People with diabetes are prone to serious foot infections, ulcers  and other foot conditions that can begin with a scratch or bunion. Most of these problems, however, are easy to prevent. Following a regular program of diabetes care, foot care and hygiene can promote good health and can prevent hospitalizations, amputations and other drastic measures.

Diabetes increases the risk of foot problems for many reasons:

• Diabetic neuropathy (nerve damage)
• Suppressed immune system
• Hyperglycemia (high blood glucose)
• Impaired circulation
• Hyperlipidemia (high levels of fat in the blood)
• Peripheral arterial disease
• High blood pressure

These risk factors create a cycle that make the feet susceptible to infections and complicate healing. For example, diabetic neuropathy impairs the ability to feel pain. An individual may not be able to feel a blister caused by tight shoes. Ignored, this blister can become an open wound that allows infection to enter. Excess sugar in the blood aids the spread of the infection. Hyperlipidemia and peripheral arterial disease worsen circulation. The reduced blood flow adds to suppression of the immune system by hindering infection-fighting white blood cells. The compromised immune system fails to stop the infection. The infection worsens into a system-wide problem that weakens the body, further impairs the immune system and sets the stage for another cycle.

A program of diabetic foot care, however, can help a patient avoid these complications. Such a program should include:

• Controlling glucose, blood pressure and cholesterol
  
• Skin care including daily hygiene and inspection
  
• Toenail care to prevent ingrown nails and other problems
  
• Proper footwear to avoid blisters and other potentially serious injuries
  
• Control of risk factors such as smoking, diet and lack of exercise
  
• Routine medical care to catch problems early and avoid complications