Diabetic foot damage, especially nerve damage (neuropathy) from long-term high blood sugar, is generally not fully reversible, but its progression can be stopped or slowed significantly, and symptoms managed to improve quality of life. Early-stage issues like blisters or infections can often heal, but permanent nerve or circulatory damage requires aggressive management through strict blood sugar control, proper foot care (podiatry), healthy lifestyle changes (diet, exercise, no smoking), and sometimes medication to prevent worsening and complications like ulcers or amputation.
What is the treatment for diabetes-related foot conditions?
Autonomic neuropathy can also cause erectile dysfunction (ED) when it affects the nerves that control erection with sexual arousal. However, sexual desire does not usually decrease. Diarrhea can occur when the nerves that control the small intestine are damaged. The diarrhea occurs most often at night.
Each year, diabetic foot ulcers affect nearly 18.6 million people globally, contributing to more than 1.6 million amputations annually. These devastating outcomes are not only preventable but reversible when interdisciplinary care and a systematic approach to diabetic limb preservation are employed.
Diabetic neuropathy has no known cure. The goals of treatment are to: Slow the disease from getting worse. Relieve pain.
Good glycemic control, the only proven treatment for diabetic neuropathy in humans (1), is only known to prevent the development or halt the progression of the disease and has not been shown to reverse established lesions.
If you have diabetes, you can develop nerve problems at any time. Sometimes, neuropathy can be the first sign of diabetes. Significant nerve problems (clinical neuropathy) can develop within the first 10 years after a diabetes diagnosis. The risk of developing neuropathy increases the longer you have diabetes.
Most people with diabetic neuropathy are unaware that they have nerve damage, until it is picked up on routine screening by their doctor or when they develop complications. Although there is no cure, early diagnosis and treatment can improve quality of life and reduce the risk of further complications.
What is the rule of 50 for diabetic foot? The rule of 50 describes poor outcomes in certain cases: 50% of patients with diabetic ulcers have poor circulation, 50% become infected, and 50% of infected ulcers lead to amputation. That's why early care matters.
The 5 stages of diabetic foot ulcers generally progress from a healthy foot (Stage 1) through increasing severity: a high-risk foot (Stage 2, with calluses/blisters), a shallow ulcer (Stage 3), a deeper infected ulcer (Stage 4, involving bone/tendon), and finally gangrene or necrosis (Stage 5, tissue death, often needing amputation). Management focuses on preventing progression, especially in earlier stages, through good foot care, blood sugar control, and addressing neuropathy and poor circulation.
By keeping tight control over your blood glucose, you may be able to reduce the symptoms associated with neuropathy, or avoid them altogether. By keeping your A1C at 7% or less, you'll be taking control of your blood glucose, and increasing your chances of avoiding neuropathy.
Common nerve healing signs include
With improved blood sugar management, symptoms of diabetes-related neuropathy like numbness and other abnormal sensations may fade within one year. The more severe neuropathy is, the less likely it is that it'll be reversible.
Diabetic foot ulcers are one of the most serious complications of diabetes, arising from neuropathy, peripheral arterial disease, and impaired wound healing. These ulcers predispose patients to infections, osteomyelitis, gangrene, and amputation, contributing to high morbidity and mortality.
A podiatrist is an important part of any diabetes health care team. At The Walking Clinic, our team of podiatrists are specifically trained in diabetes foot care and can assess nerve damage, identify specific foot health risks and help come up with a treatment and prevention plan.
Self-Care Don'ts
A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours means you have diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) means you have prediabetes.
Visit your regular doctor or foot doctor if you have any of these symptoms: Tingling, burning, or pain in your feet. A change in the color and temperature of your feet. Dry, cracked skin on your feet.
Even though foot ulcers are more likely to develop in patients with diabetic nephropathy, they are no less likely to heal than are those in diabetic patients with normal renal function. Consequently, attempts to save the diabetic foot even in this high-risk population are justified.
Usually a peripheral neuropathy can't be cured, but you can do a lot of things to prevent it from getting worse. If an underlying condition like diabetes is at fault, your healthcare provider will treat that first and then treat the pain and other symptoms of neuropathy.
Why does diabetes cause pain in your feet? When you have diabetes, high blood sugar levels can damage nerves and blood vessels. The nerves and blood vessels supplying the feet are long and delicate. Because of that, the feet — and especially the toes — often get affected first.
Peripheral sensorimotor neuropathy
In fact, some individuals with neuropathy eventually end up needing to use a wheelchair because of the lack of balance, numbness, and discomfort that tends to accompany late-stage neuropathy.
Recognizing these subtle improvements is key to understanding your progress. Reduced numbness in the hands and feet is a positive sign that the nerves are regenerating and sensation is returning. Tingling or a pins-and-needles sensation is a common early sign.
Numbness, Tingling, and Pain in the Extremities
These are some of the earliest symptoms you might experience during the first stage of diabetic neuropathy. You may also have burning sensations in your extremities or experience sensitivity to touch.