Diabetic Foot Problems – What To Know About It

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 13 min read
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Diabetic Foot Problems are common in people with diabetes. You might be afraid you’ll lose a toe, foot, or leg to diabetes, or know someone who has, but you can lower your chances of having diabetes-related foot problems by taking care of your feet every...

For severe symptoms, danger signs, pregnancy, child illness, or sudden worsening, seek urgent medical care.

বাংলা রোগী নোট এখনো যোগ করা হয়নি। পোস্ট এডিটরে “RX Bangla Patient Mode” বক্স থেকে সহজ বাংলা সারাংশ যোগ করুন।

এই তথ্য শিক্ষা ও সচেতনতার জন্য। এটি ডাক্তারি পরীক্ষা, রোগ নির্ণয় বা প্রেসক্রিপশনের বিকল্প নয়।

Article Summary

Diabetic Foot Problems are common in people with diabetes. You might be afraid you’ll lose a toe, foot, or leg to diabetes, or know someone who has, but you can lower your chances of having diabetes-related foot problems by taking care of your feet every day. Managing your blood glucose levels, also called blood sugar, can also help keep your feet healthy. Anatomy And Physiology...

Key Takeaways

  • This article explains Anatomy And Physiology in simple medical language.
  • This article explains How can diabetes affect my feet? in simple medical language.
  • This article explains What can I do to keep my feet healthy? in simple medical language.
  • This article explains Tips to Take Care of Your Feet in simple medical language.
Educational health guideWritten for patient understanding and clinical awareness.
Reviewed content workflowUse writer and reviewer profiles for stronger trust.
Emergency safety firstUrgent warning signs are highlighted below.

Seek urgent medical care if you notice

These warning signs are general safety guidance. Local emergency numbers and clinical judgment should always come first.

  • Severe symptoms, breathing difficulty, fainting, confusion, or rapidly worsening illness.
  • New weakness, severe pain, high fever, or symptoms after a serious injury.
  • Any symptom that feels urgent, unusual, or unsafe for the patient.
1

Emergency now

Use emergency care for severe, sudden, rapidly worsening, or life-threatening symptoms.

2

See a doctor

Book a professional medical evaluation if symptoms persist, worsen, recur often, affect daily activities, or occur in a high-risk patient.

3

Learn safely

Use this article to understand possible causes, tests, treatment options, prevention, and questions to ask your clinician.

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Definition

Diabetic Foot Problems are common in people with insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।" data-rx-term="diabetes" data-rx-definition="Diabetes is a condition where blood sugar stays too high because insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।">diabetes. You might be afraid you’ll lose a toe, foot, or leg to diabetes, or know someone who has, but you can lower your chances of having diabetes-related foot problems by taking care of your feet every day. Managing your blood glucose levels, also called blood sugar, can also help keep your feet healthy.

Anatomy And Physiology

The diabetic foot differs from a normal foot in several ways. Changes to the diabetic foot include musculoskeletal, dermatologic, vascular, and neurological etiologies.

In the musculoskeletal system, a decrease in intrinsic musculature, limited joint mobility, changes in foot type, and ankle equinus, and others all occur in the diabetic foot.

Limited joint mobility of the first metatarsophalangeal joint (hallux limitus) is often present in patients with insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।" data-rx-term="diabetes" data-rx-definition="Diabetes is a condition where blood sugar stays too high because insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।">diabetes, which can be caused by a thickening of the Achilles tendon and plantar fascia. This thickening of the plantar fascia and Achilles tendon leads to a more rigid foot type, increased pes planus, and possible unsteadiness of gait.

The pedal musculature becomes disorganized and infiltrated with adipose tissue as a result of long-standing insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।" data-rx-term="diabetes" data-rx-definition="Diabetes is a condition where blood sugar stays too high because insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।">diabetes. Intrinsic pedal muscles become weaker than extrinsic muscles resulting in foot deformities such as hammertoes or claw toe deformities.

