What causes diabetic foot problems?

Grant L. Beck, DPM
Foot & Ankle Surgery
Diabetics develop foot problems because they experience neuropathy, or prolems with the nerves. Learn more from Grant Beck, DPM, from Sunrise Hospital in this video.
Douglas S. Denham, DO
Family Medicine

Diabetic foot ulcers are one of the complications associated with diabetes mellitus. They can have multiple and interrelated causes. Most commonly they are the result of decreased sensation in the lower extremities. As a consequence of decreased sensation in the feet, any injury can go undetected and can eventually become an ulcer that can become infected and require care. Other complications of diabetes can also play a part in ulcers and the ability to heal them. Atherosclerosis of the arties of the lower extremity can result in decreased blood flow to the foot and this can impede healing. Poorly controlled diabetes also can affect the ability of the body to heal. Also physical effects such as poorly fitting shoes, not wearing shoes or poor hygiene can contribute to foot ulcers in diabetics.

William Lee Dubois
Endocrinology Diabetes & Metabolism

Scary but true story: a man with diabetes came home from work super-tired one day and decided to grab a quick nap. He sat down on his couch, took his shoes off, slipped his glasses into one of the shoes for safe-keeping and nodded off. (About half of you out there know where this is going….)

We was woken with a start by the phone ringing. His wife had just been in a car accident and was in the Emergency Room. He jumped off the couch, pulled his shoes on, and dashed off to the hospital. Don’t worry. She wasn’t badly hurt. But it was eight hours later before they both got home. When he took his shoes off again he found his glasses. In the shoe. For eight hours he'd worn a shoe with a pair of glasses in them and had no clue.

I saw his custom-molded shoe insert, still bearing the exact imprint of his glasses, sort of like fossilized dinosaur tracks.

So, to answer your question, diabetic foot problems actually happen because in some people, many years of high blood sugar causes them to lose all sensation in their feet. Most of us get annoyed when we get a pebble in our shoes. The hero of our story had an entire pair of glasses in his shoe and couldn’t feel it!

Lack of sensation is exactly half the story. The second half is that most people aren’t in the habit of looking at the bottom of their feet, largely because there is no real reason for most people to do so.

If you don’t feel pain when you injure your foot. And you don’t look at your feet, how would you know if you’d been hurt? Right. You wouldn’t.

And that’s exactly what causes 84,000 non-traumatic amputations every year in our county. Of course all amputations are traumatic to the amputee, but in this case we simply mean medically necessary amputations that aren’t the result be being run over  by a riding mower or being in a car accident.

The exact progression is: injury, infection, ulcer, gangrene--a.k.a. tissue necrosis, literally the death of part of your body that is still attached to you--and finally, amputation.

So the single best thing you can do to prevent this from happening to you is to “kiss” your feet goodnight every night. Look at your feet at bedtime. If you are to… um…ah... too hefty to see your feet use a hand mirror placed on the floor. Make sure everything looks OK. Start doing this now, even if you have great sensation in your feet, that way if you lose it in the future you will already be in the habit of taking care of them.

Continue Learning about Diabetes Complications

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.