What are the typical effects of diabetes on your legs and feet?
The effects on a diabetics legs and feet may or may not be detectable in its early stages which is why all diabetics must be fully aware of how to prevent feet and leg problems before they occur and to seek the right treatment when they do.
Although treatment for “diabetic foot” problems has greatly improved over the last several years, keeping your feet healthy, protecting them by wearing diabetic socks, and maintaining control of blood sugar level, remains the best way to prevent and manage diabetic complications.
Some important facts about the effects of diabetes on the legs and feet:
- 1 in 6 diabetics will develop a foot ulcer during their lifetime.
- Diabetics are 25 times more likely to lose a leg due to an ulcer.
- Up to 70% of all leg amputations occur in people with diabetes.
- Foot ulcers can result from a blister or sore that may develop on the foot due to poorly fitting socks and shoes and increased the amount of friction from perspiration.
- Calluses form thickly on the feet pads
- Swelling occurs in both legs and feet due to poor circulation
- Peripheral neuropathy (nerve damage)
Specific foot problems
Nerve Damage
Diabetic peripheral neuropathy is nerve damage caused by diabetes. It can affect the arms, hands, legs and feet. There are three different groups of nerves can be affected by diabetic neuropathy:
- Sensory nerves, which enable people to feel pain, temperature, and other sensations
- Motor nerves, which control the muscles and give them their strength and tone
- Autonomic nerves, which allow the body to perform certain involuntary functions, such as sweating.
Diabetic peripheral neuropathy doesn’t emerge overnight, but instead develops slowly and worsens over time. Having diabetes for several years may increase the likelihood of having diabetic neuropathy although some patients may have this condition long before they are actually diagnosed with diabetes.
The loss of sensation and other problems associated with nerve damage make a patient prone to developing skin ulcers (open sores) that can become infected and are difficult to heal or in some cases may never heal, which can lead to loss of an appendage or even loss of life.
Diabetic peripheral neuropathy
The nerve damage that characterizes diabetic peripheral neuropathy is more common in patients with poorly managed diabetes, however, even those diabetic patients who have excellent blood sugar (glucose) control can develop diabetic neuropathy.
There are several theories as to why this occurs, including the possibilities that high blood glucose or constricted blood vessels produce damage to the nerves.
As diabetic peripheral neuropathy progresses, various nerves are affected. These damaged nerves can cause problems that encourage development of ulcers.
For example: Motor Neuropathy (Deformity) coupled with ill-fitting shoes and sensory neuropathy (numbness) can equal ulcers (sores).
Deformities such as bunions or hammertoes resulting from motor neuropathy may cause shoes to rub against toes, creating a sore.
The numbness caused by sensory neuropathy can make the patient unaware that this is happening. Because of this numbness, a diabetic may not realize that he or she has stepped on a small object and cut or scraped the skin.
Cracked skin caused by autonomic neuropathy, combined with sensory neuropathy’s numbness and problems associated with motor neuropathy can lead to developing a sore.
Symptoms of diabetic peripheral neuropathy
Depending on the type(s) of nerves involved, one or more symptoms may be present in diabetic peripheral neuropathy.
For sensory neuropathy:
- Numbness or tingling in the feet
- Pain or discomfort in the feet or legs, including prickly, sharp pain or burning feet
For motor neuropathy:
- Muscle weakness and loss of muscle tone in the feet and lower legs
- Loss of balance
- Changes in foot shape that can lead to areas of increased pressure
For autonomic neuropathy:
- Dry feet
- Cracked skin
Diagnosis of diabetic peripheral neuropathy
To diagnose diabetic peripheral neuropathy, the foot and ankle surgeon will obtain the patient’s history of symptoms and will perform simple in-office tests on the feet and legs.
This evaluation may include assessment of the patient’s reflexes, ability to feel light touch, and ability to feel vibration. In some cases, additional neurologic tests may be ordered.
Treatment of diabetic peripheral neuropathy
First and foremost, treatment of diabetic peripheral neuropathy centers on control of the patient’s blood sugar level. In addition, various options are used to treat the painful symptoms.