Hammertoes and claw toes along with hallux limitus correlated with increased risk for ulcer occurrence. Bus et al. studied elevated plantar pressures in patients with insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।" data-rx-term="diabetes" data-rx-definition="Diabetes is a condition where blood sugar stays too high because insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।">diabetes with hammer and claw toes and found that plantar metatarsal head pressures significantly increased with increasing toe deformity. They noted that there is a transfer of load from distal to proximal in such toe deformities, with possible distal fat pad displacement as a mechanism.

Searle et al. found that patients with insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।" data-rx-term="diabetes" data-rx-definition="Diabetes is a condition where blood sugar stays too high because insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।">diabetes have a high rate of ankle equinus, defined as less than 5 degrees of ankle dorsiflexion. This condition has correlations with increased forefoot pressure and tissue breakdown, both barefoot and with shoegear. 

Dermatologic integrity is one of the most important functions of human skin, but as a result of chronic insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।" data-rx-term="diabetes" data-rx-definition="Diabetes is a condition where blood sugar stays too high because insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।">diabetes, many changes put this critical organ at risk. Autonomic dysfunction as a result of diabetes decreases perspiration in the foot, which leads to increased fissuring and xerosis.

Repetitive stress and pressure to one area, in conjunction with pain, numbness, tingling, or weakness. সহজ বাংলা: স্নায়ুর ক্ষতি/সমস্যা।" data-rx-term="neuropathy" data-rx-definition="Neuropathy means nerve damage or irritation causing pain, numbness, tingling, or weakness. সহজ বাংলা: স্নায়ুর ক্ষতি/সমস্যা।">neuropathy, causes infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation and ulceration. Plantar skin tissue thickness decrease in patients with type 2 insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।" data-rx-term="diabetes" data-rx-definition="Diabetes is a condition where blood sugar stays too high because insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।">diabetes mellitus with neuropathy compared to non-neuropathic patients with diabetes, adding to the increased risk for ulceration.  Even once healed, the tissue surrounding former ulceration is at increased risk for rapid breakdown and re-ulceration.

Blood flow to the lower extremity is also an area where insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।" data-rx-term="diabetes" data-rx-definition="Diabetes is a condition where blood sugar stays too high because insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।">diabetes can affect the foot and ankle.

Three main arteries and their branches supply the six angiosomes of the foot and ankle. The posterior tibial artery originates from the popliteal artery and supplies the plantar foot. The peroneal artery originates from the posterior tibial artery and supplies the anterolateral ankle and rearfoot. The anterior tibial artery originates from the popliteal artery and continues into the foot as the dorsalis pedis artery. It supplies the anterior ankle and dorsal foot.

Patients with insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।" data-rx-term="diabetes" data-rx-definition="Diabetes is a condition where blood sugar stays too high because insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।">diabetes have an increased risk of developing peripheral arterial disease (PAD). PAD is the atherosclerotic occlusive disease of the lower extremities. While over half of patients can be asymptomatic, some patients may experience such symptoms as intermittent claudication (aching in lower extremities with activity and relieved with rest) and rest pain, or in more severe cases tissue loss and gangrene.

Neurologically, the foot receives innervation from five main nerves and their branches: the tibial, superficial peroneal, deep peroneal, sural, and saphenous nerves. The tibial nerve originates from the sciatic nerve and divides into the medial and lateral plantar nerves, which further divide into the digital nerves. The tibial nerve provides motor innervation to the posterior lower leg muscles and sensory innervations to the plantar foot and heel. The superficial peroneal nerve (SPN) originates from the common peroneal nerve and branches into the medial and intermediate dorsal cutaneous nerves. The SPN innervates the peroneus longus and brevis muscles and also provides the sensory function to the anterior lower leg and dorsal foot and toes (except for the first webspace). The deep peroneal nerve originates from the common peroneal nerve. It has motor innervations to the anterior compartment muscles and sensory innervations to the first web space. The sural nerve forms from the tibial nerve and peroneal nerve, and it provides sensory innervation to the posterior lateral lower leg and posterior-lateral foot. The saphenous nerve originates from the femoral nerve and provides sensory innervation to the medial-distal leg, ankle, and foot.

