A variety of factors work in unison to cause foot problems in people with diabetes. These mainly involve poor circulation and nerve disease (neuropathy). Neuropathy affects your ability to feel pain or discomfort in your feet, making you more susceptible to extensive injury-related damage. Also, diabetes can impair your ability to heal by both damaging your immune system and decreasing the blood flow in your legs. This can lead to bone and joint deformities, such as Charcot foot.

Diabetes can also affect your vision, making it harder for you to notice sores or injuries to your feet. You may not notice an injury or infection until your condition is so serious that you require surgery, possibly removal (amputation) of your foot and even part of your leg.

Risk factors for developing foot ulcers include:

• Age. Risks increase with age.
• Gender. Males are at higher risk.
• Race. African Americans, Hispanic Americans, and Native Americans are at higher risk.
• Duration of diabetes. The longer you have diabetes, the greater your risk.
• Other complications from diabetes (small blood vessel disease or atherosclerosis of large blood vessels).
• Poor blood glucose control. Having blood sugar levels above a target blood sugar range over time speeds up the damage to blood vessels and nerves.
• Smoking, which contributes to blood flow problems in your extremities.