Updated July 19, 2006

Taking Steps Toward Healthy Feet

by Laura Hieronymus, M.S.Ed., A.P.R.N., B.C.-A.D.M., C.D.E., and Belinda O'Connell, M.S., R.D., C.D.E.

Diabetes is notorious for causing foot problems. In fact, it is the number one cause of lower limb amputations in the United States. In 2001, the latest year for which statistics are available, some 82,000 amputations—over half of all performed—were caused by diabetes.

But it doesn’t have to be this way. You don’t have to end up losing a limb because you have diabetes. It is estimated at least 50% of the amputations that occur each year in people with diabetes could be prevented through proper care of the feet and legs. By learning about the risks for foot problems and ways to take proper care of your feet, you raise your chances of keeping them for a lifetime.

Are you at risk?
The American Diabetes Association (ADA) has identified an increased risk of ulcers and amputations in the following groups of people with diabetes:

• Those who have had diabetes for ten years or longer
• Men
• People whose blood glucose control is less than optimal
• People who already have other diabetes complications, such as cardiovascular (heart) disease, retinopathy (eye disease), or nephropathy (kidney disease)
• People with a history of smoking, because smoking is associated with early development of vascular (blood vessel) complications in diabetes.

In addition, the ADA associates the following foot-related complications with an increased risk of amputation:

• Nerve damage (neuropathy) that has caused diminished sensation in the feet (ability to sense heat, cold, pressure, or pain)
• Alterations in the normal structure and movement of the foot in the presence of neuropathy
• Evidence of increased pressure on a part of the foot, such as redness, bruising, or bleeding under a callus
• Bone deformity in the foot
• Peripheral vascular disease that has caused a decrease or absence of pulses in the feet
• Disease, damage, or deformity of the toenails.

Make sure you have your doctor examine your feet at least once a year to check for the presence of foot problems and to assess your risk of developing problems in the future. (Click here for a checklist of questions to ask your doctor about foot care.) A commonly used test for detecting peripheral neuropathy (damage to the nerves supplying the feet, legs, hands, and arms) involves the physician pressing a Semmes–Weinstein monofilament, a flexible piece of nylon, against several places on the foot. The inability to sense the pressure of the filament at several points indicates neuropathy. To test for peripheral arterial disease, physicians examine the strength of the pulses in the feet and evaluate a person’s ankle–brachial index, which is the ratio of the blood pressure in the calves to the blood pressure in the arms. If you have neuropathy or peripheral arterial disease, your feet should be carefully inspected at every office visit. Your diabetes care team can also advise you on steps you can take to maintain good foot health and keep your risk of foot problems as low as possible.

Risk reduction plan
Here are some of the most important steps you can take now to prevent diabetes-related foot complications:

Blood glucose control. The development of peripheral neuropathy is one of the most important predictors of foot ulcers and amputation. Peripheral neuropathy usually manifests itself as numbness, pricking, or tingling in the fingers or toes, and it can spread up the limb and affect muscles and sweat glands as well. Neuropathy can be prevented or delayed significantly by keeping blood glucose levels as near to the normal range as possible. Optimal blood glucose control can also be beneficial in keeping your blood vessels and circulation healthy and helping the body resist, as well as fight off, infections.

Also in this article:
For More Information
How Can I Get My Doctor to Help Me Take Care of My Feet?
What Can I Do to Take Care of My Feet?

Laura Hieronymus is the program coordinator/nurse educator at Drs. Borders & Associates, PSC, an American Diabetes Association–recognized education service in Lexington, Kentucky. Belinda O’Connell is a Diabetes Nutrition Specialist in the Minneapolis, Minnesota, area and a freelance health and science writer.

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