A neurological manifestation of insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।" data-rx-term="diabetes" data-rx-definition="Diabetes is a condition where blood sugar stays too high because insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।">diabetes is diabetic pain, numbness, tingling, or weakness. সহজ বাংলা: স্নায়ুর ক্ষতি/সমস্যা।" data-rx-term="neuropathy" data-rx-definition="Neuropathy means nerve damage or irritation causing pain, numbness, tingling, or weakness. সহজ বাংলা: স্নায়ুর ক্ষতি/সমস্যা।">neuropathy. Distal symmetrical polyneuropathy is the most common type of diabetic neuropathy. It can involve a combination of sensory or motor neuropathy due to small and/or large nerve fiber dysfunction. Large fiber (A alpha/beta fiber damage) neuropathy is painless paresthesia with reduced sensations in vibration, joint position, touch, pressure, and loss of ankle reflexes. Small fiber (myelinated A-delta and unmyelinated C fiber damage) neuropathy is painful, burning, with reduced pain and temperature sensations.

Diabetic peripheral neuropathy usually starts distally in the toes and progresses proximally. With progression, the patient may start to notice decreased sensation in their upper extremities in a stocking-glove distribution. Symptoms may worsen at night during sleep. Muscle weakness may also develop later in the disease. The exact pathogenesis of diabetic peripheral neuropathy is still the subject of research; however, a major suspect in this process may be chronic hyperglycemia with related metabolic changes leading to a combination of direct axonal injury and nerve ischemia.

A dreaded complication of uncontrolled diabetes and peripheral neuropathy is Charcot neuroarthropathy (CN).  This condition is likely the result of both neurovascular changes (i.e., arteriovenous shunting causing increased blood flow and increased bone resorption) and micro-trauma. These changes result in collapsed joints and severe pedal deformities. The most common joint to collapse in CN is the tarsometatarsal joint, which leads to a rocker bottom deformity.

Patients with Charcot foot have a 17% chance annually to develop ulceration. The lower extremity amputation risk for CN patients who have ulceration is 12 times higher compared to patients who have Charcot foot without ulceration. Early detection and treatment of CN improve outcomes; therefore, astute providers should suspect CN when a diabetic patient presents with a warm, erythematous, edematous foot with possible pedal structural changes.

How can diabetes affect my feet?

Over time, diabetes may cause nerve damage, also called diabetic neuropathy, that can cause tingling and pain, and can make you lose feeling in your feet. When you lose feeling in your feet, you may not feel a pebble inside your sock or a blister on your foot, which can lead to cuts and sores. Cuts and sores can become infected.

Diabetes also can lower the amount of blood flow in your feet. Not having enough blood flowing to your legs and feet can make it hard for a sore or an infection to heal. Sometimes, a bad infection never heals. The infection might lead to gangrene.

Gangrene and foot ulcers that do not get better with treatment can lead to an amputation of your toe, foot, or part of your leg. A surgeon may perform an amputation to prevent a bad infection from spreading to the rest of your body, and to save your life. Good foot care is very important to prevent serious infections and gangrene.

Although rare, nerve damage from diabetes can lead to changes in the shape of your feet, such as Charcot’s foot. Charcot’s foot may start with redness, warmth, and swelling. Later, bones in your feet and toes can shift or break, which can cause your feet to have an odd shape, such as a “rocker bottom.”

What can I do to keep my feet healthy?

Work with your health care team to make a diabetes self-care plan, which is an action plan for how you will manage your diabetes. Your plan should include foot care. A foot doctor, also called a podiatrist, and other specialists may be part of your health care team.

Check your feet every day

You may have foot problems, but feel no pain in your feet. Checking your feet each day will help you spot problems early before they get worse. A good way to remember is to check your feet each evening when you take off your shoes. Also check between your toes. If you have trouble bending over to see your feet, try using a mirror to see them, or ask someone else to look at your feet.

