What is diabetes? Too much sugar in the blood right?!
Diabetes is a chronic condition characterised by high levels of glucose (sugar) in the blood. There are primarily two types: type 1 and type 2. In type 1 diabetes, the body doesn’t produce insulin, a hormone necessary for converting glucose into energy. Type 2 diabetes, on the other hand, occurs when the body becomes resistant to insulin or doesn’t produce enough of it. Regardless of the type, uncontrolled diabetes can lead to various complications affecting different parts of the body, including the feet.
According to recent research by the International Diabetes Federation (IDF), Singapore has seen a rise in diabetes cases over the years, with approximately 13.7% of the population aged 18 to 69 living with diabetes. The vast majority of diabetes cases in Singapore are type 2 diabetes, which is closely linked to lifestyle factors such as unhealthy diet, lack of physical activity, and obesity.
Why does diabetes pose a problem to the foot?
Diabetes can pose significant problems for the feet due to its impact on blood circulation and nerve function. Here are the complete reasons that are important for you to know.
1. Peripheral Neuropathy
High blood sugar levels can damage nerves, leading to peripheral neuropathy. This condition reduces sensation in the feet, making it difficult for individuals with diabetes to detect injuries or sores. Without prompt treatment, these minor injuries can progress into serious infections or ulcers.
2. Peripheral Artery Disease (PAD)
Diabetes can also affect blood vessels, leading to peripheral artery disease. Reduced blood flow to the feet impairs the body’s ability to heal wounds and fight infections. Poor circulation exacerbates the risk of tissue damage and slow healing.
3. Increased risk of infection
Diabetes weakens the immune system, making individuals more susceptible to infections. Combined with reduced sensation and impaired circulation, even minor foot injuries like blisters or cuts can become infected and difficult to treat.
4. Foot Deformities
Diabetes can cause changes in the structure of the foot, such as Charcot foot, where the bones weaken and fracture due to nerve damage. Foot deformities can lead to abnormal pressure points, increasing the risk of developing ulcers.
5. Delayed Wound Healing
High blood sugar levels can impair the body’s ability to heal wounds. Even minor cuts or abrasions can take longer to heal in individuals with diabetes, increasing the risk of infection and complications.
Early stage of diabetic foot signs that indicate the need to seek help
The early stages of foot problems in diabetes patients often go undetected because their symptoms can resemble those of other medical conditions outside of diabetes. However, some common signs typically experienced in the early phase of diabetic foot include:
Pain or cramps in your legs, calves, thighs, or buttocks, This pain is mainly felt during activity.
Numbness (loss of sensation) or reduced ability to feel heat or cold in your feet.
Burning, tingling, or pain sensations in your feet.
Dry, cracked skin on your feet.
Decreased hair growth on your feet, toes, and lower legs.
Fungal infections like athlete’s foot (tinea pedis) or other infections between your toes.
Thickened, yellow toenails.
Presence of sores, blisters, ulcers, infected corns, or ingrown toenails.
Swelling (edema) in the feet.
Redness or warmth in the feet.
Changes in foot shape, potentially resulting in a “rocker bottom” appearance, which can indicate a rare diabetic foot condition called Charcot foot neuropathy, where the bones in the feet and toes shift or fracture.
Why is the foot more prone to problems or injuries?
The feet bear the brunt of our body weight and are constantly exposed to pressure and friction. For individuals with diabetes, even minor injuries like blisters or cuts can escalate into serious complications due to impaired healing mechanisms.
Why is it a problem for healing?
High blood sugar levels hinder the body’s ability to fight infection and repair damaged tissue. This compromised healing process, coupled with reduced blood flow and nerve damage, can turn a small wound into a chronic ulcer if not promptly addressed.
Why is it important to manage both foot care and nutrition, particularly sugar intake?
Managing diabetes involves a multifaceted approach, and proper foot care is paramount. This includes daily inspection of the feet, wearing comfortable footwear, keeping the skin moisturised, and avoiding activities that could cause injury. Equally important is maintaining a balanced diet to regulate blood sugar levels. Limiting sugar intake and consuming a variety of nutrient-rich foods can help prevent complications and promote overall health.
Here are some things you can do to support diabetic foot health and prevent more dangerous conditions.
Avoid smoking, as it diminishes blood flow to the feet.
Adhere to a nutritious diet, prioritising fruits and vegetables while reducing sugar and salt intake.
Engage in regular physical activity; consistency is key, aiming for 10 to 20 minutes daily rather than sporadic longer sessions.
Ensure to take medications according to your doctor’s instructions.
How can Podiatry help?
Podiatrists specialise in diagnosing and treating foot conditions, including diabetic foot ulcers. They play a crucial role in the prevention and management of foot complications associated with diabetes. Podiatric interventions may include wound debridement, offloading pressure points, prescribing custom orthotics, and providing education on proper foot care practices.
Early stage diabetic foot ulcers are a serious concern that requires proactive management. By understanding the risks associated with diabetes, prioritising foot care and nutrition, and seeking timely podiatric intervention, you can minimise the likelihood of complications and maintain optimal foot health. Remember, your feet are the foundation of your mobility, so take care of them diligently.
References
Luis López-López, Marta Elena Losa-Iglesias, Juan Gómez-Salgado, Ricardo Becerro-de-Bengoa-Vallejo, Carlos Romero-Morales, Daniel López-López, Carmen de Labra, Emmanuel Navarro-Flores, The implications of diabetic foot health-related with quality of life: A retrospective case control investigation, Journal of Tissue Viability, Volume 31, Issue 4, 2022, Pages 790-793,
Everett E, Mathioudakis N. Update on management of diabetic foot ulcers. Ann N Y Acad Sci. 2018 Jan;1411(1):153-165. doi: 10.1111/nyas.13569. PMID: 29377202; PMCID: PMC5793889.
Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World J Diabetes. 2015 Feb 15;6(1):37-53. doi: 10.4239/wjd.v6.i1.37. PMID: 25685277; PMCID: PMC4317316.
