Diabetes-Related Foot Conditions

Overview

People with diabetes often have problems with their feet. They may develop foot develop sores, deformities and infections more easily.

If not treated quickly, a foot ulcer or blister on a person with diabetes can get infected. Sometimes a surgeon must amputate (remove) a toe, foot or part of the leg to prevent the spread of infection.

Foot problems often occur in people with diabetes, especially among those who have:

  • Nerve damage or poor blood flow in the feet.
  • Trouble managing blood glucose levels over long periods, including frequent episodes of hyperglycemia (blood sugar that’s too high).
  • A BMI of more than 25 (overweight/obesity).
  • Had diabetes for a long time.
  • High blood pressure or high cholesterol.

The chance that a person with diabetes will develop a foot condition at some time in their life is about 15%.

Symptoms and Causes

Long-term high blood sugar can cause a type of nerve damage called diabetes-related neuropathy. Diabetes-related neuropathy can occur throughout the body, but most often in the legs and feet.

The condition might make you lose feeling in your feet. If your feet are numb, you might not notice a blister, cut or sore. You might not even feel a pebble in your sock that is cutting your foot, for example. Wounds that go unnoticed and untreated can become infected.

Diabetes can also affect blood flow to your legs and feet. People with diabetes are more likely to develop peripheral artery disease (PAD). This condition causes arteries to become narrowed or blocked. Reduced blood flow (poor circulation) can make it difficult for a diabetes-related foot ulcer or infection to heal.

The signs of diabetes-related neuropathy may include:

  • Darkened skin on the affected area.
  • Diminished ability to sense hot or cold.
  • Loss of hair in the area.
  • Numbness.
  • Pain.
  • Tingling.

If diabetes-related neuropathy leads to foot ulcers, symptoms to watch out for include:

  • Any changes to the skin or toenails, including cuts, blisters, calluses or sores.
  • Discharge of fluid or pus.
  • Foul smell.
  • Pain.
  • Redness.
  • Skin discoloration.
  • Swelling.

Diagnosis and Tests

To diagnose diabetes-related foot conditions, a healthcare provider will:

  • Ask about your symptoms and how well you’re managing blood glucose.
  • Examine your toes, feet and legs.
  • Touch the toes, feet and legs with various tools to check whether you have numbness.

If a diabetes-related ulcer or blister is present, the healthcare provider will likely:

  • Examine it for any signs of infection, such as redness, swelling, warmth, discoloration or discharge.
  • Order tests to take pictures deeper than the skin, such as X-ray or MRI.
  • Take a sample of the skin or discharge to test for infection.

Management and Treatment

Care for diabetes-related foot pain may involve a doctor who specializes in the feet, called a podiatrist. Treatment may include:

  • Cleaning the wound.
  • Draining any fluid or pus from the ulcer.
  • Removing or cutting away dead or infected tissue (called debridement).
  • Applying special bandages and ointments to absorb extra fluid, protect the wound and help it heal.
  • Prescribing a wheelchair or crutches to take weight off the affected foot (called offloading).
  • Prescribing oral or IV antibiotics to control and eliminate infection.

Depending on how severe the infection is, your healthcare provider may recommend hospitalization. Sometimes amputation is necessary to prevent infection from spreading to other parts of the body.

Prevention

To avoid hyperglycemia and diabetes-related neuropathy, you should manage blood sugar carefully.

You can also reduce the risk of diabetes-related foot problems by:

  • Checking your feet every day for any changes. Don’t forget to look between your toes. Ask someone for help or use a mirror if needed.
  • Getting your feet checked at every visit with a healthcare provider.
  • Keeping your toenails trimmed and filed. Cut them straight across to prevent ingrown toenails.
  • Maintaining blood flow to the feet. For example, keep your feet elevated when you sit, and wiggle your toes often. Stay active, but choose activities that are gentler on the feet, such as walking or swimming.
  • Putting cornstarch or talcum powder between the toes to prevent moisture buildup.
  • Smoothing any corns or calluses.
  • Wearing socks and shoes (or slippers) all day. Make sure your socks aren’t too tight and that your shoes fit properly. Some people with diabetes wear therapeutic shoes or shoe inserts to help prevent wounds or sores.
  • Washing your feet every day in warm water, not hot. Dry them thoroughly afterward, including between the toes. Then apply lotion to the tops and bottoms of the feet, but not between the toes.

It’s just as important to avoid certain things. Don’t:

  • Cut calluses or corns or apply chemicals.
  • Smoke.
  • Soak your feet.
  • Walk around barefoot.
  • Wear tight socks or shoes.

Outlook / Prognosis

Diabetes-related foot ulcers are fairly common in people who have had diabetes for a long time. Even with foot checks and careful blood glucose monitoring, some people with diabetes develop infections.

The outlook depends on factors such as:

  • How early the wound was found.
  • Presence of infection and how much it spreads.
  • Treatment effectiveness.

If the infection can’t be controlled and spreads too far, amputation may be necessary.

Living With

If you have diabetes, tell your healthcare provider right away if you experience:

  • Any changes in foot shape.
  • Any changes to the skin on the feet, including a wound, redness or darkness, warmth or a funny smell.
  • Hair loss on your toes, feet or legs.
  • Loss of feeling in the toes, feet or legs.
  • Pain, tingling, burning or cramping in the feet or legs.
  • Thick, yellow toenails.

What other conditions can affect the feet of people with diabetes?

People with diabetes also can develop Charcot foot, a rare complication that can cause permanent deformity. In Charcot foot, nerve damage weakens the bones and joints. The bones can break, and the joints can dislocate or collapse.

Read more about preventing diabetes complications.

A note from Cleveland Clinic

People with diabetes are at risk for ulcers and infections, which may go unnoticed in people with diabetes-related neuropathy and numbness. If you have diabetes, it’s important to care for your feet every day and report any problems to your healthcare provider. Early treatment can prevent hospitalization, deformity and amputation.

Last reviewed by a Cleveland Clinic medical professional on 04/26/2021.

References

  • American College of Foot and Ankle Surgeons. Diabetes Complications and Amputation Prevention. (https://www.foothealthfacts.org/conditions/diabetic-complications-and-amputation-prevention) Accessed 4/10/2021.
  • American Diabetes Association. Foot Complications. (https://www.diabetes.org/diabetes/complications/foot-complications) Accessed 4/10/2021.
  • American Orthopaedic Foot & Ankle Society. The Diabetic Foot and Risk. (https://www.footcaremd.org/conditions-treatments/the-diabetic-foot/the-diabetic-foot-and-risk) Accessed 4/10/2021.
  • Centers for Disease Control and Prevention. Diabetes and Your Feet. (https://www.cdc.gov/diabetes/library/features/healthy-feet.html) Accessed 4/10/2021.
  • Kruse I, Edelman S. Evaluation and treatment of diabetic foot ulcers. (https://clinical.diabetesjournals.org/content/24/2/91) Clinical Diabetes. 2006;24(2):91-93. Accessed 4/10/2021.
  • National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes and Foot Problems. (https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/foot-problems) Accessed 4/10/2021.
  • National Library of Medicine. Diabetic Foot. (https://medlineplus.gov/diabeticfoot.html#cat_77) Accessed 4/10/2021.
  • Zhang P. Lu J, Jing Y, Tang S. Global Epidemiology of Diabetic Foot Ulceration: A Systemic Review and Meta-Analysis. Annals of Med 2016;49(2):1-21. Accessed 4/10/2021.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy