About Diabetic Foot Disease

What is diabetes?

Diabetes is a serious and complex condition that can affect the entire body. Around 1.7 million Australians have diabetes, however, only 1.2 million of these have been formally diagnosed, with many others still yet to become aware of their changing health status. Diabetes is increasingly becoming a major health concern, with more than 100,000 Australians developing diabetes in the past year alone.

Diabetes and the Feet

In people with diabetes, the feet are an often over-looked area given the other aspects of diabetes that also require attention. However, foot and limb problems in people with diabetes are an extremely common and often debilitating problem.

The most common of these are Diabetic Foot Ulcers, which are a wound occurring on the foot (or lower limbs) commonly caused by a lack of sensation and/or blood supply in a person with diabetes. These can occur in people with both Type 1 and Type 2 diabetes.

What is a diabetic foot ulcer?

The term ‘foot ulcer’ refer to a patch of broken down skin usually on the feet but may also occur on the lower leg. In people with diabetes, high or fluctuating blood sugar levels, reduced blood flow to the extremities and nerve damage can inhibit the ability of the skin to repair itself. Because of this impaired rate of healing, even a mild injury can start a foot ulcer.

Why are people with diabetes more likely to develop a foot ulcer?

A common symptom of diabetes is damage to the nerves in your feet, blood circulation and infection. The damaged nerve function is also called neuropathy, and about half of all people with diabetes have some form of nerve damage. This neuropathy results in either pain, tingling, weakness or reduced sensation in the feet and lower limbs. A loss of sensitivity in the feet often leads to an abnormal walking pattern, causing increased pressure in certain areas of the foot. The development of new calluses can be an indication of abnormal pressure being applied to parts of the feet. Continuing to walk unnaturally on an ‘insensitive foot’ increases the likelihood of ulcers forming, and reduces the ability of the body to heal an existing ulcer.

Because of the loss of sensation in the foot, a person with diabetes are also less likely to realise they’ve injured their foot, simply because they may not register the ‘bump’ or ‘pain’ sensation. This then means they are less likely to notice and promptly treat an injury, unintentionally allowing it to progress to a more serious, advanced stage.

Another common side effect of diabetes is reduced blood flow to the feet, caused by narrowed arteries and/or blood vessels. The reduced blood flow to the extremities can impair the ability of the body’s own immune system to heal injuries. When an injury to the foot cannot self-heal, a foot ulcer can then develop. Therefore, even minor injuries caused by a small cut, bruise or a blister can develop into a diabetic foot ulcer.

Other factors that can increase the risk of developing a diabetic foot ulcer, includes smoking, a lack of exercise, being overweight, high cholesterol and/or high blood pressure, wearing poor-fitting footwear (or no footwear, particularly outside where cuts and injuries are more likely to occur), and suboptimal management of the overall diabetes condition.

Further information on foot ulcers, their prevention and management is available on this website.