Look for problems such as

  • cuts, sores, or red spots
  • swelling or fluid-filled blisters
  • ingrown toenails, in which the edge of your nail grows into your skin
  • corns or calluses, which are spots of rough skin caused by too much rubbing or pressure on the same spot
  • plantar warts, which are flesh-colored growths on the bottom of the feet
  • athlete’s foot
  • warm spots

If you have certain foot problems that make it more likely you will develop a sore on your foot, your doctor may recommend taking the temperature of the skin on different parts of your feet. A “hot spot” can be the first sign that a blister or an ulcer is starting.

Cover a blister, cut, or sore with a bandage. Smooth corns and calluses as explained below.

Wash your feet every day

Wash your feet with soap in warm, not hot, water. Test the water to make sure it is not too hot. You can use a thermometer (90° to 95° F is safe) or your elbow to test the warmth of the water. Do not soak your feet because your skin will get too dry.

After washing and drying your feet, put talcum powder or cornstarch between your toes. Skin between the toes tends to stay moist. Powder will keep the skin dry to help prevent an infection.

Smooth corns and calluses gently

Thick patches of skin called corns or calluses can grow on the feet. If you have corns or calluses, talk with your foot doctor about the best way to care for these foot problems. If you have nerve damage, these patches can become ulcers.

If your doctor tells you to, use a pumice stone to smooth corns and calluses after bathing or showering. A pumice stone is a type of rock used to smooth the skin. Rub gently, only in one direction, to avoid tearing the skin.

Do NOT

  • cut corns and calluses
  • use corn plasters, which are medicated pads
  • use liquid corn and callus removers

Cutting and over-the counter corn removal products can damage your skin and cause an infection.

To keep your skin smooth and soft, rub a thin coat of lotion, cream, or petroleum jelly on the tops and bottoms of your feet. Do not put lotion or cream between your toes because moistness might cause an infection.

Trim your toenails straight across

Trim your toenails, when needed, after you wash and dry your feet. Using toenail clippers, trim your toenails straight across. Do not cut into the corners of your toenail. Gently smooth each nail with an emery board or nonsharp nail file. Trimming this way helps prevent cutting your skin and keeps the nails from growing into your skin.

Have a foot doctor trim your toenails if

  • you cannot see, feel, or reach your feet
  • your toenails are thick or yellowed
  • your nails curve and grow into the skin

If you want to get a pedicure at a salon, you should bring your own nail tools to prevent getting an infection. You can ask your health care provider what other steps you can take at the salon to prevent infection.

Wear shoes and socks at all times

Wear shoes and socks at all times. Do not walk barefoot or in just socks – even when you are indoors. You could step on something and hurt your feet. You may not feel any pain and may not know that you hurt yourself.

Check the inside of your shoes before putting them on, to make sure the lining is smooth and free of pebbles or other objects.

Make sure you wear socks, stockings, or nylons with your shoes to keep from getting blisters and sores. Choose clean, lightly padded socks that fit well. Socks with no seams are best.

Wear shoes that fit well and protect your feet. Here are some tips for finding the right type of shoes:

  • Walking shoes and athletic shoes are good for daily wear. They support your feet and allow them to “breathe.”
  • Do not wear vinyl or plastic shoes, because they do not stretch or “breathe.”
  • When buying shoes, make sure they feel good and have enough room for your toes. Buy shoes at the end of the day, when your feet are the largest, so that you can find the best fit.
  • If you have a bunion, or hammertoes, which are toes that curl under your feet, you may need extra-wide or deep shoes.1 Do not wear shoes with pointed toes or high heels, because they put too much pressure on your toes.
  • If your feet have changed shape, such as from Charcot’s foot, you may need special shoes or shoe inserts, called orthotics. You also may need inserts if you have bunions, hammertoes, or other foot problems.

When breaking in new shoes, only wear them for a few hours at first and then check your feet for areas of soreness.

