The monetary impact is staggering. Infection may more common in the diabetic, and once established it is more severe and much more difficult to treat. Infection occurs more frequently in diabetics with longstanding disease and multiple secondary complications. Infection impairs metabolic control leading to worsening hyperglycemia, ketoacidosis, and further impairment of host defense mechanisms. Infection is a major pathway to ultimate amputation.
Trivial infections can have disastrous effects.
The natural cushioning and compliance of the foot are diminished. As toes claw, weight remains concentrated on metatarsal heads. Sensory neuropathy with its attendant vibratory and proprioceptive loss lead to frequent foot injury, unrecognized and not felt by the patient. Autonomic and sympathetic nervous system deficits cause vasodilation, arteriovenous shunting, and edema. This leads to decreased local nutrition, and dry hyperkeratotic skin which fissures and ulcerates.