There are three major triggers for foot problems in people with diabetes:

• Weakened immunity. Poor control of glucose (blood sugar) can damage the immune system’s ability to fight infections. Elevated levels of glucose (hyperglycemia) can hinder immune cells from reaching the foot to fight invading microorganisms and infections.
   
• Peripheral neuropathy. Nerve damage is a common complication of diabetes. It often causes numbness. People with diabetes who suffer from numbness in their feet are less likely to recognize foot problems that arise. Broken foot bones are a particular problem for those with neuropathy. Nerve damage in the feet can also prevent the patient from sensing temperature. Patients are more likely to suffer burns from hot bath water, hot pavement, heating pads, radiators and space heaters.
  
  
• Peripheral arterial disease. People with diabetes are more likely to have abnormal levels of cholesterol and triglycerides, leaving them vulnerable to atherosclerosis. The resulting blockages and hardening of the arteries often impede blood flow. High blood pressure (hypertension), another condition associated with diabetes, can accelerate this process.

In addition, there are several other risk factors that make a person more likely to suffer diabetic foot problems. Diabetic men are more likely to have lower-extremity amputations than diabetic women, according to the National Diabetes Education Program. Other risk factors associated with foot ulcers and amputations include:

• History of 10 years or more with diabetes
• Diabetic retinopathy
• Cardiovascular problems
• Kidney problems
• History of skin ulcers
• History of bunions, corns or calluses
• Deformed foot bones
• Thick toenails