Diabetic foot is a relatively common complication that occurs when blood sugar levels remain elevated for many years or decades. The direct consequences of this condition include numbness, foot ulcers, infections, and foot deformities.
In some instances, the damage can become quite severe. As a result, the infection may spread to nearby tissues and organs. Unfortunately, diabetic foot may lead to amputation if proper intervention is not delivered promptly.
Although most individuals with diabetes do not experience severe foot complications, diabetes continues to be a major cause of amputations.
If you’re not familiar with diabetes, here’s a quick breakdown:
There are two types of diabetes – Type one and type two. Type one diabetes results from an autoimmune reaction where the body attacks the cells in the pancreas that produce insulin. A deficiency in this hormone will cause chronically elevated blood sugar levels. Type two diabetes results from a combination of insulin deficiency and high resistance to its action. [1]
These two diseases are complicated and require a comprehensive approach to treatment. Unfortunately, millions of people do not comply with proper treatment, which causes a high rate of diabetic foot.
In this article, we will go over everything there is to know about diabetic foot, including how it may present and the consequences of not treating this condition.
What you need to know about diabetic foot
Chronically elevated blood sugar levels can progressively harm your nerves, particularly the limbs. Damage to the nerves results in numbness, tingling, and burning sensations. High blood sugar can also speed up the blockage of blood vessels, which causes reduced circulation to your organs. The compromised blood flow can result in heart disease, stroke, kidney issues, and vision impairment.
Damage to nerves impact the sensory feedback in your feet, which causes the following complications:
Diabetic neuropathy
According to the Centers for Disease Control and Prevention (CDC), up to 50% of diabetic patients will experience some form of diabetic neuropathy (i.e., nerve damage). When the nerves of the foot get affected, they precipitate something called diabetic peripheral neuropathy. Nerve damage may cause tingling and burning pain in your feet. As the condition progresses, you might lose all sensation in your feet, which makes diabetic neuropathy quite dangerous. [2]
Keep in mind that pain serves as a signal that something is wrong within the body. It can draw attention to cuts, sores, or blisters on your feet. However, with diabetic neuropathy, if you lose sensation in your feet, a cut or blister could go unnoticed for an extended period. Without timely treatment, these injuries can cause serious infections.
Diabetic neuropathy is also the leading cause of diabetic foot ulcers. These ulcers usually develop in high-pressure areas where calluses or corns are present. The lack of sensation does not stop an individual from constantly applying pressure to those areas, leading to tissue breakdown and ulcer formation.
Charcot foot
Charcot foot is a rare condition that arises from uncontrolled diabetes and neuropathy. This usually occurs when an injury (e.g., sprain, fracture) or repeated stress to the foot goes unnoticed due to the lack of sensation caused by peripheral neuropathy. Unfortunately, further walking on the injured foot exacerbates the injury. [3]
Charcot foot is a destructive condition that significantly changes the foot structure. The early symptoms of Charcot foot include swelling, redness, and warmth in the affected foot. As the condition progresses, the bones of the foot start to break, and joints become dislocated and collapse. The foot’s arch also collapses, often resulting in a rounded shape on the bottom of the feet.
Damage to blood vessels also impacts circulation in your feet, which causes the following complications:
Peripheral vascular disease
Diabetes may also contribute to a circulatory disorder called peripheral vascular disease. This cardiovascular condition arises from restricted blood flow to the legs and feet, and blood vessel blockage further limits circulation.
Though this condition can affect anyone, individuals with diabetes face a higher risk because changes in blood vessels commonly disrupt normal blood flow. Additionally, high blood sugar levels can thicken the blood, which makes it harder for it to circulate efficiently.
Gangrene
Peripheral vascular disease also precipitates gangrene, a limb-threatening condition. Diminished blood flow to the feet can stop the healing of sores or infections. Untreated infections may develop into gangrene, which is the death of tissue due to insufficient blood flow.
If gangrene begins to spread to other areas, your doctor may need to amputate a toe, foot, or leg to prevent its progression and infection from spreading.
What are the symptoms of diabetic foot?
Diabetic foot presents with a wide range of signs and symptoms.
Common signs and symptoms include:
- Loss of sensation
- Numbness or tingling
- Blisters or wounds without any pain
- Skin discoloration
- Wounds with or without drainage
- Painful burning sensation
- Redness, swelling, and warmth
If an infection occurs, additional symptoms may occur, including:
- Fever
- A general feeling of being unwell
- Chills
- Uncontrolled blood sugar levels despite treatment
- Shaking
- Shock
- Redness
The table below summarizes the clinical presentation of diabetic foot and its management:
| Presentation | Symptoms | Management plan |
| Loss of sensation | Numbness and tingling, but no pain. | Regular inspections, protective footwear, and patient education. |
| Blisters/wounds | Painless blisters or wounds. | Wound care and topical antibiotics. |
| Skin changes | Skin discolouration. | Circulation evaluation and vascular intervention. |
| Redness and swelling | Redness and swelling of the foot and ankle. | Immediate evaluation, possible blood test and x-rays. |
| Wounds with drainage | Open sores and fluid drainage. | Debridement and advanced dressings. |
| Painful tingling | Persistent tingling pain. | Neuropathy medications, pain management, and infection monitoring. |
| Infections | Fever, chills, and redness. | Antibiotics, hospitalization, and surgical intervention if needed. |
| Non-healing ulcers | Persistent ulcers or wounds. | Advanced wound care, offloading, and vascular assessment. |
| Gangrene | Blackened and dead tissue. | Surgical consultation, possible amputation, and infection control. |
| Foot deformity | Structural foot changes. | Custom orthotics, protective footwear, and corrective surgery. |
| Charcot foot | Foot deformity and swelling. | Immobilization, custom footwear, and possible surgery. |
Complications that arise from diabetic foot
Without adequate and prompt treatment, diabetic foot can be extremely severe.
Here are some of the complications that may occur:
- Foot ulcers that do not heal.
- Various types of infections, including skin, bone, and abscesses.
- Gangrene.
- Foot deformities.
- Charcot foot.
- Damage to nearby structures, such as the legs.
In some cases, doctors may be able to reverse complications such as infections. However, more severe complications, such as gangrene, may result in permanent physical changes. Complications often gets more serious with time, therefore early intervention is key to preventing amputations.
Takeaway message
Diabetic foot is a serious complication that occurs when blood sugar levels are not controlled over a long period. Without proper medical and/or surgical intervention, diabetic foot may precipitate severe complications, including amputation.
We hope that this article has highlighted what you need to know about diabetic foot, including how it presents and what complications it may trigger.
Nobel Diabetic Foot Care
If you have diabetes and are concerned about your foot health, we can help you. At Nobel Diabetic Foot Care, we have a team of Orthopaedic surgeons and Podiatrists who provide holistic management of all diabetic foot problems. Our multidisciplinary approach will help minimise any delay in assessment and treatment and ensure that you receive the right care en route to recovery. Don’t hesitate to contact us and schedule an appointment today.
References
- https://www.cdc.gov/diabetes/about/index.html
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7096070/
- https://www.ncbi.nlm.nih.gov/books/NBK553110/
