Diabetes can quietly damage the nerves and blood vessels in the feet. Because the damage often reduces feeling, a small blister or cut can go unnoticed and turn into a serious ulcer. Diabetic foot problems are a leading cause of hospital admission and lower-limb amputation in people with diabetes, yet most amputations are preventable with good daily care and regular checks.
What diabetic neuropathy is
Diabetic peripheral neuropathy is nerve damage caused by years of raised blood sugar, often together with high blood pressure, high cholesterol, smoking and heavy alcohol use. It usually starts in the toes and feet, then may spread up the legs and to the hands in a “stocking and glove” pattern. It is very common: up to about half of people with diabetes develop it over time.
Early signs
- Tingling, pins and needles or a “buzzing” feeling in the feet
- Burning, sharp or electric-shock pains, often worse at night
- Numbness, or feeling as if you are wearing socks when you are not
- Reduced ability to feel temperature, so you may not notice very hot bath water
- Feeling unsteady, especially in the dark
- Very sensitive skin, where even bed sheets feel painful
Some people have no symptoms but still have reduced sensation that their doctor can detect.
Why it leads to foot ulcers
- Loss of protective sensation: you may not feel a stone in your shoe, a tight shoe rubbing, or a burn
- Changes in foot shape: nerve damage weakens small foot muscles, leading to hammer toes and pressure points
- Dry, cracked skin: nerves that control sweating are affected
- Poor circulation: peripheral artery disease is common in diabetes and slows healing
- Higher infection risk: high blood sugar weakens the immune response
A minor injury can become an open sore (ulcer) that gets infected and, if it reaches bone, may lead to amputation.
Get your feet checked
Everyone with diabetes should have a comprehensive foot exam at least once a year. This includes testing sensation with a monofilament (a thin nylon fiber) and a tuning fork, checking pulses, and examining skin, nails and foot shape. People with neuropathy, poor circulation, a previous ulcer or foot deformities need checks more often, usually by a podiatrist.
Ask your doctor to look at your bare feet at every diabetes visit.
Keep reading
The rest of this guide is free. Watch a short ad to unlock it and support independent health writing.
Preparing your ad…
Daily foot-care routine
- Check your feet every day, including the soles and between the toes. Use a mirror or ask someone to help. Look for cuts, blisters, redness, swelling, calluses or color changes.
- Wash your feet daily in warm (not hot) water. Test the temperature with your elbow or a thermometer, not your feet. Dry carefully, especially between the toes.
- Moisturize the tops and bottoms of your feet to prevent cracking, but not between the toes, where moisture encourages fungal infection.
- Trim toenails straight across and smooth sharp edges. If you cannot see or reach them, or nails are thick, see a podiatrist.
- Never walk barefoot, indoors or outdoors.
- Wear well-fitting shoes with plenty of room for your toes, and check inside them for stones or rough seams before putting them on. Break new shoes in gradually.
- Wear clean, dry socks without tight elastic or thick seams.
- Do not treat corns or calluses yourself with blades or medicated corn plasters. See a podiatrist.
- Avoid heating pads and hot water bottles on your feet.
Managing neuropathy
There is no cure for nerve damage that has already occurred, but you can slow it and ease symptoms:
- Improve blood sugar control. Keeping HbA1c near target slows progression.
- Control blood pressure and cholesterol, stop smoking and limit alcohol.
- Check vitamin B12 levels, especially if you take metformin, since low B12 can cause or worsen neuropathy.
- Medicines for painful neuropathy include duloxetine, pregabalin, gabapentin and certain antidepressants such as amitriptyline. Topical capsaicin can help some people.
- Stay active with low-impact exercise suited to your feet, such as cycling or swimming, if you have reduced sensation.
When to get urgent care
Contact your doctor or podiatrist the same day if you notice:
- A blister, cut or sore that is not healing
- Redness, warmth or swelling in the foot
- Drainage or a bad smell from a wound
- A change in skin color, especially black or blue areas
- A sudden change in foot shape or a hot, swollen foot without injury, which can be Charcot foot, a serious bone and joint complication
Seek emergency care if a foot wound comes with fever, chills or spreading redness.
Insurance coverage
Medicare Part B covers a foot exam and treatment every six months for people with diabetic neuropathy and loss of protective sensation. It also covers therapeutic shoes and inserts for eligible people with diabetes, when prescribed. Many private plans offer similar coverage.
The bottom line
Diabetic neuropathy can take away the warning signals that protect your feet. Check your feet every day, wear proper shoes, never walk barefoot, and have a professional foot exam at least once a year. Report any wound that is slow to heal. Most diabetes-related amputations can be prevented with early action.
This article is for general information and does not replace medical advice.