Protect your feet from hot and cold

If you have nerve damage from diabetes, you may burn your feet and not know you did. Take the following steps to protect your feet from heat:

  • Wear shoes at the beach and on hot pavement.
  • Put sunscreen on the tops of your feet to prevent sunburn.
  • Keep your feet away from heaters and open fires.
  • Do not put a hot water bottle or heating pad on your feet.

Wear socks in bed if your feet get cold. In the winter, wear lined, waterproof boots to keep your feet warm and dry.

Keep the blood flowing to your feet

Try the following tips to improve blood flow to your feet:

  • Put your feet up when you are sitting.
  • Wiggle your toes for a few minutes throughout the day. Move your ankles up and down and in and out to help blood flow in your feet and legs.
  • Do not wear tight socks or elastic stockings. Do not try to hold up loose socks with rubber bands.
  • Be more physically active. Choose activities that are easy on your feet, such as walking, dancing, yoga or stretching, swimming, or bike riding.
  • Stop smoking.

Get a foot check at every health care visit

Ask your health care team to check your feet at each visit. Take off your shoes and socks when you’re in the exam room so they will remember to check your feet. At least once a year, get a thorough foot exam, including a check of the feeling and pulses in your feet.

Get a thorough foot exam at each health care visit if you have

  • changes in the shape of your feet
  • loss of feeling in your feet
  • peripheral artery disease
  • had foot ulcers or an amputation in the past1

Ask your health care team to show you how to care for your feet.

When should I see my health care provider about foot problems?

Call your health care provider right away if you have

  • a cut, blister, or bruise on your foot that does not start to heal after a few days
  • skin on your foot that becomes red, warm, or painful—signs of a possible infection
  • a callus with dried blood inside of it,which often can be the first sign of a wound under the callus
  • a foot infection that becomes black and smelly—signs you might have gangrene

Ask your provider to refer you to a foot doctor, or podiatrist, if needed.

References
Doctor visit helper

Prepare before seeing a doctor

A simple rural-patient checklist to help you explain symptoms clearly, ask better questions, and avoid unsafe self-treatment.

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

  • Write when the problem started and how it changed.
  • Bring old prescriptions, investigation reports, and current medicines.
  • Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
  • Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

  • What is the most likely cause of my symptoms?
  • Which danger signs mean I should go to hospital quickly?
  • Which tests are necessary now, and which can wait?
  • How should I take medicines safely and what side effects should I watch for?
  • When should I come for follow-up?

Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
  • CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
  • Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
  • Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Drink safe fluids and monitor temperature.
  • In dengue-prone areas, discuss CBC and platelet count when fever persists or warning signs appear.
  • Use tepid sponging for high fever discomfort; avoid ice-cold bathing.

OTC medicine safety

  • For fever, common fever medicine may be discussed with a clinician or pharmacist.
  • Avoid aspirin/ibuprofen-like medicines in suspected dengue unless a doctor says it is safe.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Fever with breathing difficulty, confusion, repeated vomiting, bleeding, severe weakness, stiff neck, or dehydration needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Doctor / qualified healthcare provider
Tests to discuss with doctor
  • Basic vital signs: temperature, pulse, blood pressure, oxygen level if needed
  • Relevant blood, urine, imaging, or specialist tests only after clinical assessment
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Diabetic Foot Problems – What To Know About It

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

RX Patient Help

Ask a health question safely

Write your symptom story. A health professional or site editor can review it before any answer is prepared. This box is not for emergency care.

Emergency first: Severe chest pain, breathing trouble, unconsciousness, stroke signs, severe injury, heavy bleeding, or rapidly worsening symptoms need urgent local medical care now.

