Amy Tenderich was diagnosed with type 1 diabetes in May of 2003. She is the founder and editor-in-chief of Diabetes Mine and co-authored the book Know Your Numbers, Outlive Your Diabetes. You will frequently find her speaking at diabetes, health, and social media events across the country.

Diabetes can cause problems, literally head-to-toe. And the damage that can occur to your feet is no joke.

While most of us have a vague idea that diabetic feet need special care, we usually don’t look into the details until it’s absolutely necessary—in other words, when things are already going wrong.

That’s why I’d encourage you—whether you’ve experienced trouble with your feet to date or not—to take a moment to learn about foot health with diabetes.

There’s a lot of power in the notion of “know thy enemy.” Do you really know why foot damage occurs with diabetes?

Many people assume that foot complications stem from impaired circulation caused by atherosclerosis (or narrowing of the arteries), just as atherosclerosis in the heart and head can lead to heart attacks and strokes.

This isn’t actually true. While circulation changes certainly contribute to foot problems, a larger factor is neuropathy, which means injury to the nerves—in this case to the small sensory nerves in the feet.

Neuropathy is more likely to occur if your A1c (average blood glucose level) remains high over time. One of the biggest dangers here is that the numbness neuropathy can cause in your feet often goes unnoticed by you.

A common scenario is that a person with foot neuropathy steps on something sharp, or gets a blister or scratch, and does not notice the injury. Untreated, it then becomes infected and festers (ewww, I know, but this is what leads up to the need for amputation).

How do you know if you have loss of sensation in your feet? Try running a feather or other soft object across the sole of your foot. Can you feel it? That’s a basic home test just to give you a start.

More important is the test your doctor will do: a check for decreased sense of vibration in your feet using a tuning fork (128 Hz or low C, for the musically inclined). They will give this funny-looking “fork” a whack so that it vibrates intensely, and then hold it against your foot to check whether you are able to detect the vibration.

With decreased sensory input, your feet are more at risk for injury, partly because they are not constantly making the small micro-corrections that you need to keep your balance and to move the pressure points on your feet around. With neuropathy, any decreases in blood flow to large or small vessels increases the chance of damage to your feet.

NOTE: Smoking has a major negative impact here. Even if you’re not worried about the other side effects of smoking—lung cancer, emphysema, strokes, and heart attacks—please be kind to your feet and keep trying ways to stop smoking cigarettes.

Other articles in this series:

With Neuropathy, No Pain Isn't Always a Good Sign
Diabetic Neuropathy Symptoms: Beware of Tingling Feet
How to Prevent Diabetes Foot Damage
How to Check Your Feet for Signs of Diabetic Neuropathy, Sores