The feet and legs are common sites for complications in people with diabetes, and for this reason good foot care is very important.

Having diabetes can damage the nerves and blood vessels that supply your legs and feet. This puts affected people at increased risk of developing ulcers on the feet and legs which can become infected, and in the worst cases, develop gangrene (where the tissue dies, resulting in the need for amputation).

Nerve damage

An injury to the foot or leg can be painful, but in people suffering from diabetic neuropathy (nerve damage due to diabetes) the sensations are dulled and minor injuries may go undetected and untreated, potentially leading to more serious damage.

Loss of temperature sensation is also a significant risk factor for injury in people with diabetes. This can result in problems such as burns from hot water or sitting too close to a heater.

Diabetic neuropathy can also result in damage to the joints, bones, muscles and structure of your feet.

In addition to numbness, diabetic neuropathy can sometimes also result in unpleasant feelings such as tingling, pain and burning in the legs and feet.

Poor circulation

Circulatory disorders, particularly blocked arteries, commonly occur in the lower extremities of people with diabetes. If injured, areas with poor circulation heal badly and, if left unattended, such injuries may develop into ulcers or even become gangrenous. If blood supply is severely impaired, ulcers can occur even in the absence of injury.

A lack of blood supply to the leg muscles can also lead to pain in the legs when walking, which typically comes on after walking a certain distance and is relieved by rest. This is known as intermittent claudication.

Infection

High blood sugar levels can increase your risk of infections. Sores or ulcers on the feet and legs have a higher risk of becoming infected and taking longer to heal in people with diabetes compared with people who don’t have diabetes. Infection is also more prone to spreading to other tissues, including the underlying bones.

Caring for your feet

When you have diabetes, looking after your feet involves:

• daily foot care;
• regular visits to a health professional (doctor or podiatrist); and
• treatment of diabetic neuropathy and/or poor circulation, if needed.

Foot care

Good foot care is vitally important for people with diabetes.

• Every day, wash your feet in warm (not hot) water, and dry carefully, including between your toes.
• After washing and drying, apply a moisturiser to your feet, but avoid moisturising between your toes.
• If you notice a callus forming, you can try to gently remove it (for example, with a pumice stone). However, once formed, calluses should only be treated by professionals.
• When you cut your toenails, cut straight across and file down any sharp edges. Use a nail trimmer rather than scissors.
• Always wear shoes and socks, and choose your shoes carefully. Shoes should be large enough to be comfortable, but not large enough to be slipping off. They should have resilient (but not soft) insoles, and be smooth on the inside, with no rough areas.
• Corn plasters should not be used as they may cause foot ulcers.

Checking your feet

Check your feet each night, looking for:

• dry, scaly, red, itching or cracked skin;
• areas where something has been rubbing on your feet;
• blisters;
• cuts or abrasions;
• corns or calluses;
• infections;
• thickened or discoloured nails;
• blueness or any swelling; and
• any red, hot or swollen areas.

If your vision is poor, get someone to check for you.

Treating diabetic neuropathy and poor circulation

Specific treatment of conditions that can affect the legs and feet in people with diabetes – diabetic neuropathy and poor circulation in the legs and feet – is necessary.

Tight control of the amount of glucose in the bloodstream has been shown to reduce the risk of neuropathy, slow its progress and help improve symptoms.

Reducing other risk factors for diabetic neuropathy and poor circulation to the legs and feet can also help. These include:

When to see your doctor or podiatrist

• Any breaks in the skin need to be treated straight away, so see your doctor or podiatrist. Also, try to work out what might have caused the problem so that you can prevent it happening again.
• If one of your feet is hot and swollen, check it again the next day — see your doctor if it remains hot and swollen. Antibiotics may be needed to treat an infection.
• Toenail infections should be treated promptly.
• Let your doctor know if you develop pain in the feet and legs or notice changes in the colour or temperature of your feet and legs.

Your feet should also be examined regularly by a doctor, diabetes specialist or podiatrist. Your doctor or podiatrist can advise you on foot care and also on the selection of appropriate footwear.

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