Your feet are the foundation of an active lifestyle. But if diabetes has been damaging the nerves in your lower extremities, you may begin experiencing peripheral neuropathy (numbness, tingling, or burning in the feet and toes). With the loss of feeling comes other serious risks such as loss of balance leading to frequent falls and open sores on the feet, causing possible amputations.
Just as your blood vessels are damaged by high blood sugar (glucose) levels, so too are your nerves. The nerves in your feet allow you to feel the pressure of the ground, sense temperature changes, and recognize when cuts or calluses appear. If the nerves of the foot are damaged by uncontrolled diabetes, then peripheral neuropathy results. This serious condition affects as much as 50% of the diabetic population (Mayo Clinic).
Peripheral neuropathy often starts with a chronic tingling or burning feeling in the toes, especially noticeable during sleep. Even light pressure, such as from a bedsheet, can cause painful symptoms. Eventually, as nerves are further damaged, you lose more and more sensation and experience widespread numbness in your feet. You must be very diligent with the care of your feet if this happens … using your other senses such as sight to make up for this loss of tactile sensation.
Proactive recommendations if neuropathy is present:
• Inspect your feet and toes daily
• Inspect your shoes both inside and out before wearing them
• Inspect your socks for possible protruding seams or holes
Don’t expose your feet to extremes of temperature as you won’t be able to sense if they are too hot or cold. During your daily inspection, look for cuts, scrapes, calluses, warts, or perhaps even a piece of glass or other foreign body that you may not otherwise be aware of. Use a mirror to check the bottoms of your feet if you can’t inspect them thoroughly. You can also test sensitivity levels by gently poking the foot with a monofilament wire (ask for one from your podiatrist). This small wire can detect if you are “at-risk” for amputation due to LOPS (Loss of Protective Sensation). This qualifies you to get podiatric care covered under Medicare and other Medicare Advantage plans.
Missing a small cut or sore on the foot can lead to a severe infection that rapidly spreads to bone and/or soft tissue, resulting in amputation. There are around 73,000 lower limb amputations annually in the US performed on persons with diabetes. Another research study showed a life expectancy of only two years for 50% of people with diabetes following amputation. A simple daily diabetic foot exam can prevent these issues and keep your feet safe.
Once numbness sets in, you are now also at a greater risk of falling. In fact, your risk of falling triples if you have a nerve disorder such as peripheral neuropathy (Foundation for PN). If you fall once, it doubles your chances of falling again. One in five falls causes a serious injury, with 18,000 fatalities yearly in older adults (CDC).
During November, which is National Diabetes Month, we hope you have learned that diabetes is a serious condition that, when unmanaged, can lead to neuropathy, falling, ulcers and amputation.
Talk to your health care team about available resources such as physical therapy to improve balance and strength; Dietary counseling, exercise via Silver Sneakers or even a personal trainer, and other weight loss options to improve glucose control; and see your podiatrist regularly to keep that active lifestyle you deserve.
Dr. Jane Graebner is founder of the Foot and Ankle Wellness Center in Delaware. She is a practicing podiatrist of 40 years and president of the Delaware County Diabetes Association.