How can diabetes hurt my feet and skin?

July 7, 2004

How can diabetes hurt my feet?

High blood glucose from diabetes causes two problems that can hurt your

feet:

Nerve damage. One problem is damage to nerves in your legs and feet. With

damaged nerves, you might not feel pain, heat, or cold in your legs and

feet. A sore or cut on your foot may get worse because you do not know it

is there. This lack of feeling is caused by nerve damage, also called

diabetic neuropathy (ne-ROP-uh-thee). It can lead to a large sore or

infection.

Poor blood flow. The second problem happens when not enough blood flows

to your legs and feet. Poor blood flow makes it hard for a sore or

infection to heal. This problem is called peripheral vascular disease.

Smoking when you have diabetes makes blood flow problems much worse.

Make sure you wear shoes that fit well.

These two problems can work together to cause a foot problem.

For example, you get a blister from shoes that do not fit. You do not

feel the pain from the blister because you have nerve damage in your

foot. Next, the blister gets infected. If blood glucose is high, the

extra glucose feeds the germs. Germs grow and the infection gets worse.

Poor blood flow to your legs and feet can slow down healing. Once in a

while a bad infection never heals. The infection might cause gangrene. If

a person has gangrene, the skin and tissue around the sore die. The area

becomes black and smelly.

To keep gangrene from spreading, a doctor may have to do surgery to cut

off a toe, foot, or part of a leg. Cutting off a body part is called an

amputation.

What can I do to take care of my feet?

Wash your feet in warm water every day. Make sure the water is not too

hot by testing the temperature with your elbow. Do not soak your feet.

Dry your feet well, especially between your toes

Look at your feet every day to check for cuts, sores, blisters, redness,

calluses, or other problems. Checking every day is even more important if

you have nerve damage or poor blood flow. If you cannot bend over or pull

your feet up to check them, use a mirror. If you cannot see well, ask

someone else to check your feet.

If your skin is dry, rub lotion on your feet after you wash and dry them.

Do not put lotion between your toes.

File corns and calluses gently with an emery board or pumice stone. Do

this after your bath or shower.

Cut your toenails once a week or when needed. Cut toenails when they are

soft from washing. Cut them to the shape of the toe and not too short.

File the edges with an emery board.

Always wear shoes or slippers to protect your feet from injuries.

Always wear socks or stockings to avoid blisters. Do not wear socks or

knee-high stockings that are too tight below your knee.

Wear shoes that fit well. Shop for shoes at the end of the day when your

feet are bigger. Break in shoes slowly. Wear them 1 to 2 hours each day

for the first 1 to 2 weeks.

Before putting your shoes on, feel the insides to make sure they have no

sharp edges or objects that might injure your feet.

Take off your shoes and socks so your doctor will check your feet.

How can I get my doctor to help me take care of my feet?

Tell your doctor right away about any foot problems.

Ask your doctor to look at your feet at each diabetes checkup. To make

sure your doctor checks your feet, take off your shoes and socks before

your doctor comes into the room.

Ask your doctor to check how well the nerves in your feet sense feeling.

Ask your doctor to check how well blood is flowing to your legs and feet.

Ask your doctor to show you the best way to trim your toenails. Ask what

lotion or cream to use on your legs and feet.

If you cannot cut your toenails or you have a foot problem, ask your

doctor to send you to a foot doctor. A doctor who cares for feet is

called a podiatrist.

What are common diabetes foot problems?

Anyone can have corns, blisters, and athlete's foot. If you have diabetes

and your blood glucose stays high, these foot problems can lead to

infections.

Corns and calluses are thick layers of skin caused by too much rubbing

or pressure on the same spot. Corns and calluses can become infected.

Blisters can form if shoes always rub the same spot. Wearing shoes that

do not fit or wearing shoes without socks can cause blisters. Blisters

can become infected.

Ingrown toenails happen when an edge of the nail grows into the skin.

The skin can get red and infected. Ingrown toenails can happen if you cut

into the corners of your toenails when you trim them. If toenail edges

are sharp, smooth them with an emery board. You can also get an ingrown

toenail if your shoes are too tight.

A bunion forms when your big toe slants toward the small toes and the

place between the bones near the base of your big toe grows big. This

spot can get red, sore, and infected. Bunions can form on one or both

feet. Pointy shoes may cause bunions. Bunions often run in the family.

