Diabetes complications can include nerve damage and poor blood circulation. These problems make the feet vulnerable to skin sores (ulcers) that can worsen quickly.
The good news is that proper diabetes management and careful foot care can help prevent foot ulcers. In fact, better diabetes care is probably why the rates of lower limb amputations have gone down by more than 50 percent in the past 20 years.
When foot ulcers do develop, it's important to get prompt care. More than 80 percent of amputations begin with foot ulcers. A nonhealing ulcer that causes severe damage to tissues and bone may require surgical removal (amputation) of a toe, foot or part of a leg.
Some people with diabetes are more at risk than others. Factors that lead to an increased risk of an amputation include:
- High blood sugar levels
- Nerve damage in the feet (peripheral neuropathy)
- Calluses or corns
- Foot deformities
- Poor blood circulation to the extremities (peripheral artery disease)
- A history of foot ulcers
- A past amputation
- Vision impairment
- Kidney disease
- High blood pressure, above 140/80 millimeters of mercury (mmHg)
Here's what you need to know to keep your feet healthy, the signs you need to see a doctor and what happens if amputation is necessary.
Preventing foot ulcers
The best strategy for preventing complications of diabetes — including foot ulcers — is proper diabetes management with a healthy diet, regular exercise, blood sugar monitoring and adherence to a prescribed medication regimen.
Proper foot care will help prevent problems with your feet and ensure prompt medical care when problems occur. Tips for proper foot care include the following:
- Inspect your feet daily. Check your feet once a day for blisters, cuts, cracks, sores, redness, tenderness or swelling. If you have trouble reaching your feet, use a hand mirror to see the bottoms of your feet. Place the mirror on the floor if it's too difficult to hold, or ask someone to help you.
Wash your feet daily. Wash your feet in lukewarm (not hot) water once a day. Dry them gently, especially between the toes. Use a pumice stone to gently rub the skin where calluses easily form.
Sprinkle talcum powder or cornstarch between your toes to keep the skin dry. Use a moisturizing cream or lotion on the tops and bottoms of your feet to keep the skin soft. Preventing cracks in dry skin helps keep bacteria from getting in.
- Don't remove calluses or other foot lesions yourself. To avoid injury to your skin, don't use a nail file, nail clipper or scissors on calluses, corns, bunions or warts. Don't use chemical wart removers. See your doctor or foot specialist (podiatrist) for removal of any of these lesions.
- Trim your toenails carefully. Trim your nails straight across. Carefully file sharp ends with an emery board. Ask for assistance from a caregiver if you are unable to trim your nails yourself.
- Don't go barefoot. To prevent injury to your feet, don't go barefoot, even around the house.
- Wear clean, dry socks. Wear socks made of fibers that pull sweat away from your skin, such as cotton and special acrylic fibers — not nylon. Avoid socks with tight elastic bands that reduce circulation or socks with seams that could irritate your skin.
Buy shoes that fit properly. Buy comfortable shoes that provide support and cushioning for the heel, arch and ball of the foot. Avoid tightfitting shoes and high heels or narrow shoes that crowd your toes.
If one foot is bigger than the other, buy shoes in the larger size. Your doctor may recommend specially designed shoes (orthopedic shoes) that fit the exact shape of your feet, cushion your feet and evenly distribute weight on your feet.
- Don't smoke. Smoking impairs circulation and reduces the amount of oxygen in your blood. These circulatory problems can result in more-severe wounds and poor healing. Talk to your doctor if you need help to quit smoking.
- Schedule regular foot checkups. Your doctor or podiatrist can inspect your feet for early signs of nerve damage, poor circulation or other foot problems. Schedule foot exams at least once a year or more often if recommended by your doctor.
Signs of trouble
Contact your doctor if you have:
- Ingrown toenails
- Plantar warts on the soles of your feet (flesh colored bumps with dark specks)
- Athlete's foot
- An open sore or bleeding
- Warmth in one area
- Pain (though you may not feel anything if you have nerve damage)
- Discolored skin
- A foul odor
- An ulcer that lasts longer than one to two weeks
- An ulcer bigger than 3/4 inch (2 centimeters)
- A sore that doesn't quickly begin to heal
- An ulcer so deep you can see the bone underneath
Your doctor will inspect your foot to make a diagnosis and prescribe the appropriate course of treatment.
What if amputation is the only option?
Treatments for foot ulcers vary depending on the severity of the wound. In general, the treatment employs methods to remove dead tissue or debris, keep the wound clean, and promote healing. Wounds need to be monitored frequently, at least every one to four weeks.
When the condition results in a severe loss of tissue or a life-threatening infection, an amputation may be the only option.
A surgeon will remove the damaged tissue and preserve as much healthy tissue as possible. After surgery, you'll be monitored in the hospital for a few days. It may take four to six weeks for your wound to heal completely.
In addition to your primary care doctor and surgeon, other medical professionals involved in your treatment plan may include:
- An endocrinologist, who is a physician with special training in the treatment of diabetes and other hormone-related disorders
- A physical therapist, who will help you regain strength, balance and coordination and teach you how to use an artificial (prosthetic) limb, wheelchair or other devices to improve your mobility
- An occupational therapist, who specializes in therapy to improve everyday skills, including teaching you how to use adaptive products to help with everyday activities
- A mental health provider, such as a psychologist or psychiatrist, who can help you address your feelings or expectations related to the amputation or to cope with the reactions of other people
- A social worker, who can assist with accessing services and planning for changes in care
Even after amputation, it's important to follow your diabetes treatment plan. People who've had one amputation have a higher risk of having another. Eating healthy foods, exercising regularly, controlling your blood sugar level and avoiding tobacco can help you prevent additional diabetes complications.