PATIENT EDUCATION
Diabetic Foot
Diabetes can affect the feet in two important ways: it can reduce sensation, so injuries may go unnoticed, and it can reduce blood supply, so wounds may heal poorly.
Why early attention matters
A foot problem that might be minor in someone without diabetes can become serious quickly when sensation or circulation is reduced. If you have diabetes, treat almost anything new on your foot as a reason to be assessed rather than simply watching and waiting.
Select a symptom below to view more information.
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Loss of Sensation or Numbness in the Feet
What you'll notice or feel
- Reduced ability to feel the ground, or a sense of walking on cotton wool.
- Numbness, tingling or burning, often beginning in the toes and gradually spreading upward.
- Symptoms usually affecting both feet fairly evenly.
- Not noticing small injuries, stones in your shoe or water that is too hot.
- Symptoms that may be worse at night.
Common causes
- Nerve damage from long-standing raised blood sugar.
- Poor blood sugar control over time, although neuropathy may also develop despite reasonable control.
- Vitamin B12 deficiency, which can coexist and worsen nerve symptoms.
- Other causes of nerve damage including thyroid disease, kidney disease or alcohol.
What it could be
- Diabetic peripheral neuropathy — commonly progressing slowly upward from the toes in a stocking-like pattern.
- Vitamin B12 deficiency contributing to nerve damage.
- Nerve compression at the ankle or originating from the lower back.
- Reduced blood supply contributing to symptoms.
Daily prevention and foot care
- Check both feet every day — including the soles, heels and between every toe.
- Use a mirror or ask someone to help if you cannot see the soles easily.
- Never walk barefoot, indoors or outdoors.
- Check inside your shoes with your hand before putting them on.
- Never use hot-water bottles, heaters or direct heat on your feet.
- Moisturise dry skin, but not between the toes.
- Cut nails straight across and do not cut corns or calluses yourself.
When to see a doctor urgently
- Any wound, blister, ulcer, crack or colour change — however small or painless.
- Sudden worsening of numbness or new weakness.
- A hot, swollen foot, with or without pain.
When to see a doctor
- Any new numbness, tingling or burning in the feet.
- If you have diabetes and have never had a formal foot assessment.
- If daily self-checking is difficult for you.
A Wound, Blister or Ulcer
What you'll notice or feel
- A break in the skin, often on the sole, heel, toe or over a bony prominence.
- A wound that may be completely painless if sensation is reduced.
- Discharge, staining on the sock or an unusual odour.
- Redness, warmth or swelling around the wound.
Common causes
- Repeated pressure or friction that goes unnoticed because of reduced sensation.
- Poorly fitting or rubbing footwear.
- Minor injuries such as stones, hot surfaces or cuts while trimming nails.
- Pressure over bunions or claw toes.
- Reduced blood supply preventing normal healing.
What it could be
- A diabetic foot ulcer caused by pressure and reduced sensation.
- A wound complicated by infection.
- An ulcer associated predominantly with poor circulation.
- Infection extending into the underlying bone (osteomyelitis).
What you can do while arranging urgent assessment
- Arrange medical assessment the same day or next day.
- Keep the wound clean and covered with a simple dressing.
- Keep weight off the affected foot as much as possible.
- Do not cut or debride the wound yourself.
- Do not apply home remedies or corn-removing preparations.
When to see a doctor urgently
- Any wound, blister or ulcer on a diabetic foot.
- Spreading redness, swelling, warmth, discharge or odour.
- Fever, feeling unwell or an unexplained rise in blood sugar.
- Dark or black tissue around the wound.
- A wound that suddenly becomes painless when it previously hurt.
When to see a doctor
- Any break in the skin that has not healed within a few days.
- Repeated wounds or blisters occurring at the same location.
A Hot, Red or Swollen Foot
What you'll notice or feel
- One foot noticeably warmer than the other.
- Swelling and redness.
- Possible change in the shape of the foot.
- The problem may occur with little or no pain.
- Sometimes it follows a seemingly minor injury.
Common causes
- Infection involving the soft tissues or bone.
- Charcot foot associated with nerve damage.
- Gout or another inflammatory joint disorder.
- A blood clot in the leg.
What it could be
- Foot infection, particularly when accompanied by a wound or fever.
- Charcot foot — weakening and collapse of bones and joints in a foot with nerve damage.
- Gout or inflammatory arthritis.
- A deep vein thrombosis requiring separate urgent assessment.
