Diabetic foot: symptoms, prevention and treatment

The diabetic foot is one of the most delicate complications of diabetes. It is not a single disease but a set of problems that can arise above all from nerve damage and reduced blood circulation in the lower limbs. A combination that can turn a small blister, a cut or a callus into a wound that is difficult to heal.

The key point is precisely this: the problem can begin without pain. For a person with diabetes, therefore, waiting for the foot to hurt before checking it is not always a safe strategy.

Why diabetes can damage the feet

High blood glucose over time can contribute to the deterioration of the peripheral nerves. This is known as diabetic neuropathy.

The foot can gradually become less sensitive to pain, pressure and changes in temperature. Some people feel tingling, burning, pins and needles or numbness; others may lose sensation without immediately realizing it.

And it is precisely this reduced ability to perceive pain that represents a risk.

A shoe that is too tight can cause an injury. A small stone left in the shoe can exert pressure for hours. A source of heat can cause a burn. A callus can hide an underlying wound.

Those with normal sensation tend to notice quickly. Those with significant neuropathy may keep walking on the injured area, making it worse without realizing it.

It is not only a matter of sensation

Alongside neuropathy there may be a second problem: blood circulation.

Diabetes is associated with a higher risk of peripheral artery disease. When the arteries of the lower limbs narrow, less blood reaches the tissues, and therefore less oxygen and fewer nutrients.

A wound that in normal conditions might heal quickly can therefore have more difficulty healing.

When neuropathy and reduced circulation are present at the same time, the risk increases further: the patient may not adequately feel an injury and, at the same time, that injury may have more difficulty healing.

It can all start with a small wound

One of the characteristics of the diabetic foot is the possible disproportion between the apparent triviality of the initial problem and its consequences.

An abrasion, a blister, a crack in the skin, an ingrown toenail or a callus should not automatically be a cause for alarm, but in a person with diabetes they deserve greater attention.

If the wound is not recognized and treated properly, it can develop into a foot ulcer. The presence of an ulcer also increases the risk of infection, which in the most complex cases can involve the deep tissues and even the bone.

This is why in the diabetic foot promptness is so important.

Pain is not a reliable indicator

It is easy to think: “If it were something serious, it would hurt.”

In the diabetic foot this reasoning can be dangerous.

Neuropathy can reduce precisely the signal that normally warns us of the presence of damage. A significant wound can therefore cause little or even no pain.

This is why a person with diabetes should learn to look at their feet, without relying only on sensations.

Persistent redness, swelling, blisters, cuts, cracks, large calluses, changes in skin color or a wound that does not tend to heal deserve a medical assessment.

Looking at your feet every day can become a form of prevention

Prevention starts with extremely simple actions.

Looking every day at the sole, the top of the foot, the toes and the spaces between them makes it possible to detect any changes early. When it is difficult to check the sole of the foot, a mirror or the help of a family member can be useful.

Hygiene is also important. The feet should be washed with water at a suitable temperature and dried carefully, especially between the toes. Skin that is too dry can promote cracking and may require appropriate moisturizers, avoiding however the application of creams between the toes unless indicated by a professional.

Particular attention should also be paid to footwear: shoes must be comfortable, the right size and must not create pressure points. Before putting them on, it is a good habit to check that there are no small objects or irregularities inside.

Calluses and nails: better to avoid do-it-yourself

For those with reduced sensation or circulation problems, even normal foot care requires a few extra precautions.

Cutting a nail improperly or trying to remove a callus by yourself with sharp instruments can accidentally cause a wound.

The same applies to corn removers or other aggressive treatments used without professional advice.

When neuropathy, foot deformities, previous ulcers or vascular problems are present, it is advisable to agree with the healthcare team on the safest way to care for nails and calluses.

When a wound must not wait

Not all small wounds develop into a serious problem. But some situations require a rapid assessment.

A wound that does not heal, the appearance of discharge, a bad smell, swelling, redness that tends to spread, changes in the color or temperature of the foot and signs compatible with an infection should not be neglected.

A foot that suddenly becomes very cold, pale or shows significant changes in color also requires prompt attention.

In these cases it is important to avoid improvised home treatments and to contact the physician or the reference center.

The diabetic foot requires a team

When the risk increases or a wound is already present, the pathway may involve several areas of expertise.

Diabetologist, podiatrist, vascular surgeon, orthopedic surgeon, specialized nurse and other professionals may step in at different times depending on the needs.

Treating the wound is not enough. It is necessary to understand why it formed, assess the sensation and circulation of the foot, control any infection, reduce the pressure exerted on the injured area and manage diabetes properly.

It is this overall view that makes it possible to address not only the ulcer but the patient as a whole.

Preventing to protect your independence

The most severe complications of the diabetic foot can lead to hospital admissions, surgery and, in the most advanced cases, even amputations. This is a course that does not concern everyone with diabetes and that should not cause alarm, but it explains why prevention is so important.

Many problems can be caught much earlier.

Controlling blood glucose, not smoking, managing blood pressure and cholesterol, undergoing the recommended assessments and paying daily attention to your feet means acting on the different factors that contribute to the risk.

For those with diabetes, therefore, looking at your feet should become as natural as checking your blood glucose.