Frequently Asked Questions

Anatomy And Physiology The diabetic foot differs from a normal foot in several ways. Changes to the diabetic foot include musculoskeletal, dermatologic, vascular, and neurological etiologies. In the musculoskeletal system, a decrease in intrinsic musculature, limited joint mobility, changes in foot type, and ankle equinus, and others all occur in the diabetic foot. Limited joint mobility of the first metatarsophalangeal joint (hallux limitus) is often present in patients with diabetes, which can be caused by a thickening of the Achilles tendon and plantar fascia. This thickening of the plantar fascia and Achilles tendon leads to a more rigid foot type, increased pes planus, and possible unsteadiness of gait.[rx] The pedal musculature becomes disorganized and infiltrated with adipose tissue as a result of long-standing diabetes. Intrinsic pedal muscles become weaker than extrinsic muscles resulting in foot deformities such as hammertoes or claw toe deformities.[rx] Hammertoes and claw toes along with hallux limitus correlated with increased risk for ulcer occurrence. Bus et al. studied elevated plantar pressures in patients with diabetes with hammer and claw toes and found that plantar metatarsal head pressures significantly increased with increasing toe deformity. They noted that there is a transfer of load from distal to proximal in such toe deformities, with possible distal fat pad displacement as a mechanism.[rx] Searle et al. found that patients with diabetes have a high rate of ankle equinus, defined as less than 5 degrees of ankle dorsiflexion. This condition has correlations with increased forefoot pressure and tissue breakdown, both barefoot and with shoegear. [rx] Dermatologic integrity is one of the most important functions of human skin, but as a result of chronic diabetes, many changes put this critical organ at risk. Autonomic dysfunction as a result of diabetes decreases perspiration in the foot, which leads to increased fissuring and xerosis.[rx] Repetitive stress and pressure to one area, in conjunction with neuropathy, causes inflammation and ulceration. Plantar skin tissue thickness decrease in patients with type 2 diabetes mellitus with neuropathy compared to non-neuropathic patients with diabetes, adding to the increased risk for ulceration.[rx]  Even once healed, the tissue surrounding former ulceration is at increased risk for rapid breakdown and re-ulceration.[rx] Blood flow to the lower extremity is also an area where diabetes can affect the foot and ankle. Three main arteries and their branches supply the six angiosomes of the foot and ankle. The posterior tibial artery originates from the popliteal artery and supplies the plantar foot. The peroneal artery originates from the posterior tibial artery and supplies the anterolateral ankle and rearfoot. The anterior tibial artery originates from the popliteal artery and continues into the foot as the dorsalis pedis artery. It supplies the anterior ankle and dorsal foot.[rx] Patients with diabetes have an increased risk of developing peripheral arterial disease (PAD). PAD is the atherosclerotic occlusive disease of the lower extremities. While over half of patients can be asymptomatic, some patients may experience such symptoms as intermittent claudication (aching in lower extremities with activity and relieved with rest) and rest pain, or in more severe cases tissue loss and gangrene. Neurologically, the foot receives innervation from five main nerves and their branches: the tibial, superficial peroneal, deep peroneal, sural, and saphenous nerves. The tibial nerve originates from the sciatic nerve and divides into the medial and lateral plantar nerves, which further divide into the digital nerves. The tibial nerve provides motor innervation to the posterior lower leg muscles and sensory innervations to the plantar foot and heel. The superficial peroneal nerve (SPN) originates from the common peroneal nerve and branches into the medial and intermediate dorsal cutaneous nerves. The SPN innervates the peroneus longus and brevis muscles and also provides the sensory function to the anterior lower leg and dorsal foot and toes (except for the first webspace). The deep peroneal nerve originates from the common peroneal nerve. It has motor innervations to the anterior compartment muscles and sensory innervations to the first web space. The sural nerve forms from the tibial nerve and peroneal nerve, and it provides sensory innervation to the posterior lateral lower leg and posterior-lateral foot. The saphenous nerve originates from the femoral nerve and provides sensory innervation to the medial-distal leg, ankle, and foot.[rx][rx] A neurological manifestation of diabetes is diabetic neuropathy.[rx] Distal symmetrical polyneuropathy is the most common type of diabetic neuropathy. It can involve a combination of sensory or motor neuropathy due to small and/or large nerve fiber dysfunction. Large fiber (A alpha/beta fiber damage) neuropathy is painless paresthesia with reduced sensations in vibration, joint position, touch, pressure, and loss of ankle reflexes. Small fiber (myelinated A-delta and unmyelinated C fiber damage) neuropathy is painful, burning, with reduced pain and temperature sensations. Diabetic peripheral neuropathy usually starts distally in the toes and progresses proximally. With progression, the patient may start to notice decreased sensation in their upper extremities in a stocking-glove distribution. Symptoms may worsen at night during sleep. Muscle weakness may also develop later in the disease. The exact pathogenesis of diabetic peripheral neuropathy is still the subject of research; however, a major suspect in this process may be chronic hyperglycemia with related metabolic changes leading to a combination of direct axonal injury and nerve ischemia.[rx][rx] A dreaded complication of uncontrolled diabetes and peripheral neuropathy is Charcot neuroarthropathy (CN).  This condition is likely the result of both neurovascular changes (i.e., arteriovenous shunting causing increased blood flow and increased bone resorption) and micro-trauma.[rx] These changes result in collapsed joints and severe pedal deformities. The most common joint to collapse in CN is the tarsometatarsal joint, which leads to a rocker bottom deformity. Patients with Charcot foot have a 17% chance annually to develop ulceration. The lower extremity amputation risk for CN patients who have ulceration is 12 times higher compared to patients who have Charcot foot without ulceration.[rx] Early detection and treatment of CN improve outcomes; therefore, astute providers should suspect CN when a diabetic patient presents with a warm, erythematous, edematous foot with possible pedal structural changes. How can diabetes affect my feet?

