Type 2 diabetes feet complications arise when persistently high blood glucose damages nerves and blood vessels in the lower limbs. Peripheral neuropathy reduces sensation, meaning injuries often go unnoticed, whilst poor circulation impairs healing and infection control. Together, these mechanisms can transform minor cuts or blisters into serious ulcers or infections. Approximately 10% of people with diabetes will develop a foot ulcer, yet up to 80% of diabetes-related amputations are preventable with good glycaemic control, daily foot inspection, and timely professional care. Understanding how diabetes affects your feet empowers you to take protective action and seek help early when problems arise.

How Type 2 Diabetes Affects Your Feet

Type 2 diabetes can have significant effects on foot health through two primary mechanisms: peripheral neuropathy and peripheral arterial disease. Persistently elevated blood glucose levels can damage the small blood vessels that supply nerves in the feet, leading to diabetic peripheral neuropathy. This condition reduces sensation, meaning you may not feel pain, temperature changes, or minor injuries such as blisters, cuts, or pressure sores. Without the protective warning system that pain provides, small problems can progress unnoticed.

Simultaneously, diabetes accelerates atherosclerosis—the narrowing and hardening of arteries—which reduces blood flow to the lower limbs. Poor circulation impairs the body's ability to heal wounds and fight infection. When neuropathy and poor circulation occur together, even minor foot injuries can develop into serious complications, including ulcers and, in severe cases, tissue death requiring amputation.

The risk of developing foot problems increases with longer diabetes duration, poor glycaemic control (elevated HbA1c), smoking, high blood pressure, high cholesterol, previous foot ulcer or amputation, and chronic kidney disease. Approximately 10% of people with diabetes will develop a foot ulcer at some point, making foot care an essential component of diabetes management. Understanding these mechanisms helps explain why daily foot inspection and proper footwear are not merely recommendations but vital preventive measures.

Maintaining good blood glucose control remains the most effective way to reduce the risk of diabetic foot complications. Many amputations are preventable with good diabetes management and timely foot care; Diabetes UK reports that up to 80% may be preventable. NICE guidelines (NG19) emphasise that optimal diabetes management, combined with regular foot surveillance and integrated care, can prevent most serious complications.

Common Foot Problems in Type 2 Diabetes

People with type 2 diabetes are susceptible to several specific foot conditions. Diabetic foot ulcers are the most serious complication, typically developing on pressure points such as the ball of the foot or under the big toe. These open sores may appear painless due to neuropathy but can quickly become infected and extend into deeper tissues, including bone. Heavy callus or bleeding under callus can mask underlying ulceration, so any callus with discolouration or blistering over pressure points warrants prompt review.

Calluses and corns form more readily in diabetic feet due to abnormal pressure distribution caused by neuropathy-related changes in foot structure. If calluses become too thick, they can break down underneath, forming ulcers. Regular removal by a podiatrist is important. Do not use corn plasters or chemical callus removers (such as salicylic acid preparations), as these can damage skin and are contraindicated in many people with diabetes. Attempting self-treatment with sharp instruments also risks injury.

Fungal infections, particularly athlete's foot and fungal nail infections, are more common and persistent in diabetes. The warm, moist environment inside shoes provides ideal conditions for fungal growth, and reduced immune function can make these infections harder to clear. Cracked skin from fungal infections creates entry points for bacterial infection.

Charcot foot is a less common but serious condition where bones in the foot weaken and can fracture with continued walking. The foot may become deformed, red, and swollen, though often without significant pain due to neuropathy. If your foot is red, hot, and swollen, or you suspect Charcot foot, stop weight-bearing immediately and seek same-day assessment by the multidisciplinary foot care service. Early recognition and treatment with immobilisation are essential to prevent permanent deformity.

Other problems include dry, cracked skin (due to autonomic neuropathy affecting sweat glands), ingrown toenails, blisters from poorly fitting shoes, and hammertoes or bunions resulting from muscle imbalance caused by nerve damage. Each of these seemingly minor issues requires prompt attention in people with diabetes to prevent progression to more serious complications.

Warning Signs of Diabetic Foot Complications

Recognising early warning signs of diabetic foot complications can prevent serious outcomes. Any break in the skin—including cuts, blisters, grazes, or cracks—should be treated as potentially serious, even if painless. The absence of pain does not indicate the absence of a problem; neuropathy may mask significant injury. If a break in the skin is not improving within 7 days, or sooner if worsening, seek medical advice.

Changes in skin colour warrant immediate attention. Redness, particularly if warm to touch, may indicate infection or inflammation. Conversely, pale, blue, or black discolouration suggests inadequate blood supply and possible tissue death. A red, swollen foot that feels warm could indicate either infection or Charcot foot, both requiring urgent medical assessment. If you notice a red, hot, swollen foot, avoid weight-bearing and seek same-day specialist assessment.

Persistent or unusual pain in the feet or legs warrants evaluation. Cramping pain in the calves when walking that improves with rest (intermittent claudication) suggests peripheral arterial disease. Pain that worsens at night or is relieved by hanging the leg over the bed may indicate severe arterial disease. New onset of pain, burning, or tingling in the feet should be reported to your diabetes team, as these may indicate worsening neuropathy or other complications requiring assessment.

Discharge, odour, or visible pus from any wound indicates infection requiring immediate medical attention. Similarly, fever or feeling generally unwell alongside any foot problem suggests systemic infection. Swelling in one foot compared to the other, particularly if accompanied by warmth, requires prompt evaluation.

Other concerning signs include changes in foot shape, thickened or discoloured toenails (which may harbour infection), loss of hair on toes or feet (indicating poor circulation), and acute limb ischaemia (sudden onset of a cold, pale or blue, very painful foot with numbness, weakness, or absent pulses—call 999 immediately). If you notice any of these warning signs, contact your GP, the multidisciplinary foot care service, or NHS 111 without delay. Early intervention significantly improves outcomes and can prevent hospital admission or amputation.

Daily Foot Care for People with Type 2 Diabetes

Establishing a daily foot care routine is essential for preventing complications. Inspect your feet thoroughly every day, examining all surfaces including between toes and the soles. Use a mirror or ask someone to help if you cannot see all areas clearly. Look for cuts, blisters, redness, swelling, or any changes from the previous day.

Wash your feet daily in warm (not hot) water—test the temperature with your elbow or a thermometer, as neuropathy may prevent you from sensing excessive heat. Use mild soap and dry thoroughly, especially between the toes, as moisture promotes fungal infection. Avoid prolonged soaking, which can macerate skin. Apply moisturising cream to prevent dry, cracked skin, but avoid applying between the toes where excess moisture can accumulate. Avoid direct heat sources such as hot water bottles, heat packs, and foot spas, as these can cause burns in people with reduced sensation.

Nail care requires caution. Cut toenails straight across (not curved into corners) and file sharp edges. If you have reduced sensation, poor vision, or thick nails, arrange regular podiatry appointments rather than attempting this yourself. Never use sharp instruments to remove calluses or corns, and do not use corn plasters or chemical callus removers—see a podiatrist instead.

Footwear selection is crucial. Always wear well-fitting shoes that do not rub or create pressure points. Never walk barefoot, even indoors, as you may not feel injuries from sharp objects. Check inside shoes before wearing them for foreign objects or rough areas. Choose seamless socks that do not constrict circulation, changing them daily. Avoid tight elastic tops that can impair blood flow.

Maintain good circulation by keeping active, avoiding crossing your legs for extended periods, and elevating your feet when sitting. Stop smoking—tobacco significantly worsens circulation problems and impairs wound healing. Your GP can refer you to NHS stop smoking services for evidence-based support. Keep blood glucose, blood pressure, and cholesterol within target ranges as advised by your diabetes team. These measures, combined with daily inspection, form the foundation of diabetic foot care and can prevent most serious complications.

When to Seek Medical Help for Diabetic Foot Problems

Certain foot problems in diabetes constitute medical emergencies requiring same-day assessment. Any active foot problem—including a new ulcer or open wound, suspected infection, suspected Charcot foot, or signs of acute ischaemia—requires same-day assessment by the multidisciplinary foot care service or urgent hospital care as recommended by NICE (NG19). Contact your GP immediately, call NHS 111, or attend an Urgent Treatment Centre if you develop any break in the skin that is not healing or shows signs of infection (redness, warmth, swelling, discharge, or odour), or a foot that becomes red, hot, and swollen even without an obvious wound.

Seek emergency care (call 999 or attend A&E) if you develop a foot ulcer with signs of severe infection, including fever, rigors (shaking chills), confusion, or feeling very unwell. Acute limb ischaemia—sudden onset of a cold, pale or blue, very painful foot with numbness, weakness, or absent pulses—is a medical emergency requiring immediate hospital assessment. Black or blue discolouration of toes or foot, or any injury that penetrates deeply, also require emergency care. These situations may indicate limb-threatening complications requiring immediate specialist intervention.

Arrange a routine appointment with your GP or podiatrist for persistent problems such as thickened or ingrown toenails, corns or calluses requiring professional removal, athlete's foot or fungal nail infections not responding to over-the-counter treatment, or changes in foot shape or structure. New onset of numbness, tingling, or burning sensations should also be reported, as these may indicate worsening neuropathy.

If you notice reduced ability to feel your feet, difficulty distinguishing hot from cold, or loss of balance, inform your diabetes care team. These symptoms suggest progression of neuropathy and may warrant more frequent foot surveillance. Similarly, report new symptoms of poor circulation such as cold feet, cramping pain when walking that improves with rest, or slow-healing minor injuries.

Do not delay seeking help due to concerns about wasting healthcare professionals' time. In diabetic foot care, early intervention prevents serious complications. Your diabetes team would rather assess a minor problem promptly than manage a preventable severe complication later. Most areas have specialist diabetic foot services (Foot Protection Services and Multidisciplinary Foot Care Services) that can provide rapid assessment when needed.

NHS Foot Checks and Support Services

The NHS provides structured foot surveillance for all people with diabetes as part of the annual diabetes review. NICE guidelines (NG19) recommend that everyone with diabetes receives at least one foot examination per year to assess risk and determine the frequency of future checks. During this assessment, healthcare professionals examine your feet for signs of neuropathy (using a monofilament test and tuning fork), check circulation (feeling pulses and examining skin condition), and inspect for structural problems, callus, or existing damage.

Based on this assessment, your feet are classified into risk categories according to NICE guidance: low risk (normal sensation, palpable pulses, no other risk factors), moderate risk (neuropathy or absent pulses, or other risk factors such as callus or non-critical limb ischaemia), high risk (previous ulceration or amputation, or neuropathy/ischaemia with callus and/or deformity, or neuropathy/ischaemia with end-stage renal disease on dialysis), or active problem (current ulceration, spreading infection, critical limb ischaemia, gangrene, or unexplained hot, red, swollen foot with or without pain). This classification determines how frequently you need professional foot checks—ranging from annually for low risk to every 1–2 months for high risk (locally agreed intervals within NICE recommendations), with immediate same-day referral to the multidisciplinary foot care service for active problems.

Specialist multidisciplinary foot care services are available across the NHS for people at high risk or with active foot problems. These teams typically include diabetologists, podiatrists, specialist nurses, vascular surgeons, and orthotists working together to prevent and manage complications. Any active foot problem should be referred within 24 hours to the multidisciplinary foot care service; limb- or life-threatening problems require same-day emergency care. NICE guidance ensures that people with urgent foot complications receive rapid specialist assessment and treatment.

The NHS also provides Foot Protection Services and podiatry services for routine foot care, particularly for people who cannot safely manage their own nail care due to reduced sensation, poor vision, or mobility problems. Access to these services varies by area, but people at moderate or high risk should receive regular podiatry input. Additionally, diabetes education programmes such as structured education courses include foot care guidance, helping you understand why foot care matters and how to implement daily preventive measures effectively. Speak to your diabetes nurse or GP about accessing these services if you have not received a foot check in the past year.

Frequently Asked Questions