This week marks the start of Diabetes Awareness Week. With Diabetes, especially Type 2, on the rise in Scotland it is important that not only those currently affected, but those who are at risk of developing diabetes understand the signs, symptoms and potential problems which may arise in the feet.
How does Diabetes Mellitus affect the feet?
As those with diabetes struggle to break down glucose (sugar), they have a higher level of this circulating the blood. Over time this glucose causes damage to areas of the body including the legs and feet. The central nervous system is often most affected, stopping important messages getting from one area of the body to another. This can then affected the way the body moves, feels sensation and heals. Damage to this nervous system is called 'neuropathy'.
The nervous system is made up of three different types of nerves:
Damage to the sensory nerves causes the foot to lose sensation, often feeling numb. The neuropathy prevents feeling pain, temperature change or vibration. The person is therefore unable to tell when something is causing pain, breaking the skin or in more severe cases infected.
Motor neuropathy affects the muscles which will in turn affect the joint position. Muscles can shorten causing toes to become clawed and weight bearing areas to become especially prominent and susceptible to pressure. In other cases muscles can become very lax and loosen around joints causing partial or full dislocation of joints and severe deformity.
Autonomic neuropathy can often be over looked. This affects the sweat glands, causing them to reduce the amount of sweat the feet can produce. This in turn will cause the skin to become very dry and devitalised. Good skin health is vital to prevent breaks in skin and the chance of infection.
As well as affecting the nervous system, high glucose levels can damage the blood vessels which supply blood to the feet. If inadequate levels of blood are reaching the feet the tissues begin to lack the nutrients that the blood carries. This can cause poor skin health, muscle fatigue and cramps as well as increased healing time to any breaks in the skin.
What Do I Look Out For?
Changes to nerves:
• Tingling or pins and needles
• Sweating less
• Feet may look red and feel hot to the touch
• Changes in the shape of your feet
• Hard skin
• Losing sense of the position of your feet and legs
Changes to blood supply:
• Cramp in your calves
• Shiny, smooth skin
• Losing hair on your feet and legs
• Thickened toenails
• Cold, pale feet
• Change in the colour of the skin on your feet
• Wounds or sores
• Pain in your feet
How Do These Changes Affect Me?
Loss of sensation in the feet means that if you step on anything, develop a blister or a cut and are unable to feel this you may not realise the break in the skin is there. This is similar with temperature, if you do not feel the hot or cold you may damage your foot without realising. This is especially common whilst on holiday in warmer climates and not realising the feet or legs are burning in the sun leading to blisters and open wounds.
Dry, cracked skin makes the feet more susceptible to infection.
Changes to the muscles and joints can alter your foot position and the way you walk often resulting in build up or hard skin (callous). This can become painful or cause further pressure over areas of prominence.
Increase in healing times can often make any wounds trickier to heal and in some cases require special dressings and regular checks from your podiatrist or wound care team.
How Do I Check My Feet?
The most important part of checking your feet is doing so regularly. By checking daily, you will get to know your feet and will therefore notice any changes quickly. Look out for any areas of hard skin, especially if these are new, and for any blisters, cuts or red marks. How the skin feels, is it drier than usual? Get to know the temperature of your feet. It is usual to have a slight temperature gradient from warm to cooler as you move towards the toes but very cold or very warm feet may be cause for concern. Keep and eye on the joint position of your foot, is your arch lower than normal? Have your toes changed position?
What Can I Do To Prevent Any Problems?
As well as checking feet regularly, good foot care is essential to prevent problems from occurring in the first place. Ensure skin is kept in good condition by washing and moisturising the feet every day. Avoid creams between the toes where the skin tends to be more moist unless advised by your podiatrist. If you think you have any infection or ulcer see your GP or Podiatrist immediately. Make sure any nail, skin or joint problems are dealt with quickly to ensure they don't develop further. It is also important that footwear and hosiery is correctly fitted ensuring no pressure, rubbing or pinching.