Medications are available to help relieve specific symptoms, such as tingling or burning. Sometimes a combination of different medications is used.
In some cases, the patient may also undergo physical therapy to help reduce balance problems or other symptoms.
Prevention of diabetic peripheral neuropathy
A diabetic plays a vital role in minimizing the risk of developing diabetic peripheral neuropathy and in preventing its possible consequences. Some important preventive measures include:
- Keep blood sugar levels under control.
- Wear well-fitting shoes to avoid getting sores.
- Inspect your feet every day. If you notice any cuts, redness, blisters, or swelling, see your foot and ankle surgeon right away. This can prevent problems from becoming worse.
- Visit your foot and ankle surgeon on a regular basis for an examination to help prevent the foot complications of diabetes.
- Have periodic visits with your primary care physician or endocrinologist. The foot and ankle surgeon works together with these and other providers to prevent and treat complications from diabetes.
Damage to the blood vessels puts a diabetic at risk of incurring Deep Vein Thrombosis (blood clotting). In concert those two conditions along with poor circulation in the feet and legs, can develop insensitivity or a loss of ability to feel pain, heat, and cold and as a result diabetics can incur minor cuts, scrapes, a blood blister, or pressure sores that they may not be aware of.
Also, normal sweat secretion and oil production that lubricates the skin of the foot is impaired, which in combination, can lead to abnormal pressure on the skin, bones, and joints of the foot during walking and can lead to breakdown (or splitting) of the skin of the foot and leg.
For diabetics damage to blood vessels (vascular disease) can also occur. Both of these complications, in concert, will cause poor circulation, which can lay the groundwork for more serious complications such as blood clots, blood pooling, and edema, thereby not only effecting your feet and legs, but your entire system, especially the heart.
While Some diabetics with nerve damage will have no symptoms, others may experience pain and or tingling, followed by numbness or loss of feeling.
Peripheral Arterial Disease (PAD)
Peripheral Arterial Disease (PAD) affects 8-12 million older adults in the United States alone. PAD is a disorder that is the result of a high level of blood sugar that is present in the system. High blood sugar can cause hardening and narrowing of the main arteries that carry blood, oxygen, and nutrients to the legs and feet, resulting in a reduction of blood flow to the legs and feet, which can cause pain to the feet (sensitive feet) and legs and ultimately a loss of feeling in both.
Decreased Resistance to Infection
When a loss feeling occurs in the legs and feet small sores become difficult to properly heal. If a sore can not or is slow to heal, infection can set in.
Without the proper nutrients and oxygen carried by an ample supply of blood an infection becomes difficult to stop and amputation often becomes the only solution to keep from spreading.
Charcot foot
Damage to blood vessels and impairment of the immune system from diabetes make it difficult for these types of wounds to heal. Bacterial infection of the skin, connective tissues, muscles, and ultimately to the bones ( this can result in getting Charcot foot – a condition in which the bones of the foot are weakened enough to fracture.
With continued walking, the foot eventually changes shape. As the disorder progresses, the joints collapse and the foot takes on an abnormal shape, such as a rocker-bottom appearance).
These infections can easily develop into gangrene. Because of the poor blood flow, antibiotics cannot get to the site of the infection easily.
If it progresses to that point, quite often the only treatment for this is amputation of the foot or leg and even worse, if the infection spreads to the bloodstream, this process can be life-threatening.
Achilles-tendon thickness (ATT)
The effect of diabetes on the Achilles-tendon may contribute to the long-term complications in the foot-ankle complex with respect to the relationship between the disease and the tendon’s thickening.
In controlled analysis between female diabetics patients with type 2 diabetes and female non-diabetics, thickening of the Achilles-tendon is found to more common in the former, but no significant difference could be found between type 2 diabetic male patients and their non-diabetic controls.
This might indicate a possible impact of diabetes on the ATT depending upon gender, but other physical deficiencies or diseases may also contribute to thickening of Achilles tendon.
Understanding how diabetes effects your feet and legs as well as proactively take every precaution to manage the disease will help a diabetic live and longer and healthier life.
