Diabetic foot

Over time, diabetes can damage two things in the feet: the nerves and the arteries. Damaged nerves (neuropathy) mean you may not feel a cut, a blister or a tight shoe. Narrowed arteries mean less blood reaches the foot, so a wound heals slowly and infection takes hold more easily.

Together these turn a small, unnoticed injury into a wound or ulcer that will not heal. Infection can then spread quickly into deeper tissues and bone.

This is why diabetic foot problems need early, organised care. Most serious problems, including amputation, start with a small wound. Finding it early and restoring good blood flow give the foot the best chance to heal.

Anyone with diabetes can develop foot problems, but the risk is higher if you have:

Diabetes for many years, or sugar that is often poorly controlled

Numbness, tingling or burning in the feet

Weak foot pulses or calf pain on walking

Smoking, high blood pressure or high cholesterol

Kidney disease, including patients on dialysis

A previous foot ulcer or amputation

Hard skin, corns, deformed toes or poor eyesight that makes self-checks difficult

Everyday habits matter too. Walking barefoot, ill-fitting shoes and cutting corns at home are common starting points for a wound.

The doctor looks closely at both feet, checks the pulses and tests sensation. Any wound is measured and examined for depth and signs of infection.

The circulation is then assessed with simple, painless tests:

A duplex Doppler scan of the leg arteries

The ankle–brachial index (a blood pressure comparison between ankle and arm). Because diabetes can make arteries stiff, toe pressures or Doppler wave patterns may also be used.

An X-ray may be needed if infection could have reached the bone, and blood tests check sugar control and infection. Bring your latest sugar readings, your medicines and any previous scans or reports, and wear shoes and socks you can remove easily.

Diabetic foot care is a programme rather than a single procedure. It usually combines:

Specialist wound care: regular cleaning, removal of dead tissue and the right dressings.

Treating infection: antibiotics, and sometimes draining an abscess or removing infected tissue.

Offloading: taking pressure off the wound with special footwear, insoles or a cast, because a wound under pressure cannot heal.

Restoring blood flow (revascularisation): if the arteries are narrowed, they are opened with a balloon or stent through a pinhole, or a bypass is performed, so that enough blood reaches the wound.

Shared care with your diabetologist: better sugar, blood pressure and cholesterol control help every other step work.

If part of a toe or foot is already beyond saving, a limited operation may be needed to protect the rest of the foot.

Diabetic foot wounds heal slowly, often over weeks to months, even when blood flow has been restored. Regular dressing visits and keeping pressure off the wound are essential, so expect several follow-up appointments.

Once the wound has healed, the risk of a new one stays higher than before. Prevention then becomes the main goal:

Check both feet every day, using a mirror or a family member for the soles

Never walk barefoot, even at home

Wear well-fitting shoes and check inside them before putting them on

Keep sugar, blood pressure and cholesterol under control, and stop smoking

Keep your follow-up visits, including circulation checks if your arteries were treated

If you have diabetes, book a circulation check if you have weak foot pulses, calf pain on walking or numbness in the feet.

Contact the clinic the same day if:

A cut, blister or wound has not started to heal within a few days

A toe changes colour, becomes pale, blue or dark

The foot becomes red, warm or swollen, even without pain

Go to the emergency department straight away if:

Redness or swelling is spreading quickly up the foot or leg

You have fever, shivering or feel generally unwell with a foot wound

There is pus, a bad smell, or a toe or area of skin turns black

The foot suddenly becomes cold, pale and painful

Remember that nerve damage can hide pain, so do not wait for a wound to hurt.