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Diabetes is a growing epidemic in Singapore, with about one in nine adults suffering from the disease. Some of its most debilitating complications are foot-related problems. These can lead to more severe consequences such as leg amputations. These are some of the ways that diabetes can affect feet.

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Diabetic neuropathy

In diabetic people, higher than normal sugar levels will damage nerves over time. This condition, called diabetic neuropathy, can have several repercussions.

Some people may have altered sensation in their feet, ranging from tingling toes to a constant burning feeling in their feet. Others may have less sensation or even completely lose feeling in their feet. The latter is dangerous as foot wounds may go unnoticed, increasing the risk of foot infections that may require amputations.

Diabetic neuropathy can also cause muscle weakness, affect balance and make them walk differently. This can result in foot and toe deformities, such as claw toes, where toes bend into a claw-like position, and hammer toes, where toes to bend or curl downward instead of pointing forward. These deformities could in turn create atypical high pressure points on the sole, raising the probability of foot ulcers.

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Furthermore, damage to the nerves supplying sweat glands in the foot will cause skin to become dry and flaky, and more likely to crack. Bacteria may enter cracked skin in feet, bringing about foot infections.

Peripheral Arterial Disease

Diabetic people are also at greater risk of developing foot infections because they cannot heal wounds as effectively as healthy people.

Diabetes increases the risk and severity of peripheral arterial disease. This condition is caused by the build-up of fatty deposits and cholesterol in arterial wall, leading to poor blood supply. As a result, this will impede the healing of wounds. High blood sugar also impairs the ability of white blood cells to go to the site of an infection, stay there and kill microorganisms.

Due to the heightened risk of foot infections, leg amputations are 10 to 20 times more common in people with diabetes than in people without diabetes. To stop minor injuries from developing into major, life-changing complications, diabetic people need to examine their feet daily, get their feet checked by a doctor or podiatrist at least once a year, and seek treatment immediately if they notice any abnormalities on their feet.

This article has been verified medically by Dr Tan Yih Kai, vascular surgeon at Surgi-TEN Specialists, Farrer Park Hospital (Singapore).

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