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Why can diabetes mellitus increase the risk of foot ulcers and amputation?

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An anatomical illustration of the human pancreas shows its location near the stomach and intestines, a detailed cross-section highlighting ducts and the islet of Langerhans, and an inset of pancreatic tissue histology with labeled alpha, beta, and delta cells. — diabetes mellitus The islets of Langerhans are responsible for the endocrine function of the pancreas. Each islet contains beta, alpha, delta, and pancreatic polypeptide (PP) cells that are responsible for the secretion of pancreatic hormones. Beta cells secrete insulin, a well-characterized hormone that plays an important role in regulating glucose metabolism.

Diabetes mellitus increases the risk of foot ulcers and amputation primarily through two major pathways: vascular disease and nerve damage.

Vascular Complications

Chronic diabetes can lead to atherosclerosis, a condition where large arteries become narrowed or blocked. When this affects the arteries supplying the legs, it significantly reduces blood flow to the feet. A severe, chronic decrease in circulation prevents proper healing of minor injuries, which can progress to ulceration, tissue death, and gangrene, often necessitating surgical removal of the affected limb.12

Neuropathy

Patients with diabetes frequently develop diabetic neuropathy, most commonly symmetric polyneuropathy. This condition causes a loss of sensation in the feet, meaning patients may not feel minor cuts, blisters, or pressure sores. Because these injuries go unnoticed and untreated, they are highly susceptible to infection and rapid progression into deep ulcers. The combination of impaired healing due to poor circulation and the inability to detect foot trauma creates a high risk for serious complications.1