People with diabetes have good reason to pay close attention to their feet.

Diabetes patients with foot wounds — especially deep or long-lasting wounds — and circulatory problems are at much higher risk to require hospitalization and even amputation.

So says a study in June’s issue of Diabetes Care. The study comes from Lawrence Lavery, DPM, MPH, and colleagues. Lavery is a professor in the surgery department of Texas A&M University. He also works at Scott and White Hospital in Georgetown, Texas.

Lavery’s study included 1,666 diabetes patients who had their feet screened and were taught about diabetes and foot care.

Patients who developed foot infections were nearly 56 times more likely to require hospitalization and more than 154 times as likely to have a foot amputated, compared with those without foot infections, the study shows.

Focusing on Feet

“Foot wounds are now the most common diabetes-related cause of hospitalization and a frequent precursor to amputation,” write Lavery and colleagues. They add that people with diabetes are 30 times more likely to have a leg or foot amputated than those without diabetes.

Why are foot problems more troublesome with diabetes? It has to do with diabetes’ effect on nerves and feeling in the feet.

For example, anyone can get a scrape or blister on their foot. Someone with diabetes who has impaired sensation in the feet might not notice that wound as soon as someone without diabetes. If foot problems fester, infection can set in and eventually cause more serious problems that may require amputation.

Participants in Lavery’s study were enrolled in a program that focused on preventing and treating foot complications in diabetes patients. They had their feet carefully checked by a podiatrist and nurse, and they were taught about diabetes and foot care.

Over the next two years or so, 151 patients — about 9 percent of the entire group — developed 199 foot infections. Thirty-five of them had more than one foot infection during the study.

Wounds Open the Door to Infection

Foot wounds were, by far, the most common risk factor for foot infections. All but one of the foot infections seen in Lavery’s study were tied to foot wounds.

Wounds literally leave the body open to infection. Foot wounds seen in Lavery’s study included burns, punctures, cuts, trauma, and even ingrown toenails.

Some wounds were more troublesome than others, in terms of infection. Wounds that lasted more than 30 days and cut down to the bone were particularly likely to become infected, the study shows.

Patients with poor blood circulation in their legs (peripheral vascular disease) were also more likely to have foot infections. Circulatory problems might make it harder to clear up infections or injuries, the researchers note.

High Rate of Foot Infections

The study shows the “relatively high incidence of foot infections in people with diabetes, even those who have been subjected to intensive efforts to prevent foot complications,” write Lavery and colleagues.

There is a “high amputation risk associated with foot infections in diabetic patients,” the researchers note. “Fortunately,” they continue, “the risk factors associated with foot wounds and infection are all easily detected by a simple screening foot examination, allowing preventative efforts to be targeted to those at greatest risk.”

The bottom line: If you have diabetes, take care of your feet — including foot screening at every medical appointment — and watch out for foot wounds.

Those steps may not totally rule out foot problems, but there’s no downside to good foot care.

“Although foot complications occurred despite our interventions, successful preventative efforts could potentially dramatically reduce the high rate of the potentially devastating problems in individuals with diabetes,” write Lavery and colleagues.

By Miranda Hitti, reviewed by Louise Chang, MD

SOURCES: Lavery, L. Diabetes Care, June 2006; vol 29: pp 128-1293. WebMD Medical News: “Diabetes: 3 Commonly Missed Tests.” News release, Rosalind Franklin University of Medicine and Science.