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People with diabetes are always advised to take great care of their feet. But many are unaware of why this is so important and how lack of care can result in serious consequences such as ulceration, infections, amputation and even death.

Currently there are 285 million people in the world with diabetes and it is thought that by 2030 this number will double. Ninety percent of these people have Type 2 diabetes, which is associated with obesity, poor diet and lack of exercise.

Diabetes is the leading cause of non-traumatic (not due to accidents) foot and leg amputation. Research has shown that once someone has had one amputation they are highly likely to have another.

Also people who have lost limbs through diabetes have a two to four-fold increased chance of dying, compared to people without diabetes.

Nerve and blood vessel disease, coupled with defects in the immune system and inadequate care form a terrible cocktail, frequently leading to serious foot problems.

Nerve disease and injury

Something that’s not well-known is that diabetes leads to nerve damage, causing a condition called peripheral neuropathy.  This simply means nerve disease affecting the nerves in the extremities – most notably in the feet and legs.  

It is a nasty problem which creeps up on people as they are often not aware of it until it is quite advanced.

At first there may just be altered or impaired sensation, but this quickly progresses to numbness.

The issue with neuropathy is that people cannot feel when damage has occurred to their feet.  For example they may not be able to feel a stone in their shoe, even when it pierces the skin and causes a wound. They will also tend to wear shoes which are too small, because they cannot feel the pressure and correctly-fitting shoes will feel loose to them.

Impaired blood supply and wound healing

Another problem is that the supply of blood to the feet is reduced.  The significance is that if there is a wound to the foot, there is not enough blood containing nutrients and white cells to heal and fight infection. Therefore, compared with a non-diabetic person, wounds are much more difficult and take longer to heal, and more likely to be infected.

In diabetes, the further away from the heart, the worse the impairment of blood supply.  So it is not unusual for foot problems to start with gangrene in the toes. 

This is where the tissues die because they have not enough blood – referred to as ischemia.  Having a wound increases the need for blood and can ‘tip the balance’ into ischemia.

Immune defects and inability to fight infection

High sugar levels, often seen in diabetes, impair the ability of immune (white) cells to fight infection. This is why diabetic foot wounds take longer to heal and can have much more serious consequences than for non-diabetic individuals.

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  • www.diabetes.co.uk/diabetes-prevalence.html