Diabetic Foot Pain

Diabetic Foot Pain | East Coast Podiatry


Diabetic patients with painful foot problems tend to seek pain relief only when it becomes too painful and too frequent. Treating the condition early at the earliest signs of symptoms is key to preventing worsen conditions. Here are 4 common foot problems that people with Diabetes in Singapore have.


1. Nerve

Nerve problems affecting people with diabetes are called Peripheral Neuropathy. It is when the nerves are damaged and affected directly by the process of diabetes. The three types of neuropathy associated with diabetes are; sensory, motor and autonomic neuropathy.


The typical form of painful neuropathy that people with diabetes always complain of is sensory neuropathy. Sensory neuropathy is a sensitivity pain, where the pain felt is exaggerated and not proportional with the amount exerted or causing it. This can be presented as numbness in the feet.  Other symptoms of sensory neuropathy will include stabbing, tingling and burning pain. In a painful sensory neuropathy, a minimal touch or contact with the affected area may result in extreme pain felt.


The second form of pain neuropathy is motor neuropathy. This is when the nerves to the muscles are damaged. A damaged nerve to the muscle can result in muscle weakness, fatigue and constant aching. Muscles that are normally affected are the thigh, the shin and the small muscles of the feet. When these muscles are affected, it can result in gait or walking imbalances which further will increased callus formation, increased rubbing of the foot in the shoes and inflammation of the skin, and eventually increased pain.


The third type is autonomic neuropathy. This neuropathy affects the sweating mechanism. Symptoms include thickened, dry cuticles and nails, as well as dry and cracked skin. These symptoms can be painful and more likely are prone to bacterial or fungal infection, which also can be the source of pain.


They are ways to treat symptoms and relieve pain from painful peripheral neuropathy. The main cause of neuropathy in the first place is a rise in blood glucose, hence you are required to check your blood sugar for the past several weeks. Diabetic shoe insoles also play a role in relieving these pain, not only it will help improves and stabilise the imbalance walking/gait, but will offer a good cushioning to protect and reduce irritations to the sensitive foot due to neuropathy.


2. Circulation Problems

Pain due to a circulatory problem can be very debilitating. Circulatory problems in people with diabetes can happen when the raised blood sugar level affects the arteries, capillaries and veins. Diabetes can accelerate the process of fatty depositions in the walls and may develop calcium deposits. The affected arteries and capillaries can get thickened and stiff, therefore the blood flow to the lower leg and feet can get blocked partially or completely. This will reduce the efficiency of oxygen delivery in the blood to and from tissues or body parts. Lack of oxygen will then occur, and this process can be extremely painful. The arteries that are most commonly affected are those behind the knee and the calf.


Veins, vice versa, is not lacking oxygen, instead, there can be more blood that the veins can handle. This happens when the blocked arteries, allows blood to create little channels to flow over to the veins instead of trying to push through the blockage. When the veins get too much blood, it became overloaded and can potentially damage the valves. Valves in the veins prevent backflow of blood, so when these valves are damaged, blood then pools in the feet and lower legs. Leakage of the pools of blood into the skin can create ulcers and can be very painful.


There are several therapies and treatment modalities that can improve circulation problems in people with diabetes. The aim is to treat the cause of pain through a thorough assessment of the lower legs before deciding which of those therapies and treatment plan are suitable for the patient.


3. Muscle and Joint Problems

Muscle and joint pain not only can affect people with diabetes but all people due to degenerative changes, overuse or injury. In diabetes, muscles are significantly affected by neuropathy, circulation problems and atrophy. It can be the source of pain and discomfort in the diabetic foot. Walking imbalance due to peripheral neuropathy, with stiff and contracted tendons or attachment of the muscle to the bones, can lead to the development of hammertoes, bunions, spurs and tiny fractures, with diabetic Charcot deformity (dislocation of bones). These deformities can lead to pain, infection, and ulcerations.


The best way to treat muscle and joint problems is to address any presenting anomalies. This is either with therapy and customised diabetic foot orthotics, to relieve pain or any discomfort. Customised diabetic foot orthotics can also help prevent further deterioration of the joint changes.


4. Recurrent Infection

People with diabetes become more prone to infections due to medical and nutritional changes that take place in the body. The types of infection that they are susceptible to include bacterial, fungal and yeast infection. Bacterial infections are the major infected that need immediate medical attention. If left untreated, it can lead to serious complication, such as amputation and death. Bacterial infection can occur secondary to injury or ulceration or even laceration (irritated skin). Bacterial infection of the skin is often referred to as cellulitis, and this can be presented with redness, swelling, warmth, pain and tenderness, and the presence of pus. This infection can spread to the bone, and bacterial infection of the bone are called osteomyelitis. Bacterial infection can be painful even neuropathy or numbness in the feet or lower leg is present. Therefore, pain can be used as an indication of bacterial infection if the diabetic individual has neuropathy. If this occurs, treatment should not be delayed and should seek immediate medical attention.


Fungal or yeast infection in the foot are often associated with fungal infection of the skin (tinea pedis) or fungal infection of the toenails. In tinea pedis, skin can become blistered, scaly, red, inflamed and painful. A chronic tinea pedis also can lead to bacterial infection and this increases the level of pain further.  Fungal toenails can result in thickening of the toenails and deposits of fungal debris under the nails causing severe irritation to the skin surrounding the nails. It may also lead to ingrown and callused nail grooves. Ingrowing toenail can further lead to bacterial infection as well. Fungal treatment modalities may vary for each condition, but it is important to treat it earlier to prevent it from spreading further, reducing the risk of ulceration and infection.