Diabetic Foot Disease
Nerve, circulation, and skin problems of the feet in diabetes
Quick Facts
- Type: Complication of diabetes
- Key problems: Nerve damage, poor circulation, ulcers, infection
- Main risk: Foot ulcers that can become serious
- Key step: Daily foot checks and regular foot exams
Overview
Diabetic foot disease is a group of foot problems that can develop in people with diabetes. Over time, high blood sugar can damage the nerves and blood vessels of the feet. Nerve damage (neuropathy) reduces the ability to feel pain, heat, or pressure, so injuries can go unnoticed. Poor circulation slows healing and makes infection more likely. Together, these changes set the stage for foot ulcers, infections, and, in severe cases, tissue loss.
Because a small foot problem can become serious in a person with diabetes, foot care is a central part of managing the disease. Many serious complications, including foot ulcers and amputations, can be prevented with daily foot care, good blood sugar control, and prompt attention to any injury or change.
Symptoms
Symptoms depend on which problems are present. Warning signs include:
- Numbness, tingling, or burning in the feet
- Loss of feeling, so cuts or blisters are not felt
- Dry, cracked skin or calluses
- Cold feet, weak pulses, or poor healing (signs of poor circulation)
- Cuts, blisters, or sores that are slow to heal
- An open sore (ulcer), often on the bottom of the foot or over a pressure point
- Redness, warmth, swelling, drainage, or a bad smell (signs of infection)
- Changes in foot shape, color, or temperature
An open sore, spreading redness, fever, or a foot that suddenly becomes hot and swollen needs prompt medical care.
Causes
Diabetic foot disease arises from the effects of long-term high blood sugar:
- Nerve damage (neuropathy): Reduces feeling, so injuries are not noticed and pressure points are not protected.
- Poor circulation: Narrowed or damaged blood vessels reduce blood flow, slowing healing and fighting of infection.
- Skin and structural changes: Dry skin, calluses, and changes in foot shape create pressure points where ulcers form.
- Infection: Breaks in the skin allow bacteria to enter; high blood sugar and poor circulation help infection spread.
Risk Factors
- Long duration of diabetes and poor blood sugar control
- Nerve damage (peripheral neuropathy)
- Poor circulation or peripheral artery disease
- A previous foot ulcer or amputation
- Foot deformities, calluses, or ill-fitting shoes
- Smoking
- Vision problems or difficulty inspecting the feet
Diagnosis
A clinician evaluates the feet to detect problems early and assess any wounds:
- Foot examination: Checking skin, nails, shape, pulses, and pressure points.
- Sensation testing: Using a thin filament and other tools to check for loss of feeling.
- Circulation tests: Feeling pulses and measuring blood flow, such as the ankle-brachial index.
- Wound assessment: Measuring and examining any ulcer for depth and infection.
- Imaging and cultures: X-rays or other scans and wound cultures if deep infection or bone involvement is suspected.
Treatment
Treatment depends on the problems present and aims to heal wounds, treat infection, and prevent complications.
- Wound care: Cleaning and dressing ulcers, removing dead tissue, and relieving pressure with special footwear or casts (offloading).
- Treating infection: Antibiotics for infected wounds, with hospital care for serious infections.
- Improving circulation: Managing peripheral artery disease, sometimes with procedures to restore blood flow.
- Blood sugar control: Keeping glucose in range supports healing.
- Specialist care: Podiatry, wound, and sometimes surgical or vascular care; severe, non-healing infection occasionally requires surgery.
Early treatment of foot problems greatly improves outcomes and helps prevent amputation.
Prevention
- Check your feet every day for cuts, blisters, redness, swelling, or sores
- Wash and dry feet daily and keep skin moisturized, but not between the toes
- Wear well-fitting shoes and clean socks; never go barefoot
- Trim nails carefully and have calluses treated by a professional
- Keep blood sugar, blood pressure, and cholesterol controlled
- Do not smoke
- Have your feet examined at regular diabetes visits and report problems early
When to See a Doctor
Contact your care team promptly for any new foot sore, blister, or change. Seek urgent care if you have:
- An open sore or ulcer that is not healing
- Spreading redness, warmth, swelling, or drainage
- A foul smell, black tissue, or a wound exposing deeper tissue
- Fever or feeling unwell along with a foot wound
- A foot that suddenly becomes hot, swollen, or changes shape
Prompt care of foot infections in diabetes is important to prevent serious complications.
Frequently Asked Questions
What is diabetic foot disease?
It is a set of foot problems in people with diabetes, including nerve damage, poor circulation, ulcers, and infections caused by long-term high blood sugar. These changes make the feet vulnerable to injuries that can heal poorly and become serious.
Why are foot ulcers dangerous in diabetes?
Nerve damage can hide pain, so injuries go unnoticed, while poor circulation slows healing and raises infection risk. An ulcer can become infected and, if not treated promptly, can lead to deeper infection or tissue loss.
How can I protect my feet if I have diabetes?
Check your feet every day, wear well-fitting shoes, never go barefoot, keep skin clean and moisturized, trim nails carefully, and keep blood sugar controlled. Have your feet examined at regular diabetes visits and report any sore right away.
What are signs of a foot infection?
Redness that spreads, warmth, swelling, drainage, a bad smell, or fever can signal infection. Any of these, or a wound that exposes deeper tissue, needs prompt medical care.
Can amputation be prevented?
Yes, many amputations can be prevented with daily foot care, good blood sugar control, and early treatment of any wound or infection. Seeing a clinician promptly when problems appear is one of the most important steps.
References
- Centers for Disease Control and Prevention (CDC). Diabetes and your feet.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diabetes and foot problems.
- American Diabetes Association. Foot care.
- MedlinePlus, U.S. National Library of Medicine. Diabetic foot.