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 at the earliest signs of symptoms is key to preventing conditions from worsening. Here are 4 common foot problems encountered by people with diabetes.


1. Nerve Problems

Nerve problems affecting people with diabetes are often due to 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 actual cause. Symptoms of sensory neuropathy will include stabbing, tingling and burning pain. In painful sensory neuropathy, a mild touch or contact with the affected area may result in extreme pain. Paradoxically, neuropathy can also manifest as numbness in the feet.


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 increase rubbing of the foot in the shoes and callus formation as well as inflammation of the skin, eventually leading to the development of foot deformities.


The third type is autonomic neuropathy. This form of neuropathy affects the sweating mechanism and other regulatory mechanisms we take for granted. Symptoms include thickened, dry cuticles and nails, as well as dry and cracked skin. These symptoms can be painful and put the feet at greater risk of bacterial or fungal infection.


There 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, long term blood sugar control is critical to preventing these developments. If symptoms have arisen, diabetic shoe insoles also play a role in relieving these pains. Orthotic insoles not only help improve and stabilise imbalances in walking/gait, but also offer form-fitted contouring to protect and reduce irritations to the at-risk diabetic foot.


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, partially or completely blocking blood flow to the lower legs and feet. This reduces the efficiency of oxygen delivery in the blood to and from tissues or body parts. Lack of oxygen to the muscles and limbs can be extremely painful. The arteries that are commonly affected are those behind the knee and the calf.


Veins take blood from the periphery back to the heart, but there can be more blood than the veins can handle. When veins get overloaded, the valves preventing the backflow of blood may be damaged. Damaged valves cause blood to pool in the feet and lower legs. This pooling of blood may leak into the skin, appearing as darkened skin, and eventually lead to leg ulcers.


There are several therapies and treatment modalities that can improve circulation problems in people with diabetes. A thorough assessment of the lower legs would be conducted before deciding on therapies and treatments suitable for the patient.


3. Muscle and Joint Problems

Muscle and joint pain affect not only 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 stress fractures. Charcot deformity is the one of the most serious complications of the diabetic foot. These foot deformities can lead to pain, loss of mobility, and foot ulcerations.


The best way to safeguard diabetic feet from muscle and joint problems is to address any presenting anomalies. This is either with therapy or customised diabetic foot orthotics, and can help relieve pain and discomfort. Customised foot orthotics specifically designed for diabetics can also help prevent further deterioration of the joints.


4. Recurrent Infection

People with diabetes become more prone to infections due to medical 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 major infections that require immediate medical attention. If left untreated, it can lead to serious complications, such as gangrene and subsequent amputation, and even death. Bacterial infection can occur secondary to injury, ulceration or even skin rashes. Bacterial infection of the skin is often referred to as cellulitis; this can present as pus, redness, swelling, warmth, and tenderness. Bacterial infection can deepen to the bone, complicating treatment and often requiring hospitalisation. Bacterial infection can be painful even when neuropathy or numbness in the feet or lower leg is present. Therefore, pain can be an indication of bacterial infection if the diabetic individual has neuropathy. If this occurs, the patient should seek immediate medical attention.


Fungal infection of the foot (tinea pedis) or toenails is quite common. In tinea pedis, the skin can become blistered, scaly, red, inflamed and itchy. A chronic tinea pedis can lead to opportunistic bacterial infection. 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 toenails, which can further lead to bacterial infection as well. Antifungal treatment modalities may vary for each condition, but it is important to treat it early to prevent the fungus from spreading further.