How Diabetes Can Affect Your Feet
Diabetes can have a profound effect on our entire body and its many systems; the feet are particularly vulnerable in people with advanced diabetes. Once you are diagnosed with diabetes, your risk of acquiring other conditions such high blood pressure and high cholesterol increases, which also compounds the risk of poor foot health. Diabetes is the leading cause of lower limb amputation, which is usually the result of severe or life-threatening ulcers/sores on the feet as a consequence of the factors which will be discussed below.
Diabetes affects the feet primarily through two ways: affecting the circulation to the feet and our nerves. As the diabetes progresses into more advanced symptoms, the symptoms will also worsen and spread from the furthest parts of the body such as our toes up to the entire leg.
Diabetes can lead to hardening of the arteries down to the feet, reducing the amount of blood flow. This is called peripheral arterial disease, which means wounds or cuts can take longer to heal if your skin integrity is compromised. Wounds which take longer to heal (or in some particularly bad cases, do not heal at all) are also more likely to be infected, which will further complicate the healing process as they are also less responsive to antibiotics due to the reduced blood flow.
Nerves are also one of the major structures which are damaged in individuals with advanced diabetes. Nerve damage due to diabetes is called diabetic peripheral neuropathy, and the symptoms are usually irreversible and happen on both sides of the body-sometimes even affecting other small nerves such as those in the fingers.
The nerves affecting our sensation of pain, temperature and balance can be damaged, which can impact our ability to have protective sensation. Pain is a normal body response to protect our body from harm, and those with advanced diabetes must ensure they are very careful as they may hurt their foot and not even know about it!
The nerves to our foot and leg muscles are also damaged, meaning there is less innervation and activation of those muscles. Remember the phrase “you lose it if you don’t use it”? Well this is very true in the diabetic foot, as the muscles in the foot can start to waste away. This will reduce overall fitness, shock absorption and can lead to clawing of the toes due to muscular imbalance. The bony prominences that arise from having curly toes and increased pressure on the ball of the foot have an increased risk of ulceration or breaking down due to the constant pressure.
The final type of nerve to be damaged in diabetes is those going to the sweat glands in the foot. With less activation of the sweat glands, the skin on the feet can get much drier, making the skin more fragile and prone to painful cracks (another source of infection if it gets deep enough).
Once you consider how poorly controlled diabetes can impact just the feet, you start to get an idea of why diabetes is one of the most debilitating conditions in the modern world.