Diabetic Foot: Risks, Care, and Prevention

November 8, 2024

Diabetic foot ulcers (DFUs) are a common complication in patients with prolonged high blood sugar, leading to damage in peripheral nerves and microvascular blood flow. This damage restricts blood supply, causing vessels to constrict and sometimes block entirely. As a result, the foot is deprived of the necessary nutrients, making it difficult for wounds to heal. Additionally, nerve damage often leads to a loss of sensation, making it easy for patients to overlook small injuries or feel no pain when touching hot or cold objects. Something as simple as a stubbed toe or an ingrown toenail can result in infection or a worsening wound, as patients may not notice it until it’s more advanced.

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Q: How common is diabetic foot in the United States, and what is the amputation risk?

A: Diabetes is the leading cause of lower-limb amputations among adults in the U.S., with approximately 150,000 diabetes-related amputations occurring each year.(1) Patients with diabetic foot ulcers (DFUs) have at least a 19% lifetime risk of lower-limb amputation.(2) Although the prevalence of diabetes has risen, the overall amputation rates have decreased since the 1990s. However, the proportion of minor amputations has increased, which may reflect improved efforts in limb preservation through increased rates of lower-limb vascular procedures.

Q: How does diabetes affect the feet?

A: Prolonged high blood sugar can lead to complications like nerve damage and poor blood circulation. Over 50% of diabetic patients unknowingly suffer from nerve damage, which leads to a gradual loss of sensation. This nerve impairment makes it challenging to feel pain or temperature changes in the feet, resulting in unnoticed wounds or injuries. For some patients, their feet may feel numb, as if “walking on cotton,” causing an unsteady sensation.

Patients with diabetic neuropathy are prone to developing DFUs due to unnoticed injuries or foot deformities, like claw toes, that increase pressure and friction on specific areas of the feet. Nerve damage may also impair the feet's natural lubrication, causing dry, cracked skin, which raises the risk of infection.

In cases of poor diabetes management, reduced blood circulation can further affect the feet, leading to peripheral arterial disease (PAD). PAD patients may experience calf pain while walking, and in severe cases, feet or toes may become cold, discolored, or even blackened. Blood circulation issues often result in non-healing or necrotic wounds on the toes or legs, increasing infection risks and, ultimately, the likelihood of amputation.

Q: How can we support the mental health of diabetic foot patients?

A: The challenges of living with diabetic foot ulcers often lead to significant mental health concerns. Studies report high levels of anxiety (37.7%) and depression (39.6%) among DFU patients. (3)

To promote a positive approach to managing diabetes, diabetic patients should consider the following:
Stay Positive: Develop a resilient mindset, finding motivation through role models or personal goals to overcome challenges.
Seek Professional Help: Collaborate with a healthcare team, including endocrinologists, dietitians, physical therapists, and mental health professionals. Avoid self-adjusting treatments.
Cultivate Acceptance: Build a proactive outlook to manage current challenges without excessive worry about potential problems.

Diabetes is manageable with the proper approach, enabling people to enjoy a quality life and a lifespan comparable to healthy individuals. Maintaining a healthy mental outlook is key to staying committed to effective diabetes care.

Reference
1: Centers for Disease Control and Prevention . National Diabetes Statistics Report. Atlanta, GA, Centers for Disease Control and Prevention, 2022. Accessed 6 June 2022. Available from https://www.cdc.gov/diabetes/data/statistics-report/index.html

2: Rodrigues BT, Vangaveti VN, Urkude R, Biros E, Malabu UH. Prevalence and risk factors of lower limb amputations in patients with diabetic foot ulcers: a systematic review and meta-analysis. Diabetes Metab Syndr 2022;16:102397. [DOI] [PubMed] [Google Scholar]

3: Ahmad, A., Abujbara, M., Jaddou, H., Younes, N. A., & Ajlouni, K. (2018). Anxiety and depression among adult patients with diabetic Foot: Prevalence and associated factors. Journal of Clinical Medicine Research, 10(5), 411–418. https://doi.org/10.14740/jocmr3352w

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