Diabetic Foot: Problems, Symptoms and When to Get Help

Diabetic foot is the name for foot problems caused, or made worse, by diabetes. It covers nerve damage, poor circulation, infection, wounds and changes in the shape of the foot. This guide explains why diabetes affects your feet, the main problems, how your risk is checked in the UK and when to get help quickly.

What does diabetic foot mean?

NICE, which sets guidance for the NHS, defines a diabetic foot problem as one caused by loss of feeling (peripheral sensory neuropathy), poor circulation (peripheral arterial disease) or both. It includes foot ulcers, skin and soft tissue infection, deep damage such as heel pressure sores, osteomyelitis (bone infection) and Charcot foot.¹

Specialists worldwide also use a wider term, 'diabetes-related foot disease', which includes gangrene and amputation.²

Most foot problems are not caused by diabetes itself. But diabetes and high blood sugar can make an everyday problem, like a blister or a toe injury, serious much more quickly.⁵

Why does diabetes affect the feet?

Over time, high blood glucose (blood sugar) can damage the nerves and small blood vessels that supply your feet.³ Four things usually work together:

• Nerve damage (neuropathy). You may lose feeling in your feet and not notice a stone in your shoe, a rubbing seam or a burn. Diabetes is the most common cause of this nerve damage in the UK.⁶
• Poor circulation (peripheral arterial disease, or PAD). Narrowed arteries carry less blood to your feet, so cuts and sores heal more slowly.⁷ Up to half of people with a diabetes-related foot ulcer have PAD. It makes poor healing, gangrene and amputation more likely.²
• Infection risk. Any break in the skin lets germs in.⁵ A mild or moderate infection often causes no fever or feeling of being unwell, so it is easy to underestimate.²
• Pressure and changes in foot shape. Nerve damage can change the shape of your foot and how your weight passes through it. Areas of high pressure build up hard skin (callus). This raises the pressure further and can lead to bleeding under the skin and, in time, an ulcer.²

This can happen with type 1 or type 2 diabetes. The NHS lists foot ulcers and infections as long-term complications of type 2 diabetes that can sometimes lead to amputation.⁸

The main diabetic foot problems

Nerve damage and foot pain

Nerve damage can cause tingling, burning or shooting pain, or take away feeling without any pain, which is easy to miss.⁶ Read more about diabetic foot pain and nerve damage.

Skin changes, spots and rashes

Dry skin, cracks, fungal infections and skin conditions linked to diabetes are common. Some are harmless; others are early warning signs. Our page on red spots, rashes and other skin changes explains how to tell them apart.

Blisters, calluses and corns

These are signs of too much pressure or rubbing and can come before an ulcer. Find out why blisters and calluses matter and how to look after them safely.

Foot ulcers

An ulcer is an open wound that needs prompt care from a health professional. See our guide to diabetic foot ulcers.

Infection

Infection can start in an ulcer, crack or blister and spread deeper, even into the bone. Learn how foot infections are recognised and treated. Deep or complicated infections may need infectious diseases specialist review as part of a wider team.

Charcot foot

In Charcot foot, the bones and joints of a numb foot are damaged and the foot can change shape. It often shows up as a red, hot, swollen foot.¹ Read about Charcot foot and its warning signs.

Poor circulation and gangrene

If the blood supply is badly reduced, sometimes with infection too, tissue can die (gangrene).¹⁰ Our page on gangrene in the diabetic foot and amputation risk explains how foot teams work to prevent it.

Nail problems

Thick, discoloured or ingrown toenails can damage the skin around them. If you think you have a fungal nail infection, see a GP.¹¹

Common symptoms to look out for

See your GP or local foot protection team if you notice any of these:³

• tingling, burning pain or loss of feeling
• swollen feet
• wounds that do not heal
• cramp in your calves
• shiny, smooth skin or hair loss on your legs and feet

Nerve damage can hide pain, so looking at your feet matters as much as how they feel. Our page on early diabetic foot symptoms groups these by cause and explains which need help the same day.

Who is at risk? NICE foot risk levels

Every adult with diabetes in the UK should have their foot risk checked at diagnosis and at least once a year.¹ There are four risk groups:

Source: NICE NG19.¹

After each check, ask which group you are in. Diabetes UK says people with diabetes are up to 20 times more likely to have an amputation, so foot problems need prompt action.⁵

How diabetic foot problems are assessed in the UK

The annual foot check

At a foot check, a trained professional examines both feet with your shoes, socks and any dressings off. They test for nerve damage with a 10 g monofilament (a thin nylon thread pressed on your skin). They also look for reduced blood supply, ulcers, callus, infection or inflammation, deformity, gangrene and Charcot foot.¹ The check is part of your annual diabetes review and is free on the NHS.³ Read what happens at your annual foot review.

Being referred to a foot protection service

If you are at moderate or high risk, you should be referred to a foot protection service, led by a specially trained podiatrist (foot specialist). First appointments should be within 2 to 4 weeks for high risk and 6 to 8 weeks for moderate risk. The service looks after your skin and nails, checks your footwear needs and checks your circulation.¹

The hospital foot team

Problems the foot protection service cannot manage go to the hospital foot team (the multidisciplinary foot care service). It includes diabetes doctors, podiatrists, vascular and orthopaedic surgeons, microbiologists and wound care staff.¹

Can foot problems in diabetes be prevented?

Most foot problems can be prevented with good foot care and yearly checks.³ What you can do:

1. Check both feet every day, including between your toes and the soles.⁴
2. Keep your blood sugar, blood pressure and cholesterol as close to target as you can, and get help to stop smoking.⁴
3. Wear well-fitting shoes and socks, indoors and outdoors, rather than going barefoot.²
4. Ask a podiatrist to deal with corns and hard skin, rather than using blades or corn plasters.⁴

Our section on looking after your feet every day covers washing, nails and footwear.

When to get help urgently

While you wait, keep weight off the foot.⁵ This website cannot assess a diabetic foot emergency, so always use local NHS services first. Our page on when to seek urgent help has a fuller checklist.