Diabetics’ toes turning black, also known as diabetic foot ulcers, is unfortunately a common complication of poorly managed diabetes. This condition is medically known as gangrene and it refers to the death of body tissue due to a lack of blood flow and oxygen. Gangrene most commonly affects the feet and toes because poor circulation is common in the extremities of diabetics. If left untreated, gangrene can be fatal as it allows infection to spread quickly. Understanding what causes diabetic foot ulcers and how to prevent their occurrence is crucial for diabetics.
What Causes Diabetics’ Toes to Turn Black?
There are a few key factors that can cause diabetics’ toes to turn black:
Nerve damage (neuropathy)
Over time, high blood sugar levels associated with diabetes can damage the nerves in the feet and toes. This nerve damage, known as diabetic neuropathy, causes decreased sensation. As a result, diabetics may not feel pain, heat, cold, or injury to the feet. Unnoticed wounds or foot irritations can develop into ulcers and infections.
Poor circulation (peripheral arterial disease)
Diabetes also causes damage to blood vessels reducing blood flow to the extremities. This problem is known as peripheral arterial disease (PAD). With inadequate blood supply, even small cuts or blisters can turn into serious ulcers and lead to tissue death and gangrene.
High blood sugar
Consistently elevated blood sugar levels affect nerve function and weaken the immune system. This makes it difficult for foot wounds to heal properly. High blood sugar also enables bacterial infections to spread quickly.
Foot injuries and wounds
Due to nerve damage and poor circulation, diabetics may not notice injuries and irritations to their feet and toes. Small cuts, blisters, or abrasions can go unnoticed and worsen over time. This provides an entry point for bacteria that can infect and kill tissue.
What Are the Stages of Diabetic Foot Ulcers?
Diabetic foot ulcers tend to follow a progression through several stages:
Stage 1: Discoloration
Early on, the affected toe may appear reddened, purplish, or dusky. There may also be skin discoloration or light drainage from a blister or wound. This stage indicates compromised circulation. Proper treatment can still heal the tissue.
Stage 2: Partial Thickness Skin Loss
As tissue damage continues, a crater-like ulcer forms. The wound penetrates through the epidermis and dermis layers of skin. There is drainage and dead tissue but the fat layer beneath the skin is not exposed.
Stage 3: Full Thickness Skin Loss
The full thickness of skin is lost, exposing the subcutaneous fat. The wound appears deep with drainage and sloughing of dead tissue. Osteomyelitis (bone infection) may be present. Urgent treatment is needed to heal the ulcer and prevent its spread.
Stage 4: Necrosis
The ulcer causes damage below the skin into muscles, tendons, and bones. Toes appear blackened and shriveled as the tissue dies (necrosis). Gangrene has set in, indicating advanced progression. Amputation may be required.
| Stage | Description |
|---|---|
| Stage 1 | Discoloration |
| Stage 2 | Partial Thickness Skin Loss |
| Stage 3 | Full Thickness Skin Loss |
| Stage 4 | Necrosis |
What Are the Symptoms of Black Toes in Diabetics?
The primary symptoms indicating a diabetic’s toes are turning black include:
- Discolored, purple, bluish or blackened toes
- Numbness in the feet or toes
- Pain, burning or tingling sensations in the feet
- Ulcers, blisters, cuts or sore spots on toes
- Foul-smelling wound drainage
- Skin that is cold to the touch
- Loss of hair on toes and feet
- Difficulty walking
These symptoms should prompt immediate medical attention to prevent progression of tissue damage and infection. Gangrene and foot ulcers should always be treated as a medical emergency.
Risk Factors
Certain diabetics are at greater risk of developing blackened toes and foot ulcers:
- Poor blood sugar control – Consistently high blood glucose levels increase risk.
- Longer duration of diabetes – The longer someone has diabetes, the more chance of nerve damage.
- Foot deformities – Bunions, hammertoes, etc. lead to friction and injury.
- Peripheral arterial disease (PAD) – Reduces blood flow to extremities.
- Peripheral neuropathy – Nerve damage in the feet causes loss of sensation.
- Smoking – Constricts blood vessels exacerbating circulation problems.
- Kidney disease – Associated with poor circulation.
- Retinopathy – May impair vision resulting in inadequate foot inspection.
