How diabetes causes foot problems

A variety of factors work in unison to cause foot problems in people with diabetes, especially poor circulation and nerve disease (neuropathy). Neuropathy significantly dulls awareness of your feet, making you more susceptible to extensive injury-related damage. If your vision has been affected by diabetic retinopathy or other eye problems, you may not detect an injury or infection early. If you get a foot infection or injury, you may not notice it until your condition is so serious that you require surgery, possibly amputation.

Who's at risk?

Risk factors for diabetic foot problems include:

• Poor blood glucose control. If your blood sugar levels are persistently above the safe range, you are more likely to have foot problems.
• Age. The risk increases with age.
• Gender. Males are at higher risk.
• Race. African-Americans, Hispanics, and Native Americans are at higher risk.
• Duration of diabetes. The longer you have the disease, the greater your risk.
• Other complications due to diabetes (small blood vessel disease, atherosclerosis of large vessels). If you already have other diabetic complications, you are more likely to have foot problems.
• Smoking. Smoking contributes to circulatory problems in your extremities, increasing your likelihood of developing foot problems.
• Peripheral neuropathy (damage to the nerves that control sensation and touch). Peripheral neuropathy results in poor sensation in your extremities, increasing your likelihood of having foot problems.

How do problems start?

Because foot disease in diabetes usually begins with neuropathy, your first step in preventing foot problems should be addressing problems with your nerves. Neuropathy causes problems in your feet by disrupting your nerves, both reducing your sensation of pain and causing problems with the way you walk. Such problems can damage your feet in the following ways:

• Reduced sensation prevents you from sensing pain and realizing that your foot has been injured. Poor eyesight can also reduce your ability to detect foot injuries and infections. For example, you may have a blister and not realize it because you do not feel any associated pain or see the blister. Without treatment, this injury may progress to infection.
• Impaired muscular control causes you to walk in an abnormal way. By making your foot position abnormal, neuropathy can increase your chances of getting pressure-related injuries, such as calluses and blisters.