What is it?
Diabetes is a disease that develops from high blood glucose levels which can cause damage to the nerve systems in your body by stopping important messages getting to and from your brain. The nerves most likely to be affected are the longest ones – those that reach all the way down to your legs and feet. This nerve damage is sometimes called neuropathy.
High blood glucose levels can also damage your blood vessels and thereby circulation to your feet and legs, due to less blood getting to your skin, muscles and tissues.
Is it serious?
Any injury or hard skin has the potential to develop into something more serious if you have diabetes. When the skin is damaged, it may not heal so easily and sometimes this can cause an ulcer to form on your foot. Additionally, if you have lost feeling in your feet then it is possible that you may unknowingly damage your feet. You may stand on sharp objects like a nail, piercing the skin even down to the bone without realising it. If not noticed and not treated appropriately this can have potentially serious consequences and could lead to an amputation. Such an outcome is less likely if you seek expert advice from your multidisciplinary foot care team.
Who gets it?
Anyone can suffer from diabetes and you are more likely to if your close relatives have the disease. Other risk factors include obesity, high cholesterol and blood pressure as well as physical inactivity and your chances also increase as you get older.
How do I know I have it?
Diabetes may affect your feet in a number of ways. One of the early changes can be loss of sensation (peripheral neuropathy) in your feet, often starting at the toes. Your chances of losing feeling in your feet (neuropathy) increases with the number of years that you have diabetes and research suggests that up to one in three people with diabetes have some loss of sensation. The onset of neuropathy is gradual and often people who develop this complication are unaware of it at the start. Often it occurs between 7 and 10 years of having diabetes, although in some cases it can occur sooner where blood sugar levels have not been so well controlled. Very occasionally pain or a burning sensation may accompany loss of feeling (painful neuropathy).
Additionally, when the nerves in your feet are affected, other changes may follow, for example, your toes may start to claw and the bones in your feet can become more susceptible to fractures.
Another change that can occur is reduced blood flow to your feet. Diabetes may also affect your ability to heal and reduce your natural ability to fight bacteria. Consequently, you should take particular care of any scratches, cuts or blisters on your feet.
How do I prevent it?
Preventing foot problems involves managing your diabetes well, controlling blood glucose levels (along with your cholesterol and blood pressure) and leading a healthy active lifestyle. Your chances of doing this will be great increased if you do not smoke. By adopting these measures, you can prevent or slow down any changes to the nerves and blood vessels that supply your legs and feet.
In addition, regular foot care is important from preventing the build-up of hard skin to moisturising your feet in order to keep the skin supple and always wearing the right shoes and socks that fit properly.
Everyone who has diabetes should also have their feet checked regularly with a healthcare professional (podiatrist, nurse or doctor) and at the very least once a year at their annual review. However, if you are at increased risk of complications, these inspections may be done more frequently.
Simple self-care measures include:
- Always check your feet every day
- Clean and dress any cuts, scratches or wounds
- Always wear footwear
- Always wear shoes that fit properly
- Never sit with your feet too close to a fire
- Visit a podiatrist for corns and calluses
- Avoid using corn plasters
What are the treatments?
If you have diabetes, you can expect your healthcare professional to see you regularly throughout the year along with ideally other members of a multidisciplinary foot care team. However, if you are at increased risk of an ulcer, these inspections may be more frequent and carried out by a podiatrist. The podiatrist will normally check both the blood supply to your feet and any evidence of loss of sensation in your feet.
Blood supply will be checked by looking at the colour of the skin, checking the pulses in the feet and by asking questions about certain kinds of pains in your feet and legs. Normally people have two pulses in their feet: one on the top (dorsalis pedis) and one on the inside of the ankle (posterior tibial). Most often the podiatrist will check these pulses by feeling the pulse with their fingers or they will use a small hand held scanner (called a doplar) to listen to the pulse.
Sensation will most commonly be checked with a monofilament and tuning fork. The monofilament is a plastic probe that is designed to buckle at a given pressure and is a good indicator for loss of feeling.
The podiatrist will also be looking for any foot deformity or signs of excessive loading that may warrant either footwear advice or in some cases an insole.
When should I see a podiatrist about it?
If you experience any form of neuropathy or pain or discomfort, it is advisable to consult your diabetic clinic or podiatrist, since it is possible in many cases to alleviate these symptoms.
If you see any of the following in your feet, you should also seek medical attention or consult your podiatrist:
- Walking becomes more difficult
- Applying or wearing shoes becomes more difficult
- Tingling sensation or pins and needles
- Part or all of your foot becomes swollen
- Breaks in the skin, opens sores/blisters or a discharge
- Skin colour changes (redder, bluer, paler, blacker) over part or all of the foot
- Swelling in your feet and/or an unusual odour
- Part or all of your foot feels much hotter or colder than usual
- Hard skin (callus)
- Cramp in your calves
- Shiny smooth skin and/or losing hair on your feet and legs
If you experience any foot care issues which do not resolve themselves naturally or through routine foot care within three weeks, it is recommended to seek the help of a healthcare professional such as your GP to refer you to your local NHS trust for free treatment but if you do not qualify for this, or need urgent attention, you should contact a private podiatrist.
To talk to a podiatrist (also known as a chiropodist) about the options available regarding treatment, you can contact an NHS podiatrist or a private practice podiatrist. In both cases, always ensure that any practitioners you visit are registered with the Health Professionals Council (HPC) and describe themselves as a podiatrist (or chiropodist).
To contact an NHS podiatrist, please contact your GP practice for information on an NHS referral (in some areas you can self-refer).
To see a private practice podiatrist, use our search Find A Podiatrist.
Diabetic foot webinar for people with diabetes
On Friday 13 November 2020 a patient-facing webinar, entitled Living with diabetes: How to avoid foot complications and stay healthy, was co-created by multiple partners with an interest in the diabetic foot. The webinar addressed the importance of foot screening and risk stratification, the patient perspective and footcare provision during the pandemic. A recording of the webinar is available here.
Further information and useful contacts
We have worked with other professional bodies with expertise in diabetes to produce a suite of eight diabetes leaflets:
- Low risk of non-healing wounds and amputation
- Moderate risk of non-healing wounds and amputation
- High risk of non-healing wounds and amputation
- Looking after your diabetic foot ulcer to reduce the risk of amputation
- Advice for looking after your Charcot foot to reduce the risk of amputation
- Looking after your foot in remission, to reduce the risk of further ulcers and amputation
- Footwear advice to reduce the risk of amputation
- Advice to help you care for your feet on holiday
For more detailed and comprehensive information about diabetes and foot care generally, please consult the websites below: