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What happens to the feet in diabetes
Over time, high blood sugar can harm your feet in two ways. Often both happen together. [Ref: IWGDF/ESVS/SVS 2023 Diabetes and PAD]
Nerve damage (neuropathy)
The feet feel numb, so you may not notice a cut, a blister or a tight shoe. A small injury can become a sore (a foot ulcer) before you know it is there.
Poor blood flow (PAD)
Plaque narrows or blocks the arteries of the leg, often below the knee. Less blood reaches the foot, so sores heal slowly and infection is harder to fight.
About half of people with diabetes and a foot ulcer also have peripheral artery disease (PAD). PAD makes poor healing, gangrene and amputation more likely. It is also a sign of higher risk of heart attack and stroke. [Ref: IWGDF/ESVS/SVS 2023 Diabetes and PAD]
Why it matters
About 1 in 13 Filipino adults has diabetes, and about half of them do not know it. [Data: IDF Atlas 2025]
Each year, about 2 in 100 people with diabetes get a foot ulcer. Up to 85 in 100 leg amputations that are not caused by an accident start with a foot ulcer. [Ref: IWGDF/ESVS/SVS 2023 Diabetes and PAD]
Warning signs
See your doctor soon if you notice any of these: [Ref: IWGDF/ESVS/SVS 2023 Diabetes and PAD] [Ref: IWGDF 2023 Practical Guidelines]
Numb, tingling or burning feetOr feet that feel like you are wearing socks when you are not.
A cut, blister or soreAny break in the skin of the foot, even if it does not hurt. A sore that is not getting better needs a check right away.
Signs of poor blood flowCold or pale feet, weak foot pulses, shiny skin with little hair, or calf pain when walking.
Foot pain at night or at restPain that eases when you hang your leg over the side of the bed can mean blood flow is very low.
PAD can be silent
In diabetes, nerve damage can hide the usual pain of PAD, and the foot may even feel warm. That is why regular foot checks by a health worker matter, even if you feel fine. [Ref: IWGDF/ESVS/SVS 2023 Diabetes and PAD]
What happens at your check-up
Everyone with diabetes should have a foot check at least once a year. Your doctor asks about your symptoms, looks at your feet and feels the pulses in your feet. [Ref: IWGDF/ESVS/SVS 2023 Diabetes and PAD]
If your doctor suspects PAD, or if you already have a foot sore, simple painless tests check the blood flow to your feet: [Ref: IWGDF/ESVS/SVS 2023 Diabetes and PAD]
Ankle-brachial index (ABI): compares the blood pressure at your ankle with your arm.
Toe-brachial index (TBI): uses a small cuff on the big toe. It is more accurate when the ankle arteries are stiff from calcium, which is common in diabetes.
Doppler sound waves: a small probe listens to the blood flow in the foot arteries.
Other tests if you have a sore: toe pressure or oxygen levels in the skin help predict how well the sore can heal.
No single test can rule out PAD, so these tests are used together. If a procedure is planned, an ultrasound, CT or angiogram maps the arteries from the belly down to the foot. PAD should also be checked before any planned foot surgery. [Ref: IWGDF/ESVS/SVS 2023 Diabetes and PAD]
How often to have your feet checked
| Your foot risk | Foot check by a health worker |
|---|---|
| No loss of feeling and no PAD | Once a year |
| Loss of feeling or PAD | Every 6 to 12 months |
| Loss of feeling or PAD, plus a foot deformity, or both together | Every 3 to 6 months |
| Loss of feeling or PAD, plus a past foot ulcer, a past amputation or kidney failure | Every 1 to 3 months |
[Ref: IWGDF 2023 Practical Guidelines]
Your doctor decides which tests you need and explains what the results mean for you.
Have diabetes? Get your feet checked.
A foot check by a doctor can find nerve damage and poor blood flow before a sore starts. Dr. Aaron Christopher P. Novales sees patients with diabetes and poor blood flow to the feet.
A foot sore with spreading redness, fever or black skin? Do not wait for a clinic visit. Go to the emergency room now →
How it is treated
About the medicines on this page
Medicines are described here only to help you understand your doctor's plan. Do not buy or take any medicine because you read about it here. Take only what your doctor prescribes for you, and never start, stop or change a dose on your own.
Care from a team
A foot ulcer with PAD is best treated by a team of health workers. Care includes cleaning the wound and removing dead tissue, taking pressure off the sore with special shoes or casts, treating infection quickly, and controlling blood sugar. [Ref: IWGDF/ESVS/SVS 2023 Diabetes and PAD]
Opening the blocked arteries
If poor blood flow is keeping a sore from healing, a procedure to restore blood flow (revascularization) may be needed. A vascular specialist decides when and how. [Ref: IWGDF/ESVS/SVS 2023 Diabetes and PAD]
A vascular specialist decides whether and when to open the arteries. An infected sore or gangrene needs urgent specialist care. If a sore is not clearly getting better after a few weeks of good care, see your doctor again so your blood flow can be rechecked.
The artery can be opened with a balloon or stent through a thin tube, or with a bypass that uses one of your own veins to go around the blockage. The goal is a clear path of blood to at least one artery of the foot. The choice depends on your health, your wishes, where the blockages are, and whether a good vein is available. Blood flow is checked again after the procedure. A procedure is not done when the chance of success is very low. [Ref: IWGDF/ESVS/SVS 2023 Diabetes and PAD]
Medicines that protect your heart and legs
People with diabetes and PAD have a high risk of heart attack and stroke. Your doctor will set targets for your blood sugar, blood pressure and cholesterol, and adjust your medicines to reach them. [Ref: IWGDF/ESVS/SVS 2023 Diabetes and PAD]
Your doctor may also prescribe a medicine that helps prevent clots. Some people at higher risk may need a second one.
For type 2 diabetes, some newer diabetes medicines also protect the heart. Your doctor will decide if they are right for you, and may pause some of them while a foot ulcer heals. Do not stop or change any medicine on your own. [Ref: IWGDF/ESVS/SVS 2023 Diabetes and PAD]
After the sore heals
About 4 in 10 people get a new foot ulcer within 1 year after a sore heals, and about 6 in 10 within 3 years. Keep up daily foot care, wear the shoes your foot team advises, and go to every foot check. [Ref: IWGDF/ESVS/SVS 2023 Diabetes and PAD] [Ref: IWGDF 2023 Practical Guidelines]
Daily foot care
Check both feet every day, including between the toes. Use a mirror for the soles, or ask a family member to help. [Ref: IWGDF 2023 Practical Guidelines]
Never walk barefootNot even at home. Socks alone or thin slippers do not protect your feet.
Wear shoes that fitNot too tight, with no rough edges. Feel inside your shoes before putting them on.
Wash and dry your feet dailyUse lukewarm water, not hot. Dry well, especially between the toes.
Moisturize dry skinUse lotion on dry skin, but not between the toes.
Cut toenails straight acrossDo not remove corns or calluses yourself with blades, acids or plasters. Let a health worker treat them.
No heat on your feetDo not use heaters or hot-water bottles. Numb feet can burn without you feeling it.
Wear clean socks without thick seams and change them every day. If you find a blister, cut, scratch or sore, see your doctor right away. [Ref: IWGDF 2023 Practical Guidelines]
Talk to your doctor about
Bring these questions to your visit.
- Do I have nerve damage or poor blood flow in my feet?
- What is my foot risk, and how often should my feet be checked?
- Should I have an ABI or toe pressure test?
- What shoes should I wear?
- Are my blood sugar, blood pressure and cholesterol at target?
Related conditions
Guideline sources for this page
- IWGDF/ESVS/SVS 2023 Diabetes and PAD: Fitridge R, Chuter V, Mills JL, et al. The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes and a foot ulcer. Diabetes Metab Res Rev 2024;40:e3686.
- IWGDF 2023 Practical Guidelines: Schaper NC, et al. Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update). Diabetes Metab Res Rev 2024;40:e3657.
- ACC/AHA/SVM 2024 PAD: Gornik HL, et al. 2024 ACC/AHA multisociety guideline for lower extremity PAD. Circulation 2024;149:e1313–e1410.
- IDF Atlas 2025: International Diabetes Federation. IDF Diabetes Atlas, 11th edition: Philippines (2024 estimates).