People with diabetes are clearly more prone to various foot problems compared to the rest of the population. Approximately 20–30 percent of people with diabetes have a chronic foot ulcer in their lifetime. A foot ulcer can also easily recur. Comparatively, the risk of foot amputation is nine times as high for men with diabetes and six times as high for women with diabetes. In most of the cases, the amputation is preceded by a foot ulcer.
Usually, foot problems are caused by a combination of different factors. Damage to the feet is caused by the nerve, blood vessel and connective tissue changes related to chronically high blood sugar. The loss of protective sensation in the feet makes a person more susceptible to ulcers. Atherosclerosis and smoking can also reduce the flow of blood in the feet. High blood sugar leads to the glycation of tissues, the connective tissue losing flexibility and reduced mobility of the joints. Calluses develop in the stress areas, which are susceptible to ulcers. Ulcers take longer to heal due to high blood sugar. Superficial cuts can easily become deeper and infected. Ulcers and infections take longer to heal due to high blood sugar.
In most cases, the predisposing factors alone are not enough to cause a serious problem, which is caused by an additional cause, a trigger factor. It triggers a series of events leading to the actual foot problem. One of the most common ones is chafing, ulcers, sores or calluses resulting from wearing unsuitable footwear.
Personal characteristics can also have an effect on how well a person is able to take care of their feet or implement care instructions. For instance, dementia, vision loss, lack of coordination or reduced mobility can affect the ability to take care of the feet.
A good blood sugar balance, non-smoking as well as normal blood pressure and cholesterol help prevent diabetic foot problems.
Regular foot examinations at the diabetes appointments, determining the risk category, guidance with regard to the self-care of feet and measures to prevent foot problems are all part of the proper treatment of diabetes.