Diabetes is a systemic disease, but its most dangerous complications often begin at the feet. Lower extremity problems are one of the leading causes of diabetes-related hospitalizations, and each year in the United States approximately 130,000 lower-limb amputations are performed on people with diabetes. The sobering statistic rarely mentioned alongside that figure: up to 85 percent of those amputations are preceded by a wound or ulcer that could have been prevented or treated early with proper foot care.
Understanding how diabetes affects your feet — and what you can do about it — is one of the most important things a person with diabetes can know.
How Diabetes Affects the Feet
Diabetes damages the feet through two primary mechanisms: neuropathy and poor circulation.
Diabetic peripheral neuropathy is nerve damage caused by chronically elevated blood sugar. It typically develops gradually and affects the longest nerves first — those running to the feet. Symptoms include numbness, tingling, burning, or a "pins and needles" sensation. In more advanced neuropathy, the feet may feel very little or nothing at all. This loss of protective sensation means a blister, a cut, or a pressure sore can develop and worsen for days or weeks without causing pain — the body's usual warning signal is simply absent.
Peripheral arterial disease (PAD), caused by diabetes-related changes to blood vessel walls, reduces circulation to the feet. Without adequate blood flow, the body's ability to fight infection and heal wounds is severely compromised. A small wound that would heal in days for a healthy person can take weeks or months in a person with diabetes — or not heal at all.
Together, these two factors create a dangerous environment: injuries that can't be felt and wounds that won't heal.
Why Small Injuries Become Serious
The sequence that leads to serious diabetic foot complications is often startlingly mundane at its start. A pebble in a shoe causes a blister. Walking barefoot on rough concrete abrades the skin. A toenail trimmed too short nicks the adjacent toe. In someone without diabetic complications, these are trivial inconveniences. In a person with neuropathy and reduced circulation, each of these can become an infected wound and, without timely care, a limb-threatening ulcer.
Infection also spreads differently in the diabetic foot. Reduced immune function means bacteria can progress rapidly into soft tissue and bone (osteomyelitis) before the patient or their family notices anything more alarming than mild redness.
Daily Foot Inspection Routine
Because neuropathy removes the body's self-reporting system, visual inspection must take its place. Every person with diabetes should inspect both feet completely every day. Use a mirror or ask a family member to help check the bottom of the feet and between the toes. Look and feel for:
- Cuts, cracks, blisters, or open sores of any size
- Redness, warmth, or swelling — signs of inflammation or early infection
- Changes in skin color, including darkening or pallor
- Unusual odor, which can indicate infection
- Thickened, discolored, or ingrown toenails
- Dry skin, calluses, or corns
- Any change in the shape of the foot or toes
If you find anything abnormal, do not wait to see if it resolves on its own. Contact your podiatrist promptly.
Call the Podiatrist Immediately If You Notice
- An open wound or ulcer of any size
- Redness or warmth spreading from a wound
- Fever, chills, or feeling generally unwell alongside foot symptoms
- A wound that has not begun to heal within a week
- Blackening or darkening of the skin (a sign of tissue death)
- Significant new swelling in one foot
These are not "wait and see" situations. Diabetic foot infections can progress to systemic sepsis or require surgical intervention in a matter of days.
Choosing Diabetic Footwear
Standard footwear is not designed with the diabetic foot in mind. Diabetic shoes feature extra depth to accommodate custom orthotics and swollen feet, seamless interiors that eliminate friction points, wide toe boxes, and soft, non-binding materials. Many patients with diabetes qualify for Medicare Part B coverage for one pair of therapeutic shoes and three pairs of custom insoles per year — ask our office about eligibility.
Avoid walking barefoot, even at home. Hard floors, scattered objects, and temperature extremes (hot pavement, cold ground) all pose risks for feet that cannot feel damage occurring.
Annual Comprehensive Foot Exams
The American Diabetes Association recommends a comprehensive foot exam at least once per year for all patients with diabetes, and more frequently for those with any history of foot problems. A comprehensive exam includes evaluation of protective sensation (monofilament testing), vascular assessment, skin and nail examination, and structural evaluation. These exams catch problems early — when they are still minor — and allow your care team to adjust your management plan proactively.
Learn more about our diabetic foot care services and our diabetic foot health patient education resources.
Big Sky Foot & Ankle provides comprehensive diabetic foot care at our Butte, Anaconda, and Bozeman offices. If you have diabetes and haven't had a foot exam in the past year, call us to schedule one — it is one of the most important preventive steps you can take.