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How does diabetes cause structural problems in the feet ?

Under the 2nd toe knuckle is particularly vulnerable

The most common structural problems in the feet are: retracted or clawed toes, bunions, prominent metatarsal heads (the knuckles on the bottom of the ball of the foot) and areas of increased pressure that lead to corns, callus or ulceration. Those with diabetes can suffer from glycosylation of the collagen.  This means that the abnormally high blood sugar causes the soft tissue, things like skin, muscles and joint capsules, to stiffen up and contract.  Toes will tend to become deformed and the bouncy fat beneath the skin thins down which makes the skin more easy to damage. All feet take a lot of pressure in daily life and these issues can increase that pressure by a factor of 500% in some places, creating pressure areas where the skin may break down or become ulcerated. Podiatrists make shoe inserts that can either make the foot function better or deflect the pressure away from problem areas, preventing or healing ulcers. To read this Q&A session as a single handbook, or to access the downloadable / printable version, please browse to our Diabetes Info Sheet. Alternatively, use this link to return to the Podiatry FAQs Blog.

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