Factors that predispose to foot problems in diabetes

Changes in the sensory nerves can result in a loss of protective sensation or loss of position sense in the feet. As a result of the loss of protective sensation, your feet are less sensitive to temperature changes, pain and pressure. Without pain giving a warning about the issue, the feet can get injured without your noticing it.

For example, person does not feel chafing caused by a pebble in the shoe or tightness of the footwear. The skin damage can worsen unnoticed, leading to a long-term ulcer. Strain on the damaged area prevents the ulcer from healing.

Damage to muscular nerves can cause muscular weakness and erroneous foot positions. Typical changes include the transverse arch of the foot descending and the longitudinal arch becoming exaggerated, i.e. arched foot. Tightening of the flexor tendons results in hammer toe.

The incorrect position changes the load on the foot, the skin becomes thicker in the strained areas, and calluses form. A haematoma or ulcer can easily occur under the callus. Hammer toe can also easily result in damage to the nails.

Damage to the autonomic nervous system reduces the flow of blood and sweating in the feet. The skin can easily become dry, flaky and cracked, especially on the heel. The cracks can become infected. Changes in the blood flow related to the nervous system expose the skin, toes and heels to ulcers which do not heal easily.

Reduced blood flow can be caused by a narrowing of the arteries in the lower limbs or the reduced operation of capillaries. This can result in a lack of oxygen, which contributes to the occurrence of ulcers and slows down their healing process.

Smoking reduces circulation and makes ulcers take longer to heal. Reduced supply of blood to the tissues makes the skin more likely to become dry and thin. A dry and thin skin is prone to ulcers and cracks.

Connective tissue changes in the foot make the tissues stiffer and the ankle and toes less flexible. Reduced mobility changes the way you walk, affects your vertical position and balance, increases strain on the sole and reduces the foot’s own ability to absorb shock. The strained areas are prone to skin alterations, especially calluses.