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Addressing Diabetic Foot Pain and Complications

diabetic foot pain

Story at-a-glance -

  • Diabetes can cause conditions associated with an increased risk of foot problems
  • If you notice skin discoloration or feel pain around an area that appears callused or irritated, go to your doctor to be treated immediately and prevent complications from developing and/or worsening

There are many complications that have been linked to diabetes. Foot pain is one of the most excruciating and debilitating conditions that can arise from this disease.

What Causes Diabetic Foot Pain?

Diabetes is known to trigger damage to blood vessels and peripheral nerves, causing problems in the legs and feet. This disease can also cause conditions associated with an increased risk of foot problems among diabetics:

Peripheral artery disease (PAD) — This disease, which can also be called peripheral vascular disease (PVD),1 is sometimes described as a “hardening” of the arteries. In PAD, there is narrowing or occlusion by atherosclerotic plaques of arteries2 outside of the heart.3

Patients with PAD suffer from pain in the calves during exercise or intermittent claudication,4 and most symptoms are related to a reduced oxygen delivery to the lower legs and feet.5

Peripheral diabetic neuropathy — Damage to the peripheral nerves is evident among people with peripheral diabetic neuropathy.6

Indicators of peripheral diabetic neuropathy include a reduced sensation in the nerves of the feet and difficulty in feeling injuries because of lack of sensation;  tingling, pain or burning in the involved areas;7 and improper function of the muscles of the feet, potentially leading to misalignment of the foot that can put pressure on certain areas.8

Foot Problems Patients With Diabetes May Encounter

Diabetics are known to have a higher risk for mild foot problems. Although these aren’t specific to diabetes, the following may occur more frequently due to problems with the nerves and circulation to the feet:9

  • Calluses and corns — They develop because of abnormal alignment of the feet or abnormal gait
  • Nail fungal infections — These infections may appear as thickened, discolored and, at times, brittle nails10
  • Tinea pedis — Also known as athlete’s foot, this is a fungal infection of the skin of the feet11
  • Hammertoes — These are bent toes due to muscle weakness
  • Bunions — the angling of the big toe toward the second toe (the area of the bunion can become reddened and irritated, causing callus formation12)
  • Ingrown toenails
  • Cracking of the skin of the feet due to dry skin

In severe cases of diabetic foot pain, ulcers can develop because of reduced blood flow to the feet. These ulcers form when skin tissue breaks down and exposes the layers underneath.13 Ulcers are most common under the big toes and balls of your feet,14 and can affect the feet down to the bones.15 Common symptoms include:16,17

  • Drainage from the foot that can stain socks or leak out in your shoe
  • Unusual swelling, irritation, redness and odor from one or both feet
  • A tan, brown or black tissue called eschar surrounding the ulcer
  • Appearance of gangrene (tissue death) around the ulcer,18 triggering odorous discharge, pain or loss of sensation in the area19

Apart from foot ulcers and gangrene, other serious problems that patients could develop include:20

  • Cellulitis (infection of the tissues underneath the skin)21
  • Osteomyelitis (infection of the bone)
  • Sepsis (infection spreads to the bloodstream)
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How Can These Foot Problems Be Treated?

Treatment for these complications depends on the foot problem that the patient experiences. For instance, corns may require the patient to wear corrective shoes,22 while other types of foot problems can be addressed by wearing proper footwear, sometimes with orthotic devices and splinting23 or bracing.

Severe cases of foot problems like hammertoes, bunions and ingrown toenails may require surgery.24

Other foot problems related to diabetes can be treated with antifungals25 or antibiotics (provided that these are a last resort)26 or through surgery. Unfortunately, if gangrene develops, it cannot be reversed. Treatments that can prevent gangrene from spreading or becoming infected can be utilized instead.27

Surgery can also be needed to remove the dead tissue, and antibiotics can be given to prevent the development of life-threatening infections.28 Should the gangrene be very severe, amputation of the affected part may be necessary.29

Preventing Diabetic Foot Complications

Untreated foot infections can result in serious complications and worsen nerve damage, pain30 or inability to feel pain,31 and so patients should find ways to prevent these problems from occurring or worsening. Here are some valuable tips:32,33,34,35

  • Check feet for cuts, sores, swelling and other problems frequently, and wash them daily with warm water and dry completely afterward.
  • Apply organic lotion on the feet to keep them moisturized, but avoid putting lotion in areas between the toes.
  • Wear comfortable, closed-toe footwear that give your feet room to move and help prevent problems.36
  • If you have new shoes, break them in slowly so they don’t hurt your feet.
  • Ask your doctor about customized shoes if regular pairs do not fit well.37
  • Cover your feet with shoes or thick socks to cushion them and prevent injuries. Make sure no objects are trapped inside the shoes that can cut or injure your feet.
  • Avoid walking barefoot, even at home. During the summertime, make sure your feet do not get burned if you walk on a hot pavement or surface by wearing shoes.
  • If you have corns or calluses, lightly smooth them with a pumice stone. Never use sharp objects to cut corns or calluses.
  • Trim toenails straight across, and don’t cut the corners shorter than the rest of the nail.
  • Have your doctor take a look at your feet during every checkup.
  • Stop smoking, because this increases the risk of arteriosclerosis and poor circulation to the feet.

It’s important to be aware of the symptoms of diabetic foot problems because some of them aren’t obvious. Some patients won’t even show signs of foot ulcers until they have become infected.

If you notice skin discoloration (especially tissue that has turned black) or feel pain around an area that appears callused or irritated, go to your doctor for treatment immediately to prevent complications from developing or worsening.

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