Diabetes and Your Feet: How to Prevent and Treat Foot Pain
Diabetes-related foot pain (also called diabetic foot neuropathy) is a common complication that happens to many people with diabetes. It happens to those with both type 1 and type 2 diabetes. The longer you have diabetes and the less controlled your blood sugar is, the more likely it is you will develop foot pain or discomfort at some point.
How does diabetes affect the health of my feet?
Diabetes-related foot pain is mainly caused by high blood sugar levels. Over time, high levels of sugar in the blood damage both the nerve endings and blood vessels throughout the body. This combination causes nerve pain and poor circulation.
The feet are especially prone to poor circulation because they’re so far away from the heart. Diabetes-related nerve pain can appear in the hands, but most people who experience it feel it in their feet first.
Other factors that can increase your risk of developing diabetes-related foot pain include being overweight, kidney disease, and smoking.
What does foot pain from diabetes feel like?
The most common symptoms of diabetes-related foot pain include:
Tingling. This is a “pins and needles” kind of sensation.
Pain or increased sensitivity. This is pain or sensitivity to what are normally not painful things. It could be pain from bed sheets brushing against your feet or feeling like certain socks are uncomfortable or painful to wear.
Numbness or weakness. Nerves help you feel, and they tell your muscles to work. When people tell me, “I don’t feel when I step on things or cut my feet,” or they bring up that their legs often feel weak when they stand up, I begin to suspect nerve damage.
Cut and wounds heal slower. Healthy blood vessels carry immune cells to wounds to help fight infections and repair the damaged tissue. If blood circulation is poor, which can happen in diabetes, those wounds take longer to heal.
What should I do if I have these symptoms?
If you start to notice any unusual sensations or pain in your feet or hands, schedule an appointment with your doctor. They’ll can do a quick test to see if your feet can feel properly. It involves your doctor brushing a soft piece of nylon (called a monofilament) along different areas of your feet as you keep your eyes closed and say “yes” every time you think you feel it.
If you have diabetes, your doctor will likely perform this test at least once a year to catch nerve problems early and help stop them from getting worse. They may also suggest that you meet with a foot doctor (podiatrist). If your doctor thinks you really do have nerve damage, they could ask you to have additional tests done to see how serious it is, but these tend to be more invasive and are not recommended on a regular basis.
What are some risks if I don’t get treatment?
Diabetes-related foot pain is more than just pain; it’s a warning sign from your body. This type of nerve pain can lead to complications if you don’t see a doctor and get treated. Below are some of the problems that can come from untreated diabetes nerve pain:
Dry, cracked skin. This may not sound too bad, but when your skin is too dry, your risk of getting skin infections goes up. If this happens, plain petroleum jelly or unscented hand creams can help. Just avoid placing moisturizers between your toes.
Calluses. This is an area of thickened skin that has less feeling. People with diabetes get calluses faster and more often than those without diabetes. You can use a pumice stone daily to help keep them at a minimum. If they get really thick, a doctor can cut or shave them down. Never attempt to do this at home as it can lead to infections.
Ulcers. These are sores that happen to some people with diabetes due to poor blood circulation. All ulcers (no matter how small) need to be seen by a doctor. The longer you go without seeing a doctor, the more likely it is that it will become infected. Infected ulcers can spread and cause you to lose your foot or leg.
Amputations. If the previously listed complications are not treated properly, they can all become infected. Skin infections can cause the skin and muscle tissues to die. Once this happens, it can’t be fixed. The only way to stop the infection from continuing to spread is by amputating the infected limb.
What can I do to manage diabetes-related foot pain?
Unfortunately, once you have diabetes-related foot pain, it can’t be cured. Doctors can only try to prevent it from getting worse. Here are 5 things you can do at home to help manage your diabetes-related foot pain and prevent complications:
1) Check your feet.
Check the bottoms of your feet every morning when you wake up and every night before you go to bed. Look for cuts and wounds and anything else unusual. These may be signs that your feet are becoming less sensitive and that something is going on with the blood vessels and nerves in your feet.
2) Wear shoes around the house.
When you have diabetes-related foot pain, you can’t always feel when you step on things. Wearing shoes helps to prevent cuts and injuries.
3) Follow up with your doctor.
It’s important to attend your regular doctor’s appointments. Not only will your doctor be able to perform foot exams, but they can catch problems earlier on so you don’t end up with serious complications.
4) Maintain a healthy diet and exercise routine.
Just because diabetes-related foot pain isn’t reversible doesn’t mean it can’t be improved. Lowering high blood sugar by watching what you eat and exercising regularly can improve some symptoms of nerve pain. Both habits can help improve your blood flow as well, which will lower your risk for complications. Just remember to consult your doctor before starting any new diet or exercise plan.
5) Stop smoking.
Smoking increases your risk of experiencing the complications we discussed earlier. If you’re having trouble quitting, it’s worth bringing this up to your doctor, as they can recommend treatments and support groups that are right for you.
What are treatment options for the pain?
Along with taking the steps above, you should talk to your doctor if your foot pain is too much to bear. Diabetes-related foot pain is treated with medications that target nerve pain as well as medications for pain in general. Here are some of the most commonly recommended ones:
Pregabalin (Lyrica). Pregabalin is one of only a few medicines approved by the FDA to help relieve diabetes-related nerve pain and is usually taken 2 to 3 times a day. Unfortunately, the price tag on it—even the generic version—can be pretty high.
Duloxetine (Cymbalta). Duloxetine is another FDA-approved medication for diabetes-related foot pain. It provides the same amount of pain relief as Lyrica and only needs to be taken once a day. It also treats depression, so it can be useful if you need to treat both conditions.
Gabapentin (Neurontin). Gabapentin may be cheaper than pregabalin and duloxetine, depending on your insurance and pharmacy. Gabapentin provides some pain relief, but it isn’t considered by many doctors to be a first choice for foot pain from diabetes.
Amitriptyline (Elavil). Amitriptyline is an older medication that was used for years to treat all sorts of nerve pain, including nerve pain from diabetes. It’s cheap, but it’s rarely recommended because doesn’t work as well as other options and can cause a lot of side effects (especially if you’re over 65 year old).
Opioids. Opioid pain relievers should only be used as a last ditch effort when other options aren’t enough. Opioids have many side effects, including nausea, vomiting, constipation, and sleepiness, just to name a few, and they can lead to dependence and addiction.
Topical lidocaine and capsaicin. Topical gels and creams like lidocaine and capsaicin are available over the counter and are best for small areas of pain. They’re usually only suggested if you have very mild symptoms or if you can’t tolerate the side effects from oral medications.
In case you were wondering about popular over-the-counter pain relievers like acetaminophen (Tylenol), ibuprofen (Motrin, Advil), and naproxen (Aleve), it’s important to know that these won’t work for foot pain from diabetes. They don’t improve nerve pain, and worse, they can cause side effects.
Can I prevent diabetes-related foot pain?
The best way you can prevent diabetes-related foot pain is by managing your diabetes as best as you can. Remember, high sugar levels is what causes the nerve pain. By managing your blood sugar levels through diet, exercise, and medications, you’re taking steps to prevent the various complications of diabetes.
If you’re already experiencing diabetes-related foot pain, it’s still important to manage your sugar levels. As we discussed, lowering your blood sugar can actually improve your symptoms. Talk to your doctor to discuss proper foot care and the best treatment options for you.
CREDIT: GOOD RX
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