Diabetic Foot Pain
Diabetes affects the nerves of the foot
Involvement of nerves is probably the most common complication of diabetes, and 50% of diabetics will experience nerve damage (polyneuropathy) eventually. The approach to diabetes, what is called “pre-diabetes,” can cause the loss of the small nerve fibers in the feet that sense pain, touch, and temperature. By the time diabetes is diagnosed, 10-18% of patients already have nerve damage in their feet. It is most often symmetrical, in both feet, but with continued sensory loss, the nerve problems and the complications that arise from them are prone to rise higher to involve the legs.
Who is at risk for diabetic foot pain?
Nerve damage due to diabetes is related to vascular damage. Every tissue in the body requires oxygenation and this requires an adequate blood supply. The vascular disease from diabetes injures the nerves by affecting the blood supply to them. Therefore, those diabetics with additional cardiovascular disease are at higher risk for diabetic foot pain, specifically:
- Those with high triglycerides
- Obese patients
- Older patients
- Those with hypertension
A global perspective
All of these risk factors should be addressed by the doctors who manage the diabetes, but since all of these put patients further at risk for the vascular disease that can complicate their diabetes, the greatest overriding risk–and the first and foremost risk to address–is the poor sugar control that partners negatively with the vascular disease. Seeing all of these contributions together is the proper way to evaluate and address diabetic foot pain.