Over time, diabetes may cause nerve damage, also called diabetic neuropathy, that can cause tingling and pain, and can make you lose feeling in your feet. When you lose feeling in your feet, you may not feel a pebble inside your sock or a blister on your foot, which can lead to cuts and sores. Cuts and sores can become infected. Diabetes also can lower the amount of blood flow in your feet. Not having enough blood flowing to your legs…

What can I do to keep my feet healthy?

Work with your health care team to make a diabetes self-care plan, which is an action plan for how you will manage your diabetes. Your plan should include foot care. A foot doctor, also called a podiatrist, and other specialists may be part of your health care team.

Tips to Take Care of Your Feet Check your feet every day. Wash your feet every day. Smooth corns and calluses gently. Trim your toenails straight across. Wear shoes and socks at all times. Protect your feet from hot and cold. Keep the blood flowing to your feet. Get a foot check at every health care visit. Check your feet every day You may have foot problems, but feel no pain in your feet. Checking your feet each day will help you spot problems early before they get worse. A good way to remember is to check your feet each evening when you take off your shoes. Also check between your toes. If you have trouble bending over to see your feet, try using a mirror to see them, or ask someone else to look at your feet. Look for problems such as cuts, sores, or red spots swelling or fluid-filled blisters ingrown toenails, in which the edge of your nail grows into your skin corns or calluses, which are spots of rough skin caused by too much rubbing or pressure on the same spot plantar warts, which are flesh-colored growths on the bottom of the feet athlete’s foot warm spots If you have certain foot problems that make it more likely you will develop a sore on your foot, your doctor may recommend taking the temperature of the skin on different parts of your feet. A “hot spot” can be the first sign that a blister or an ulcer is starting. Cover a blister, cut, or sore with a bandage. Smooth corns and calluses as explained below. Wash your feet every day Wash your feet with soap in warm, not hot, water. Test the water to make sure it is not too hot. You can use a thermometer (90° to 95° F is safe) or your elbow to test the warmth of the water. Do not soak your feet because your skin will get too dry. After washing and drying your feet, put talcum powder or cornstarch between your toes. Skin between the toes tends to stay moist. Powder will keep the skin dry to help prevent an infection. Smooth corns and calluses gently Thick patches of skin called corns or calluses can grow on the feet. If you have corns or calluses, talk with your foot doctor about the best way to care for these foot problems. If you have nerve damage, these patches can become ulcers. If your doctor tells you to, use a pumice stone to smooth corns and calluses after bathing or showering. A pumice stone is a type of rock used to smooth the skin. Rub gently, only in one direction, to avoid tearing the skin. Do NOT cut corns and calluses use corn plasters, which are medicated pads use liquid corn and callus removers Cutting and over-the counter corn removal products can damage your skin and cause an infection. To keep your skin smooth and soft, rub a thin coat of lotion, cream, or petroleum jelly on the tops and bottoms of your feet. Do not put lotion or cream between your toes because moistness might cause an infection. Trim your toenails straight across Trim your toenails, when needed, after you wash and dry your feet. Using toenail clippers, trim your toenails straight across. Do not cut into the corners of your toenail. Gently smooth each nail with an emery board or nonsharp nail file. Trimming this way helps prevent cutting your skin and keeps the nails from growing into your skin. Have a foot doctor trim your toenails if you cannot see, feel, or reach your feet your