What is a diabetic foot?
Diabetes-related foot disease includes ulceration, infection or tissue destruction associated with peripheral neuropathy, peripheral arterial disease or both. Narrowing of arteries in the legs and feet can reduce blood supply, while loss of protective sensation allows injury to go unnoticed. Diabetes-related small-vessel changes are not considered the primary cause of foot ulcers or poor healing. The process often begins with a small wound, especially on a toe.
Why does it develop?
Risk increases the longer a person has diabetes. Neuropathy reduces sensation, so a cut, scrape, blister or pressure from poorly fitting footwear may not be noticed. Skin infection, including infection between the toes, can also create a break in the skin. At the same time, poor arterial circulation limits oxygen delivery and the ability to heal.
Why is it dangerous?
Even a minor wound can become infected. Reduced blood supply weakens local defence against bacteria and makes it harder for antibiotics to reach the affected tissue. Infection may spread through the skin, disrupt glucose control and lead to tissue death. A severely neglected diabetic foot may ultimately require amputation, which is why early and active management is essential.
Warning signs
- pain in the calves while walking that improves after stopping;
- pain in the legs at night that eases when the feet hang over the side of the bed;
- cold, pale, blue or darkening toes;
- blisters, breaks in the skin, discharge, swelling or areas of dead tissue.
Because neuropathy can remove pain, the absence of discomfort is not reassuring. Inspect the entire surface of both feet every day. A specialist diabetic-foot team may include a vascular surgeon, diabetes physician, dermatologist, diabetes nurse and podiatry professional.
When to see a doctor
If you have diabetes, report any foot wound, blister or colour change promptly, however small or painless. Seek urgent care for spreading redness, warmth, swelling, pus, fever, black tissue or rapidly worsening glucose control. Early specialist assessment can prevent infection, tissue loss and amputation.