Did you know that each foot is made up of 26 bones, along with muscles, tendons, ligaments, and joints? It’s not surprising that foot problems and pain occur. People with diabetes are at risk of developing a number of different foot problems, which is why good blood sugar management and foot care are so important. Medical issues, poorly fitting shoes, and injury are all potential causes of foot pain. Let’s take a closer look at some of the causes and what you can do.
Diabetes can cause nerve damage in the legs and feet, called diabetic peripheral neuropathy. Diabetic neuropathy can cause numbness, tingling, and pain. Furthermore, if you lose feeling in your feet, you may not feel a pebble in your shoe or a blister on your foot, which can cause cuts and sores. Cuts and sores can then become infected. Infections, if not properly treated, can increase the risk of amputation.
If you’ve been diagnosed with diabetic neuropathy in your feet, your healthcare provider may prescribe medications to help relieve nerve pain. These medicines include:
- Antiseizure drugs such as pregabalin (brand name Lyrica) or gabapentin (Neurontin)
- Antidepressants such as amitriptyline, imipramine, duloxetine (Cymbalta), or venlafaxine (Effexor)
- Over-the-counter pain relievers such as acetaminophen, ibuprofen, a lidocaine patch, or capsaicin cream
Other possible treatments may include acupuncture or transcutaneous electrical nerve stimulation (TENS).
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Peripheral arterial disease
Peripheral arterial disease (PAD) occurs when blockages or spasms occur in a blood vessel. The blood vessels in the legs and feet are the most commonly affected. Having diabetes increases the risk of PAD, as does high blood pressure, high cholesterol, smoking, and overweight or obesity. Symptoms include pain in the calves when walking, pain in the toes, and wounds that don’t heal on the ankles or heels.
Lifestyle changes are a big part of treating PAD and involve regular exercise, eating healthfully, losing weight and quitting smoking. Medicines to lower blood pressure and cholesterol may be prescribed. You might also be prescribed medicine to prevent blood clots, as well as the drug cilostazol, which widens blood vessels to keep blood flowing. Surgery may be indicated for severe cases of PAD.
Bunions are a common cause of foot pain. A bunion (hallux valgus) occurs when the big toe turns in, bending towards the other toes. It results in a bony bump on the side of your foot, and it can become extremely painful, especially when you wear shoes. People with diabetes who are overweight and who have foot problems are prone to developing bunions due to decreased blood flow to the feet and nerve damage.
- Wearing roomy shoes to provide more space for the toes
- Avoiding shoes that are pointy
- Using bunion pads or cushions
- Using shoe inserts
- Taking over-the-counter pain relievers or getting a cortisone injection
- Icing the bunion
If the above methods don’t provide relief, your provider may recommend surgery, such as a bunionectomy. But there are different surgical procedures that might be used. Recovery from bunion surgery can take a long time, and if you have surgery, you’ll need to wear proper shoes afterwards to prevent a recurrence.
Gout is a type of inflammatory arthritis that can be extremely painful. It typically affects the big toe, but can also affect other toes, the ankles, and the knees. Pain, swelling, redness, and warmth are common symptoms of gout. Having diabetes increases the risk of gout; studies indicate that people with type 2 diabetes are more likely to have hyperuricemia, a condition when there is too much uric acid in the body, causing a buildup of uric acid crystals in the joints and tissues.
Gout can be treated and managed with a combination of medication and self-management strategies. These may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen sodium, indomethacin or celecoxib
- Colchicine, an anti-inflammatory drug to reduce pain
- Allopurinol, which limits the amount of uric acid made
- Febuxostat, which limits the amount of uric acid made
- Probenecid, which helps the kidneys remove uric acid
- Pegloticase, which is infused via an IV for severe gout
- Corticosteroids to control pain and inflammation
To prevent future flare-ups of gout, you might find that avoiding foods high in purines (red meat, organ meats, seafood) and limiting alcohol are helpful.
Fractures occur more often in people with diabetes than in people without diabetes due to complications (such as neuropathy), infection, diabetes medication, and a higher likelihood of falls. A foot fracture is an injury or break to the bone. Fractures can be small (called hairline fractures) or more traumatic, such as a break. Throbbing pain, swelling, bruising, tenderness, and pain with walking are common symptoms of a foot fracture.
The treatment of a foot fracture depends on the type, location, and severity. Rest and limited weight bearing will likely be advised, along with medication to reduce pain and swelling. If the bones are not aligned, you may need reduction, which is when the bones are manipulated to put them back into alignment. If the bones are not stable, you might need surgery to insert metal pins, plates, or screws to hold the bones in place until they heal (called internal fixation). You might need to wear a cast or a boot, along with crutches, as well.
Osteomyelitis is an infection and inflammation of the bone. People with diabetes are at risk of developing osteomyelitis as a result of a foot ulcer (remember that foot ulcers can result due to neuropathy, PAD, or cuts or sores on the foot that don’t heal). Osteomyelitis is difficult to treat in people with diabetes. Symptoms include pain or tenderness in the affected area, swelling, warmth, and redness. Pus may drain from the foot ulcer, as well. Other symptoms may include fever, chills, nausea, and a painful walking pattern.
An open wound or abscess on the foot might be drained to culture the wound and also to increase the effectiveness of antibiotics. Antibiotics are prescribed to kill the bacteria causing the infection. In some cases, surgery to clean out the infection and dead bone (debridement) is needed, with antibiotics administered afterwards. Osteomyelitis must be carefully monitored to make sure that the infected bone has been removed.