Dryness. If not resolved, dry skin can crack, allowing germs to get under the skin, which can lead to infection.
Fungal infections. Athlete’s foot and other fungal infections are more common in people with diabetes. Athlete’s foot can cause cracking of the skin that can allow germs to enter the body.
Calluses. Calluses usually occur as the result of pressure or rubbing in an area of the foot. If not treated, they can sometimes lead to ulceration of the skin tissue underneath. Never try to trim a corn or callus with a razor or knife. Over-the-counter chemical callus removers should also be avoided. See your doctor or podiatrist if you have trouble with thick calluses.
Bone deformity. Diabetes increases the risk of problems such as hammertoe (sometimes called mallet toe or claw toe), which is a change in the position of the toe, causing it to appear curved. Hammertoes increase the likelihood for callus or corn formation due to pressure on the deformed toe. A bunion is a deformity that occurs in the joint of the big toe. The toe is turned inward, causing the joint to protrude outward. A bunion can contribute to pain in the foot, as well as poor fit of shoes, again contributing to abnormal pressures. Charcot foot is a severe deformity in which the arch and normal foot structure break down. Usually, Charcot foot is caused by severe neuropathy. Prompt evaluation and treatment are necessary.
Seeing a specialist
If your feet need special attention, your physician may refer you to one of the following types of specialist:
Neurologist. Neurologists are doctors (M.D. or D.O.) that treat diseases of the nervous system. Tight control of your blood glucose is the best way to prevent or slow the progression of neuropathy, but a neurologist can also help if neuropathy is causing you pain or if you’re experiencing muscle weakness. Neurologists are also able to detect early signs of neuropathy.
Orthopedist. Orthopedists (also M.D. or D.O.) are concerned with the diagnosis, care, and treatment of musculoskeletal disorders. The orthopedist’s scope of practice includes disorders of the body’s bones, joints, ligaments, muscles, and tendons. Orthopedists treat problems such as bunions and hammertoes.
Pedorthist. A certified pedorthist (C.Ped.) has training and certification to design, manufacture, modify, and fit footwear to alleviate lower limb problems. A pedorthist is not a doctor, but some podiatrists are also certified as pedorthists.
Physical therapist. Physical therapists (P.T.) are health professionals who treat movement disorders. They often help people recover from a stroke or injury and also teach people how to avoid injuries. Physical therapists can help people with leg casts (to help ulcers heal), an amputation, neuropathy, or foot deformities to improve their mobility.
Podiatrist. Doctors of podiatric medicine (D.P.M.) are physicians and surgeons who practice on the lower extremities, primarily the feet and ankles. They treat problems from calluses and nail fungus to tumors, fractures, and deformities. They can fit orthotic inserts and design custom-made shoes.
Vascular surgeon. Vascular surgeons (M.D. or D.O.) specialize in treating diseases of the blood vessels. If you develop peripheral arterial disease that affects your feet, a vascular surgeon can perform an angioplasty, place a stent (a device that is placed in a blood vessel to keep it open after an angioplasty has widened it), or perform a bypass operation to improve blood flow to your feet.
The nature of your foot problems will determine which specialist’s expertise may be necessary. In addition to these, there may be a time when another specialist’s assistance is needed.