What you can do while arranging urgent assessment
- Stop walking on the foot.
- Keep weight off it until you have been assessed.
- Elevate the foot while resting.
- Do not apply heat.
- Do not assume that absence of pain means the problem is minor.
Seek same-day medical assessment if you have:
- Any hot, red or swollen foot with diabetes.
- Fever or feeling generally unwell.
- An unexplained rise in blood sugar.
- Any change in the shape or arch of the foot.
- Increasing swelling despite rest and elevation.
Colour Change, a Cold Foot or Pain at Rest
What you'll notice or feel
- The foot or toes becoming pale, blue, purple or unusually dark.
- One foot feeling colder than the other.
- Foot or toe pain at rest, often worse at night.
- Calf cramping when walking that improves with rest.
- Slow-growing nails, loss of hair or shiny skin.
Common causes
- Narrowing or blockage of arteries supplying the leg and foot.
- Smoking, high cholesterol and high blood pressure accelerating arterial disease.
- A sudden arterial blockage.
- Small-vessel disease affecting circulation to the toes.
What it could be
- Peripheral arterial disease.
- Severely reduced circulation producing pain at rest or non-healing wounds.
- An acute arterial blockage.
- Gangrene if tissue has become black and non-viable.
What you can do while arranging urgent assessment
- Arrange prompt medical assessment.
- Protect the foot carefully from injury.
- Do not apply direct heat to a cold foot.
- If you smoke, stopping is particularly important for arterial disease.
When to see a doctor urgently
- A suddenly cold, pale or painful foot — this is an emergency.
- Black or dark tissue on the foot or toes.
- Pain in the foot at rest, particularly at night.
- Any wound on a foot with poor circulation.
When to see a doctor
- Calf cramping during walking that consistently improves with rest.
- Gradual colour or temperature changes.
- If reduced foot pulses have previously been identified.
Callus, Deformity or Nail Problems
What you'll notice or feel
- Thickened hard skin, particularly under the ball of the foot or heel.
- Clawed or curled toes, or development of a bunion.
- Thickened, discoloured or ingrown nails.
- A dark spot within a callus, which may represent bleeding or an ulcer underneath.
Common causes
- Abnormal pressure distribution caused by foot deformity or altered walking.
- Nerve damage affecting the small muscles of the foot.
- Poorly fitting footwear.
- Fungal nail infection.
What it could be
- Callus caused by abnormal pressure — an important warning sign for future ulceration.
- Claw toes associated with nerve damage.
- A bunion or other structural deformity creating excessive pressure.
- Fungal or ingrown nails that can provide an entry point for infection.
Daily prevention and foot care
- Have significant callus treated professionally.
- Never cut, shave or file callus yourself.
- Do not use corn plasters or chemical corn removers.
- Wear properly fitted, wide and deep footwear.
- Continue daily foot inspection.
- Have nails treated professionally if you cannot see or reach them safely.
When to see a doctor urgently
- A dark spot, bleeding or discharge beneath a callus.
- Redness, warmth or swelling around a nail or deformity.
- Any break in the skin.
When to see a doctor
- New or increasing callus.
- Progressive toe deformity.
- Difficulty finding suitable footwear.
- Thickened or ingrown nails requiring professional care.
- Routine preventive diabetic-foot review.
YOUR CONSULTATION
What to Expect at Your Visit
- The doctor will ask about the duration and control of your diabetes, other complications, smoking and previous foot problems or ulcers.
- Both feet will be examined, including the soles and between the toes, with attention to skin, foot shape, pressure areas and footwear.
- Sensation may be formally tested using a monofilament and tuning fork, and the pulses in the foot will be assessed.
- A handheld Doppler may be used when more detailed assessment of circulation is required.
- If there is a wound, its depth and surrounding tissues will be assessed. Blood tests or other investigations may be needed when infection is suspected.
- Imaging may include X-rays, MRI for selected deeper infections or Charcot changes, and vascular investigations when blood supply is inadequate.
- Treatment may involve offloading, wound care, footwear or orthotics, treatment of infection, assessment of circulation and optimisation of diabetes control.
* IMPORTANT: A Note Before You Go
Pain is not a reliable measure of seriousness in a diabetic foot. Reduced sensation means that significant wounds, infection or Charcot changes can sometimes develop with surprisingly little pain.
Daily inspection and early assessment of new changes are therefore among the most important ways of preventing serious diabetic-foot complications.