an ingrown toenail. If the pain persists despite the use of these types of medications, surgical removal may be required.
The best way to prevent ingrown nails is to wear properly-fitted shoes. It is recommended that you wear closed-toe shoes with a heel no higher than two inches. Your orthotist may also recommend using petroleum jelly or creams on your feet before bedtime. This will help soften and smooth out any thick skin on your feet, so it doesn’t rub against your nails while sleeping.
Plantar warts are small, pink lumps that may appear on your heels. They are often mistaken for calluses, but you can tell the difference by looking at the center of the growth–plantar warts will have tiny black spots at their center. They can grow in clusters or one at a time.
A virus infects the skin on the bottom of your feet, causing plantar warts. They usually appear after a long period of friction or pressure on the foot, and they can make walking uncomfortable. They don't heal on their own and can irritate the skin around them.
To prevent plantar warts, make sure you wear shoes with a good fit and proper arch support. You should also avoid walking barefoot, which increases the risk of scrapes and cuts through which the virus can infect you.
Also, keep an eye on what you eat and drink. Sugary foods and beverages can cause the skin to harden, which is a risk factor for developing warts.
Plantar warts can be removed using a variety of methods, including over-the-counter medications and creams. If these treatments don't work, talk to your doctor about getting a salicylic acid peel or freezing them off with cryotherapy.
Tips for Preventing Foot Complications from Diabetes
See an Orthotist and a Podiatrist Regularly
Visiting your foot specialists regularly helps keep your feet in peak condition while also ensuring that you catch any arising foot issues as soon as possible.
Your doctor and orthotist will work together to develop an appropriate care routine for your specific medical needs.
Take Off Tight Shoes When Possible
This helps reduce pressure on your toes and reduces the chance of developing an ulcer or other sores that invite infection.
Be Careful About Cuts and/or Wounds
When patients ask us, “How does diabetes link to getting your feet amputated?” our first answer is always “Infection.”
Due to poor circulation, people with diabetes are much more likely to develop ulcers, sores, and other wounds. Infection is much more likely to occur if those wounds go unnoticed and untreated due to neuropathy. And where there's an infection, the risk of amputation skyrockets, so be cautious and treat even the tiniest scrapes on your feet as soon as possible.
Keep Your Home Hygienic
Eliminate any possible sources of infection in your home. This includes cleaning up spills and bacteria-covered surfaces with bleach and a damp rag. Bacteria love moist environments, so make sure that all areas of your home are clean and dry to prevent an infection from starting.
Wear Shoes That Fit Properly
Another common source of foot infections is shoes. When wearing shoes, always wear socks, even if you're only going out for a few minutes. This will prevent bacteria from infecting your foot through the fabric of your shoe.
Change your socks daily and wear breathable shoes without closed toes or heels that could clog sweat glands near the top of the foot–a common cause of infections. For more information on diabetic shoes, talk to your orthotist.
Check Your Feet Daily
Check your feet daily for blisters, cuts, sores, or any other abnormal changes. If you notice any abnormalities or signs of infection, contact your doctor immediately. The sooner you catch problems with your feet, the lower your risk of amputation.
Check Your Toenails Once a Week
Trim your toenails by clipping them straight across with a nail clipper. Avoid rounding off the corners of nails or cutting down on the sides of nails with a nail file, and then smooth them out afterward.
This helps you avoid ingrown toenails, detect fungal infections early on, and establishes a visual baseline from which you can spot any abnormalities later on.
Wash & Dry Your Feet Carefully After Exposure to Moisture
Moist environments, such as locker room floors, sweaty socks, and damp floors, are ideal bacteria breeding grounds. Keep your feet as dry as possible to avoid developing an infection. Keeping a small container of talcum or cornstarch powder in the shower or next to the sink as a reminder is one-way people with diabetes can do this.
If it is not possible to keep your feet dry, make sure that you carefully wash your feet as soon as possible and then dry them completely. Just be careful to check the water temperature before you stick your feet in the bath!
If you suffer from diabetic neuropathy or nerve damage, it can be easy to scald your skin. Make sure the water is warm enough to kill bacteria but cool enough to touch without burning yourself.
Apply Moisturizers Often
When the skin on your foot becomes dry and cracked, it is susceptible to microorganisms such as yeast and bacteria, which can cause infections such as Athlete's foot. Applying moisturizer to the skin of your feet ensures that the skin remains moist and hydrated.
Moisturizers can also help soften or remove calluses, which can be a problem for people with diabetes.
It is possible to reduce your risk of developing sores, ulcers, and infections by encouraging good circulation. Prop your feet up and wiggle your toes and ankles while sitting. To increase blood flow, do this several times a day. Crossing your legs should also be avoided as much as possible because it can cut off circulation to your feet.Quit
Smoking interferes with your circulation and slows blood flow. If you quit smoking, you should see improvements in your overall circulation and energy levels within a few weeks.
Horton’s Orthotics and Prosthetics
If you want to learn more about how diabetes links to getting your feet amputated or you suffer from diabetic foot problems, contact Horton’s Orthotics and Prosthetics today. We specialize in custom orthotics designed to help relieve foot pain and gait problems caused by diabetes.
Our pedorthotics can help you correct abnormalities in your stride, footfalls, or gait that cause leg, hip, and back pain. Our products are made to order to address your specific condition and measurements, fit the contours of your foot, and reduce your daily pain.
We offer a wide range of custom-molded shoes, custom diabetic shoes, diabetic socks and accessories, diabetic insoles, post-operative shoes, and shoe modifications. Make an appointment with one of our experienced and compassionate orthotic specialists today.