People with diabetes are at risk to develop peripheral neuropathy with loss of protective sensation. This means that they have lost the ability to feel pain--which is particularly dangerous in their feet and ankles. Without the ability to feel pain, if the shoe is rubbing on a toe or bunion, the person that can sense pain would take action to stop the discomfort while the person that does not feel pain does not know there is a problem. This can lead to the development of an ulceration (sore or break in the skin). Up to 85% of amputations are preceded by ulcerations. Once there is a break in the skin then infections can develop which can lead to more serious complications. If you combine this with the fact that there is a higher incidence of atherosclerotic disease in people with diabetes and this can lead to poor circulation (decreased blood flow) to the feet which in turn can make healing more difficult--again leading to greater risk for infection and ultimately amputation.
This is why it is imperative for people with diabetes to have their feet examined on a yearly basis by a professional that specializes in foot problems such as a podiatrist. Based on the findings of the examination, a treatment plan should be developed depending on how much at risk the person is for diabetic foot complications. People with diabetes need to know if they have loss of protective sensation, decreased circulation, etc. and need to know the steps that they can take on a daily basis to avoid developing foot problems that can lead to serious complications.