Diabetes and Foot Infections

Written by Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE , Nicole Joseph
Reviewed by Lisa Brown, RD, LD, CDE

Foot infections are a common problem for people living with both type 1 diabetes and type 2 diabetes. An infection may develop following a foot injury, laceration, or ulcer, and this infection can worsen over time if left untreated. Additionally, nail fungal infections can grow and spread across the foot. Foot infections pose special risks for people with diabetes, since they may go unnoticed for extended periods of time, and they may be more difficult to treat.

Foot infections are usually classified as being mild, moderate, or severe. Mild infections may remain near the surface of the skin, while severe infections often go deeper into the foot and may even affect the bone. Since diabetes is the leading cause of nontraumatic lower-limb amputations in American adults1, it is important for people with diabetes to take care of their feet to avoid infections, or to stop them from getting worse.

People with diabetes may have foot infections that are:

Difficult to Feel
Diabetic peripheral neuropathy (DPN) is a condition in which your nerves become damaged as a result of diabetes. If you have poor blood glucose control and experience lots of high blood glucose levels, your nerves may, over time, become damaged. Damaged nerves may fail to send messages to your brain alerting it that your body is injured and should be feeling pain. Approximately 60% to 70% of people who have diabetes also suffer from some type of neuropathy.2

This means that you may have a foot infection (or a blister, wound, or ulcer that can lead to infection), and not even know it. Since many blisters and ulcers occur on the bottoms of the feet, infections may go unnoticed until they have progressed to a severe stage.

Difficult to Fight
In healthy adults, the body’s immune system acts as a guard against a number of external threats, including harmful bacteria and a range of infections. However, for people living with chronic diseases, including diabetes, the immune system may be suppressed.

This means that your body may have a hard time fighting off infections and engaging in natural healing processes. If a sore or ulcer develops on your foot, it may heal slowly, making you more vulnerable to infections.

Difficult to Treat
Besides a suppressed immune system, many people with diabetes have circulation problems. That means that if you're given an oral antibiotic to treat an infection, your body many not be able to effectively move the medication through your bloodstream and to the site that needs it. 

Peripheral arterial disease—a condition in which narrowed blood vessels lead to decreased blood circulation in the legs and feet—affects approximately 1 in 3 people over the age of 50 living with diabetes.3

Steps to Prevent Foot Infections
Proper foot care is critical for preventing infections in people with diabetes. Remember these C’s:

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Diabetes and Foot Care