- History of foot ulcers – Prior ulcers increase risk of recurrence.
- Trauma or injury to the feet – Even small cuts can progress to infection.
Diabetics with several of these risk factors need to be exceptionally cautious and proactive with foot care.
Diagnosis
Doctors can use several methods to diagnose diabetic foot ulcers:
- Medical history – Discussing diabetes duration, blood sugar control, neuropathy symptoms, etc.
- Physical exam – Looking for wounds, testing reflexes, assessing circulation.
- Blood tests – Evaluating white blood cell count, blood sugar, and markers of infection.
- Tissue or fluid cultures – Testing for bacterial infection in wounds.
- Imaging tests – X-rays, CT scans, MRIs check for bone infection and deterioration.
- Peripheral arterial disease testing – Includes ankle-brachial index, Doppler ultrasound exam of blood vessels.
Early diagnosis and treatment provides the best chance of healing damaged tissue before gangrene sets in.
Treatment
Treatment focuses on healing the ulcer, improving circulation, and preventing complications.
Wound Care
– Keeping the wound clean and free of infected tissue. This may involve surgical debridement.
– Using wet-to-dry dressings to clean and cover the wound.
– Promoting healing with medicated ointments.
– Offloading pressure on the wound using devices like casts or special boots.
Antibiotics
– Oral or intravenous antibiotics to resolve bacterial infection.
– Topical antibiotics applied directly to the wound.
Surgery
– Angioplasty or vascular bypass surgery improve blood flow to the feet.
– Amputation of blackened, dead toes or feet is necessary if gangrene progresses extensively.
Glycemic Control
– Tight regulation of blood sugars with insulin, oral medications, and diet to support healing.
Compression Stockings
– Special stockings improve venous circulation in the legs and feet.
Home Care and Prevention
Diabetics can reduce their risk of developing blackened toes and foot ulcers by:
– Checking feet daily for wounds, blisters, irritation or discoloration and seeking prompt treatment for any abnormalities. Using a magnifying mirror aids in inspection.
– Keeping blood sugars under tight control through medication, diet and exercise. Get regular A1C testing.
– Quitting smoking to maximize circulation.
– Wearing well-fitted shoes and socks that do not rub or irritate feet. Avoid going barefoot.
– Treating minor foot injuries like blisters immediately to prevent infection.
– Using moisturizing creams to prevent dry, cracked skin.
– Asking your doctor about prescription orthotics or special diabetic shoes.
– Doing non-weight bearing exercises like swimming to avoid foot trauma.
– Getting annual podiatry checkups to assess foot health.
When to See a Doctor
Consult a podiatrist or medical professional urgently if you notice any of the following:
– Discoloration, sores, blisters, drainage or bad odor in a toe or foot
– Pain, burning, tingling, numbness in the feet
– Signs of infection like fever, increased pain, redness, swelling
– Difficulty walking or loss of balance
– Changes in foot temperature
– Loss of hair on the toes or feet
Catching and addressing diabetic foot problems early is key to preventing tissue death and gangrene. Prompt medical help can circumvent amputation. Do not wait as delaying treatment allows ulcers and infection to spread quickly in diabetics.
Outlook for Black Toes in Diabetics
With early intervention, many cases of diabetic foot ulcers and gangrene can be successfully treated with wound care, antibiotics and improved circulation. However, recurrence is common if diabetes management and foot care are not optimized. In severe cases, gangrene may necessitate partial or full amputation of the affected foot or limb.
The outlook is best when diabetics are proactive about blood sugar control and foot monitoring. Working closely with your healthcare providers and adhering to your treatment regimen can help avoid diabetes complications like blackened toes. You play a crucial role in preventing and reversing this condition.
Conclusion
Blackened, dead toes in diabetics result from a combination of nerve damage, poor circulation, high blood sugar and foot injuries. This allows wounds to worsen and infection to set in, killing off tissue. Gangrene most commonly starts in the extremities like toes. Catching it early is key, so inspecting feet daily and seeking prompt treatment for any abnormality is essential. With proper blood sugar control, wound care, antibiotics and circulation improvement, many cases can be healed. However, diabetic foot ulcers can recur easily and may lead to amputation if gangrene becomes severe. Being vigilant about diabetes management and foot health is necessary to avoid this adverse outcome.