Diabetic neuropathy occurs due to long-term exposure to HIGH blood sugars to the nerves. Diabetes damages the nerves due to which their functioning is affected. Besides experiencing hurt, diabetic neuropathy also lessens the ability to feel pain, heat, and cold. Loss of sensations also means that you could injure yourself or burn yourself yet do not experience pain at all. This is dangerous as the injury could lead to changes in the shape of your toes and feet, leading to deformities.
1. Corn and calluses: Calluses are formed on the base of the feet due to uneven distribution of weight. Corns or calluses are the build-up of hard skin, caused by improper fitting shoes or abnormality of the shoe. Very thick calluses or corn can press into the foot causing pain. The formation of calluses is a normal mechanism of the body, wherein a thick layer of skin is generated. Pressure or friction on this corn could cause an open wound. In peripheral neuropathy and diabetes, calluses may be covering up much deeper wounds or ulceration. If calluses are neglected it can cause ulceration of underlying tissue, may worsen inflammation underneath the skin. It is advisable not to peel or trim the callus on your own, leave that to the expert. Proper footwear and orthotics will help to reduce friction.
2. Fungal Infection of nails: One-third of diabetics is estimated to have nail fungus. Due to neuropathy, there is poor blood circulation and impaired nerve function in the limbs leading to loss of sensations. Thus one is more prone to cuts and injuries on the nail if gone unnoticed can allow fungi to innate the nail. If this remains untreated can lead to serious infection. Sharp infected nails can also pierce the skin around the nails allowing fungi and bacteria to enter. All of these trauma damages the toenail and skin around them. Nails with a fungal infection may become discoloured (yellowish-brown), thick and brittle, and may separate from the rest of the nail. The dark moist and warm environment of shoes can also promote fungal infection.
3. Ulceration: foot ulcers cause maximum hospitalization for diabetes than any other complication. Usually occurring on the lower legs or feet, a skin ulcer is an area of skin that is broken down and underlying the tissue. Due to loss of sensation in the feet, small cuts, injuries may go unnoticed. Also due to poor blood circulation, healing of the injury may get delayed leading to the development of an ulcer. Uncontrolled blood sugar leads to slower healing of the ulcer. If left untreated may lead to gangrene and amputation. Once healed, prevention of recurrence of ulcer by taking proper foot care is important.
4. Hammertoe: It is a foot deformity that causes the toe to bend or curl downwards instead of pointing forward. Bend of the toe occurs because of the weakening of the muscle. The curling or bending of the toe happens due to tissues that connect muscle to bone, becoming shorter. Hammertoes can cause problems with walking and can lead to forming blisters, calluses, and sores.
5. Ingrowth of toenails: Ingrowth of toenails occurs when the edges of the nail grow into the skin causing pressure and pain along the nail edges. Common causes of this condition are ill-fitting shoes, improperly trimmed nails, crowding of the toes, repeated trauma to the feet due to vigorous exercises or activities. There may be redness, swelling, pain, and infection as the edge of the nail may cut into the skin. Severe problems with the ingrown nail may require surgery.
6. Bunions: It is a deformity of the feet when the big toe angles in towards the second toe. Often the spot where the big toes join the rest of the foot may become red and calluses. This often occurs due to abnormal walking habits, ill-fitting footwear or inherited foot type, injury, birth defect, arthritis, or certain neuromuscular disorder. Bunions can form on one foot or both.