Surgery can remove bunions.

Plantar warts are caused by a virus. The warts usually form on the

bottoms of the feet.

Hammertoes form when a foot muscle gets weak. The weakness may be from

diabetic nerve damage. The weakened muscle makes the tendons in the foot

shorter and makes the toes curl under the feet. You may get sores on the

bottoms of your feet and on the tops of your toes. The feet can change

their shape. Hammertoes can cause problems with walking and finding shoes

that fit well. Hammertoes can run in the family. Wearing shoes that are

too short can also cause hammertoes.

Dry and cracked skin can happen because the nerves in your legs and feet

do not get the message to keep your skin soft and moist. Dry skin can

become cracked and allow germs to enter. If your blood glucose is high,

it feeds the germs and makes the infection worse.

Athlete's foot is a fungus that causes redness and cracking of the skin.

It is itchy. The cracks between the toes allow germs to get under the

skin. If your blood glucose is high, it feeds the germs and makes the

infection worse. The infection can spread to the toenails and make them

thick, yellow, and hard to cut.

All of these foot problems can be taken care of. Tell your doctor about

any foot problem as soon as you see it.

How can special shoes help my feet?

Special shoes can be made to fit softly around your sore feet or feet

that have changed shape. These special shoes help protect your feet.

Medicare and other health insurance programs may pay for special shoes.

Talk to your doctor about how and where to get them.

How can diabetes hurt my skin?

Drinking fluids helps keep your skin moist and healthy.

Diabetes can hurt your skin in two ways:

If your blood glucose is high, your body loses fluid. With less fluid in

your body, your skin can get dry. Dry skin can be itchy, causing you to

scratch and make it sore. Also, dry skin can crack. Cracks allow germs to

enter and cause infection. If your blood glucose is high, it feeds germs

and makes infections worse. Skin can get dry on your legs, feet, elbows,

and other places on your body.

Nerve damage can decrease the amount you sweat. Sweating helps keep your

skin soft and moist. Decreased sweating in your feet and legs can cause

dry skin.

What can I do to take care of my skin?

After you wash with a mild soap, make sure you rinse and dry yourself

well. Check places where water can hide, such as under the arms, under

the breasts, between the legs, and between the toes.

Keep your skin moist by washing with a mild soap and using lotion or

cream after you wash.

Keep your skin moist by using a lotion or cream after you wash. Ask your

doctor to suggest one.

Drink lots of fluids, such as water, to keep your skin moist and healthy.

Wear all-cotton underwear. Cotton allows air to move around your body

better.

Check your skin after you wash. Make sure you have no dry, red, or sore

spots that might lead to an infection.

Tell your doctor about any skin problems.

For More Information

Diabetes Teachers (nurses, dietitians, pharmacists, and other health

professionals)

To find a diabetes teacher near you, call the American Association of

Diabetes Educators toll-free at 1-800-TEAMUP4 (1-), or look

on the Internet at www.diabeteseducator.org and click on " Find a Diabetes

Educator. "

Dietitians

To find a dietitian near you, call the American Dietetic Association

toll-free at 1-, or look on the Internet at www.eatright.org

and click on " Find a Nutrition Professional. "

Government

The National Institute of Arthritis and Musculoskeletal and Skin Diseases

(NIAMS) is part of the National Institutes of Health. To learn more about

feet and skin problems, write or call the National Institute of Arthritis

and Musculoskeletal and Skin Diseases Information Clearinghouse, 1 AMS

Circle, Bethesda, MD 20892-3675, 1- (toll-free); or see

www.niams.nih.gov on the Internet.

To get more information about taking care of diabetes, contact

National Diabetes Information Clearinghouse

1 Information Way

Bethesda, MD 20892-3560

Phone: 1- or

Fax:

Email: ndic@...

Internet: www.diabetes.niddk.nih.gov

National Diabetes Education Program

1 Diabetes Way

Bethesda, MD 20892-3600

Phone: 1-

Fax:

Internet: http://ndep.nih.gov

American Diabetes Association

1701 North Beauregard Street

andria, VA 22311

Phone: 1-

Internet: www.diabetes.org

Juvenile Diabetes Research Foundation International

120 Wall Street

New York, NY 10005-4001

Phone: 1-

Internet: www.jdrf.org

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