Do you experience those annoying pricks and pain in your foot after a long day at work? Most of us don't really pay attention to it and just wait until it goes away on its own. However, what if I told you that your feet are trying to send you a message? - A message that it could be something more serious! Yes, Diabetes is one of the most common reasons for foot pain. According to a survey (NDSS) in 2021, 1 in 20 people are suffering from diabetes in Australia. The prevalence of this disease is higher among men as compared to women (3:1) and, specifically, in those above 40 years. Keeping in view the burden of this disease, we must understand what diabetes is and its connection with foot pain.

Understanding Diabetes

Just like a car runs on fuel, humans run on glucose, which acts as fuel for our bodies. This fuel (glucose) comes from the food that we eat. It goes from the gut to the blood, and from there, it is absorbed by the body cells. Now, the blood sugar in your blood should always be within normal limits (70 -100mg/dl ), i.e., neither too high nor too low. A hormone called insulin, produced by the pancreas, is responsible for maintaining this blood sugar within limits and helping glucose get into your cells so they can be used for energy. Diabetes is a condition where the blood sugar level stays high either because the body is not making enough insulin (Type 1) or the available insulin is not being used efficiently (Type 2).

Connection between our feet and diabetes: 

You might be thinking, what is the connection between high blood sugar levels and foot pain? Although there are few empirical studies of foot pain in diabetic patients, clinical experience shows that many impairments, often seen at hospitals, start with simple foot pain. So, does it happen overnight? No. Over a period of time, a high amount of sugar circulating in the blood damages the small blood vessels and nerves in your extremities - especially your legs and feet. This pain can lead to foot ulcers and later infections if not treated right. So, two of the most common reasons are mentioned below:

Peripheral artery disease (PAD): As we go from the body’s midline to the periphery, our blood vessels become narrower and narrower to supply oxygen-rich blood to every body tissue. If, due to any reason, these arteries are blocked or narrowed even further, such as plaque, fat deposits or uncontrolled diabetes, it can lead to poor circulation of blood, which means a lack of oxygen available to surrounding tissues, leading to a condition called PAD. Often, it is recognised by pain, numbness, and coldness of feet with or without leg cramps. Sometimes, it is accompanied by hair loss on the skin as well.

Peripheral neuropathy: In peripheral neuropathy, nerves provide sensation to the body, and there are many nerve endings at your feet, which is why they are the most ticklish part of your body. But imagine those nerve endings not being able to sense any stimulus. So, diabetes, over a period of time, causes damage to those small nerve endings, which leads to diabetic neuropathy. It is recognised by pain, lack of sensation and burning of feet. This can lead to altered biomechanics of the foot, which can be further challenging to treat at later stages.

Early recognition

Think of it as your body's way of telling you that something is not right up there. So go and check your health, please. First and foremost, you must recognise the signals your feet send—either tingling, cramps, constant pain, lack of sensation or a combination of them.

Professional help

Once you have recognised the signs, it's time to seek professional help from a physiotherapist or related health care professional. For pain management, they often recommend TENS, massage therapy or low-intensity laser therapy. Evidence has been provided for the use of these modalities. But always remember that your physical therapist can help you relieve that pain and prevent further problems from occurring, but cannot completely cure it. Diabetes is not a disease that can be treated with certain medications and therapies only. You need a lifestyle modification, including a balanced diet and regular exercise.

Regular Exercise

You do not have to set high goals like running 4 miles daily. A brisk walk of a minimum of 30 minutes, if done five times a week, can drastically affect your blood sugar levels. Always remember that every time you walk, you are improving insulin sensitivity. For people with type 1 diabetes, monitoring your blood glucose levels before exercise is essential. It is better to consume carbohydrates first if it is less than 70mg/dl.

Monitoring Blood Sugar Level

The best way to avoid pain is to monitor your blood sugar levels. In 2016, a study conducted by the National Institute of Diabetes and Digestive Kidney Disease showed that people who managed their blood glucose levels with insulin therapy had a reduction in peripheral neuropathy symptoms such as pain, tingling and burning. So controlling your blood sugar levels will help prevent peripheral neuropathy and also help ease its effects.

Lifestyle Modifications

Other lifestyle modifications include quitting smoking, avoiding a sedentary lifestyle, reducing cholesterol levels and making small changes such as taking stairs instead of a lift to your office, constantly checking your feet and toes and taking the required steps to help you manage your diabetes and avoid foot pain.

Conclusion

So, as we wrap this up, remember that the next time your foot gives you a hint that something is not right, you should get yourself properly checked before the condition progresses. Foot pain can be a sign of diabetes, especially if accompanied by other symptoms such as burning or tingling. However, not every foot pain needs to be related to diabetes. There may also be other reasons, such as low back pain radiating towards the foot or foot-related diseases, such as congenital arthritis or plantar fasciitis. Healthcare professionals must properly examine and rule out any other condition before starting treatment for foot pain related to diabetes.

References

1. Rijken, P., Dekker, J., Dekker, E., Lankhorst, G., Bakker, K., Dooren, J., & Rauwerda, J. (1998). Clinical and functional correlates of foot pain in diabetic patients. Disability and rehabilitation, 20(9), 330-336.
2. Stoekenbroek, R. M., Lokin, J. L., Nielen, M. M., Stroes, E. S., & Koelemay, M. J. (2017). How common are foot problems among individuals with diabetes? Diabetic foot ulcers in the Dutch population. Diabetologia, 60, 1271-1275.
3. Ulbrecht, J. S., Cavanagh, P. R., & Caputo, G. M. (2004). Foot problems in diabetes: an overview. Clinical Infectious Diseases, 39(Supplement_2), S73-S82.