It's estimated that 347 million people world-wide have diabetes, with nearly 26 million cases in the US. Diabetes can adversely affect various organs and other parts of the body, especially when it's poorly controlled. High blood sugar, or hyperglycemia, can affect the limbs and feet in various ways. Fortunately, many of these risks can be lessened or even prevented by taking the right precautions—the first of which is knowing the facts.
- Roughly 60-70% of all diabetics have some degree of nerve damage—also known as neuropathy—ranging from mild to severe. Neuropathy has a few possible effects on the legs and feet. One common effect is painful sensations in the limbs; another is sensory loss, which usually progresses gradually and starts in the toes. Severe neuropathy can result in a loss of feeling in parts of the feet, such that a diabetic may not feel a wound developing.
- Diabetes may also cause motor neuropathy, which affects the nerves of the lower leg and foot muscles. Motor neuropathy can lead to a progressive weakening of those muscles, making walking more difficult. Another possible effect of motor neuropathy is a change in foot structure, such as the development of contracted toes. These changes may increase pressure on certain parts of the feet, further increasing the chance of a diabetic wound.
- Diabetic neuropathy increases the chance of wounds, or ulcers, developing on the feet. Diabetic ulcers can be slow or resistant to healing. If a diabetic patient is unable to feel pain where the wound is located—on a toe, for example—then he may not be able to avoid putting pressure on the wound, making it unable to heal properly. Hyperglycemia can also weaken the immune system, which may contribute to poor wound healing and a decreased ability to fight infection.
- Diabetic wounds can be further complicated by problems with circulation to the legs and feet. Peripheral artery disease (PAD) can hinder, and sometimes even prevent, wound healing, increasing the likelihood of amputation.
- A diabetic is 10 times more likely to have an amputation than a non-diabetic. When a diabetic ulcer is complicated by neuropathy, poor limb circulation and infection, the risk of amputation increases.
- The good news is that these risks can be decreased when a diabetic has regular podiatric care as part of her team of medical care. According to a study in the Journal of the American Podiatric Medical Association, even diabetics with severe limb-threatening complications had a reduced risk of amputation when they saw a podiatrist, compared with diabetics who did not have podiatric care.
- Regular visits to a podiatrist can help identify foot problems early on, enabling a plan of action to prevent further problems. For example, regular podiatric visits will involve an assessment of a patient's circulation and nerve functioning, while checking for wounds or possible problem areas of the foot and ankle. If a diabetic ulcer has developed on the foot or ankle, podiatric care can help improve the outcome and lessen the chance of limb amputation.
American Diabetes Association. American Diabetes Month® 2012 Fact Sheet. Accessed 10/29/12.
American Podiatric Medical Association. Fact Sheet: Studies Prove Podiatrists Prevent Complications, Provide Savings. Accessed 10/30/12.
Centers for Disease Control and Prevention. National Diabetes Fact Sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
World Health Organization. Media centre Diabetes Fact Sheet, Sept. 2012 Accessed 10/30/12.