Health Care Professionals

Diabetes and the Feet: What to Tell Your Patients

Up to 25% of people with diabetes will develop a foot ulcer. More than half of all foot ulcers will become infected, requiring hospitalization—and 20% of infections result in amputation. That’s why it is critical to educate patients with diabetes about caring for their feet and to provide these patients with regular foot examinations.

Pathway to Problems

According to the American Diabetes Association, approximately 60% to 70% of people with diabetes have mild-to-severe nerve damage. Peripheral neuropathy affecting the lower extremities leads to loss of sensation and inability to feel pain or recognize when trauma occurs to the feet. The road to diabetic ulceration and amputation is thus a predictable pathway: Unrecognized repetitive trauma to the feet occurs in the course of normal daily activities, often because of poorly designed and/or poorly fitted footwear; healing is compromised by ischemia, especially in the smaller peripheral arteries and capillaries (often a result of peripheral arterial disease, or PAD, a common comorbidity of diabetes); and a small skin lesion may become infected in a matter of days. Nerve damage also can lead to dry, cracked skin through which bacteria may enter and cause infection. This combination of factors can lead to ulceration. Additionally, charcot neurarthropathy can cause deformities in the feet, producing abnormal pressure points that can quickly become ulcerated.

Untreated, infected skin lesions can lead to the formation of ulcers. If tissue death (necrosis) ensues, amputation may be the only alternative. In fact, 60% of all non-traumatic lower-limb amputations occur in people with diabetes (approximately 66,000 non-traumatic lower-limb amputations were performed on people with diabetes in 2006, the most recent year for which statistics are available [source: CDC Diabetes Fact Sheet]).

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