People with diabetes have a higher incidence of thickened, deformed, and discolored toenails. People with diabetes that have bone deformities such as a bump behind the big toe that is called Hallux Abducto Valgus or a Bunion have a higher risk for soft tissue infection, ulcers, bone infection and amputation due to formation of pressure points against the bone from their shoes. People with diabetes are subject to various neurological problems caused by chronically elevated blood sugars. People with diabetes that have bone deformities such as toes that are not straight, cocked up or bent called hammer toes, mallet toes or claw toes, have higher risk for corns, soft tissue infection, ulcers, bone infections and amputation due to formation of pressure points against the bone deformity of the toes from their shoes. People with diabetes that have soft tissue deformities such as calluses on the bottom of their foot have higher risk for soft tissue infection, ulcers and amputation due to formation of pressure points against the soft tissue lesions from their shoes. People with diabetes that have soft tissue deformities such as corns on the top, the tip or between the toes, have higher risk for soft tissue infection, ulcers, bone infections and amputation due to formation of pressure points against the soft tissue lesions from their shoes or other toes. Heel and arch pain is another common foot problem that may cause patients with diabetes to change the way they walk. Sometimes I lose my balance or even have fallen because I cannot feel the floor with my feet. People with diabetes can have soft tissue deformities such as dry scaly skin and peeling or cracking of the skin of their foot. Burning, tingling, or numbness to the feet are symptoms usually associated with neurological problems. If you can not reach your feet, you may have difficulty keeping your feet clean, treating skin infections, or dry skin. A critical part of your preventive foot health program is to visually inspect your feet daily. Every year in the United States, patients with diabetes have more than 90,000 lower extremity amputation procedures.
The Monofilament Test is the gold standard used worldwide to diagnose diabetic patients for Loss of Protective Sensation for Pain (LOPS) on the bottom of their foot is the Monofilament Test. Taking a quick look at why the feet end up so moist we find lots and lots of sweat glands between the toes and on the soles of the feet. Although it has nothing to do with diabetes, any changes in gait due to pain can cause serious problems for patients with diabetes.
Dry scaling skin is associated with autonomic neuropathy where the nerves that innervate the oil glands in the skin do not function properly. Typically, diabetic shoes are wider and deeper in the toe box to accommodate deformed feet.


If you cannot see your feet, use a mirror or have a family member or friend look at your feet for you every day.
Worldwide, there are more than 1 million lower extremity amputation procedures due to the effects of diabetes; one every 30 seconds.
LOPS causes the patient with diabetes to lose their ability to sense trauma or pain to their foot. The highest concentration of sweat glands are in the palms of our hands and the soles of our feet.
However, it is a more serious health problem for people with diabetes as it carries higher risks for soft tissue infection, ulceration, bone infection, and amputation. Most people with diabetes who have foot pain are diagnosed with diabetic sensory neuropathy and while a significant number of patients do have that problem, other sources of foot pain to be investigated as many patients have multiple or overlapping reasons for foot pain. While vascular disease is a separately diagnosable problem from diabetes, chronically elevated blood sugar levels contribute to arterial disease in the patient with diabetes. If a patient fails to visually inspect or touch their feet every day they may not know they have an ulcer until they see blood or pus on their socks. Patients with diabetes need to wash their feet with soap, rinse well, and dry well, especially between the toes.
Patients with diabetes need to examine their feet for cracks in the skin or any area that is red, warm, swollen, or tender to the touch. Without protective sensation patients with diabetes are vulnerable to silent or painless trauma of mechanical, chemical, or thermal origin. Patients may be born with nail borders that are curved and tend to chronically grow into the skin.
But, in fact, they may be suffering from numb feet and cannot feel the floor; the result of chronically elevated blood sugar levels. A problem with the venous circulation can also make the skin dry and itchy, but scratching this itch can result in a venous leg ulcer.
Chronically elevated blood sugar levels in the patient with diabetes can also affect the nervous system and produce these same symptoms.
Patients who have a foot deformity and a combination of either poor circulation or numb feet should use diabetic shoes. Dry skin on the feet and legs may be caused by a malfunction of the nerves to the sweat or oil glands that results in itching or cracking of the skin and infections. Research studies have shown that thirty eight percent of patients with diabetes who undergo a lower extremity amputation will lose the other leg within 5 years.


Other reasons for ingrown toenails are the result of faulty nail trimming; either failing to trim the nail totally across the end, thus leaving a portion of the nail at the edge that can grow into the skin or trimming the nail too far back on the sides causing a piece of nail to grow into the skin.
Cracking of the skin between the toes may be the result of a bacterial, fungal or mixed bacterial and fungal infection.
To find out if your feet and foot health can benefit from wearing diabetic shoes, you should have a monofilament test. Lotions containing a chemical name UREA are the best at bringing moisture from deep within the skin to the skin surface. Even worse, forty seven percent of those patients with diabetes who lose a leg will not survive 5 years. A deformed and long toenail can cut the skin of the toe next to it and cause a soft tissue infection, ulcer or bone infection and lead to amputation. Fissures or cracking of the skin may occur at a skin crease on the bottom of the toes or on the heels. When patients with diabetes have ulcers healing can take an unusually long time due to problems with circulation and the immune system. If you have had any part of your foot or leg amputated it is very important that you have a professional evaluation of your feet and legs by your foot care specialist to prevent another amputation at least once a year for an annual preventive foot exam and more frequently for ongoing foot care for corns, nails, and calluses. These breaks in the skin are caused by a neurological malfunction caused by chronically elevated blood sugars and may lead to infection and place the patient with diabetes at higher risk for ulcers, soft tissue infections, bone infections and amputation.
Other than diabetes, the likely causes of foot pain that is usually mistaken for neuropathy is a pinched nerve just behind and between the toes called a neuroma or neuritis in the forefoot, a pinched nerve behind the ankle, or pain in the foot that is referred from the back called radiculopathy. Luckily there are solutions to the problem that are safe and effective that can be used for patients with diabetes. Nerve damage to your feet and legs due to chronically elevated blood sugar levels may also cause you to lose your balance. If conservative care fails to alleviate the pain, then surgery is a legitimate alternative, even for patients with diabetes, to remove the affected portion of the nerve and relieve the pain.




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