toenails are thick or yellowed your nails curve and grow into the skin If you want to get a pedicure at a salon, you should bring your own nail tools to prevent getting an infection. You can ask your health care provider what other steps you can take at the salon to prevent infection. Wear shoes and socks at all times Wear shoes and socks at all times. Do not walk barefoot or in just socks – even when you are indoors. You could step on something and hurt your feet. You may not feel any pain and may not know that you hurt yourself. Check the inside of your shoes before putting them on, to make sure the lining is smooth and free of pebbles or other objects. Make sure you wear socks, stockings, or nylons with your shoes to keep from getting blisters and sores. Choose clean, lightly padded socks that fit well. Socks with no seams are best. Wear shoes that fit well and protect your feet. Here are some tips for finding the right type of shoes: Walking shoes and athletic shoes are good for daily wear. They support your feet and allow them to “breathe.” Do not wear vinyl or plastic shoes, because they do not stretch or “breathe.” When buying shoes, make sure they feel good and have enough room for your toes. Buy shoes at the end of the day, when your feet are the largest, so that you can find the best fit. If you have a bunion, or hammertoes, which are toes that curl under your feet, you may need extra-wide or deep shoes.1 Do not wear shoes with pointed toes or high heels, because they put too much pressure on your toes. If your feet have changed shape, such as from Charcot’s foot, you may need special shoes or shoe inserts, called orthotics. You also may need inserts if you have bunions, hammertoes, or other foot problems. When breaking in new shoes, only wear them for a few hours at first and then check your feet for areas of soreness. Protect your feet from hot and cold If you have nerve damage from diabetes, you may burn your feet and not know you did. Take the following steps to protect your feet from heat: Wear shoes at the beach and on hot pavement. Put sunscreen on the tops of your feet to prevent sunburn. Keep your feet away from heaters and open fires. Do not put a hot water bottle or heating pad on your feet. Wear socks in bed if your feet get cold. In the winter, wear lined, waterproof boots to keep your feet warm and dry. Keep the blood flowing to your feet Try the following tips to improve blood flow to your feet: Put your feet up when you are sitting. Wiggle your toes for a few minutes throughout the day. Move your ankles up and down and in and out to help blood flow in your feet and legs. Do not wear tight socks or elastic stockings. Do not try to hold up loose socks with rubber bands. Be more physically active. Choose activities that are easy on your feet, such as walking, dancing, yoga or stretching, swimming, or bike riding. Stop smoking. Get a foot check at every health care visit Ask your health care team to check your feet at each visit. Take off your shoes and socks when you’re in the exam room so they will remember to check your feet. At least once a year, get a thorough foot exam, including a check of the feeling and pulses in your feet. Get a thorough foot exam at each health care visit if you have changes in the shape of your feet loss of feeling in your feet peripheral artery disease had foot ulcers or an amputation in the past1 Ask your health care team to show you how to care for your feet. When should I see my health care provider about foot problems?

Call your health care provider right away if you have a cut, blister, or bruise on your foot that does not start to heal after a few days skin on your foot that becomes red, warm, or painful—signs of a possible infection a callus with dried blood inside of it,which often can be the first sign of a wound under the callus a foot infection that becomes black and smelly—signs you might have gangrene Ask your provider to refer you…

References

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