DIABETES AND OTHER PROBLEMS WITH THE HANDS, FEET, AND
The connective tissue in the
hands and around joints can be affected by diabetes, especially after many years of the disease. In the hands
and feet there is a layer of collagen (fascia) under the skin. Thickening of this fascia in the hands leads to a
condition called Dupuytren’s contractures, causing an inability to straighten ﬁ ngers, and also a condition
called trigger ﬁ nger. When the condition gets severe, surgery may be necessary. Dupuytren’s contractures occur
in the absence of diabetes, but it is about ﬁ ve times as common in people with diabetes. An inﬂ ammation of
the fascia in the foot can lead to a condition called plantar fasciitis, causing heel pain severe enough to
prevent walking. Treatment includes stretching exercises and a night splint, orthotics, physical therapy, and
nonsteroidal anti-inﬂ ammatory drugs. If these do not work, steroid injections can be tried.
The connective tissue around
the joints can also be affected, leading to a decrease in joint ﬂexibility, usually seen in hand, shoulder, and
hip joints. People with diabetes are also at risk for frozen shoulder—a condition where there is pain,
stiffness, and loss of movement at the shoulder joint. Treatment is pain control and physical therapy—it usually
gets better, but it may take a year or so.