If you have diabetes and notice any open wound, sore, blister, or skin breakdown on your foot — even if it is painless — call us the same day. Painless wounds are especially dangerous because neuropathy masks the urgency. Do not wait to see if it heals on its own.

How Diabetes Affects the Feet

Elevated blood glucose damages the body's smallest blood vessels and nerve fibers over time. In the feet, this produces two interrelated problems that work together to create serious risk:

Peripheral neuropathy is nerve damage that impairs sensation, balance, and the ability to detect pain, pressure, heat, or injury. Many patients with neuropathy develop numbness or tingling that starts at the toes and progresses upward. Others experience burning pain or electric-shock sensations, especially at night. Motor neuropathy also weakens the small muscles of the foot, leading to toe deformities (hammertoes, claw toes) that create new pressure points on the skin.

Peripheral arterial disease (PAD) is narrowing of the arteries that supply blood to the legs and feet. Reduced blood flow means wounds heal slowly — or not at all — and the immune system cannot effectively fight infection. PAD may present as cramping or fatigue in the calves with walking (claudication), but in patients with neuropathy these warning signals may be absent.

Together, neuropathy and PAD create a dangerous combination: a patient cannot feel a wound forming, and once it does, the body lacks the resources to heal it efficiently.

Diabetic Foot Complications

Neuropathic Ulcers

Diabetic foot ulcers are open sores most commonly occurring on the ball of the foot or the bottom of the big toe — high-pressure areas. They develop when repeated mechanical stress (from walking, poor footwear, or a deformity) damages tissue that cannot sense the injury occurring. Roughly 15% of people with diabetes will develop a foot ulcer during their lifetime, and foot ulcers precede approximately 85% of diabetes-related amputations.

Ulcer classification guides treatment intensity. Superficial ulcers limited to the skin may respond to offloading (total contact casting or a diabetic boot), wound care, and infection management. Deeper ulcers involving tendon, joint capsule, or bone require more aggressive intervention — including possible surgery and hospitalization.

Charcot Foot (Charcot Neuroarthropathy)

Charcot foot is a severe, potentially devastating complication in which the bones and joints of the foot fracture and dislocate as a result of neuropathy — often without the patient feeling any significant pain. The acute phase presents with a red, hot, swollen foot that is often initially misdiagnosed as gout or cellulitis. Without prompt recognition and offloading, the midfoot collapses into a rocker-bottom deformity that is extremely difficult to fit with footwear and creates severe ulcer risk on the arch.

Charcot foot is a medical emergency within the podiatric world. Early detection — before collapse — allows offloading with total contact casting to stabilize the bones as the acute inflammatory phase resolves. Advanced cases may require reconstructive surgery. If you have diabetes with neuropathy and develop a suddenly swollen, red, warm foot, even without pain, seek evaluation urgently.

Diabetic Infections

Infections in the diabetic foot can escalate rapidly. Cellulitis (soft tissue infection), osteomyelitis (bone infection), and deep space abscesses can develop from what appears to be a small break in the skin. The immunosuppressive effects of hyperglycemia impair white blood cell function, making it harder for the body to contain infection. MRSA is also more prevalent in this population.

Warning signs that demand immediate care: spreading redness, warmth, streaking, pus, foul odor from a wound, fever, or chills. Hospitalization for IV antibiotics and, in some cases, surgical debridement or amputation is sometimes required when infection is not caught early enough.

Daily Self-Care Routine

A consistent daily foot care routine is the most important preventive measure a person with diabetes can take. This takes less than 5 minutes and can prevent amputations.

  • Inspect both feet daily — top, bottom, between the toes, and around the heels. Use a mirror or ask a family member to check areas you cannot see. Look for redness, blisters, cuts, cracks, swelling, or changes in skin color or temperature.
  • Wash feet daily in lukewarm water (test temperature with your elbow or a thermometer — neuropathy means you may not feel hot water). Dry thoroughly, especially between the toes.
  • Moisturize the tops and bottoms of the feet to prevent dryness and cracking. Do not apply lotion between the toes, as moisture there encourages fungal growth.
  • Trim toenails straight across, not curved, and not too short. File sharp edges. If you cannot see your feet well or nails are thick, have a podiatrist trim them.
  • Never walk barefoot — indoors or outdoors. A small stone, a piece of glass, or even a hard floor seam can cause injury you won't feel.
  • Inspect the inside of shoes before putting them on every time. Objects inside shoes are a common cause of unnoticed foot injuries.
  • Wear properly fitting shoes and clean, dry, seamless socks that do not bind the toes.
  • Avoid heating pads, hot water bottles, and electric blankets on the feet — burns occur easily with neuropathy.
  • Do not use corn removers, razors, or chemical agents on your feet without podiatric guidance.

What Triggers Hospitalizations

Understanding what leads to diabetic foot hospitalizations helps you recognize danger signs before they escalate. The most common chain of events:

  1. A small wound or blister develops, often unnoticed due to neuropathy
  2. Walking continues on the wound because it is painless
  3. Bacterial contamination turns into infection
  4. Infection spreads into deeper tissue or bone (osteomyelitis)
  5. Systemic signs emerge (fever, elevated blood sugar, fatigue)
  6. Hospitalization, IV antibiotics, possible surgery

Breaking the chain at step 1 or 2 — through daily inspection and prompt care-seeking — prevents the cascade. Most diabetic foot hospitalizations are not inevitable.

The Annual Diabetic Foot Exam

The American Diabetes Association recommends a comprehensive foot examination at least once per year for all patients with diabetes — more frequently for those with neuropathy, PAD, prior ulceration, or foot deformities. At Big Sky Foot & Ankle, a diabetic foot exam includes:

  • Neurological assessment: monofilament sensation testing, vibration perception, reflexes
  • Vascular assessment: pulses, capillary refill, ankle-brachial index (ABI) when indicated
  • Skin and nail inspection: calluses, fissures, nail pathology, interdigital maceration
  • Structural assessment: deformities, gait abnormalities, footwear evaluation
  • Risk stratification and individualized self-care counseling

The exam takes about 30 minutes and provides a baseline that allows us to detect changes year over year — often before they become problems.

Blood Sugar Management and Foot Health

The connection between glycemic control and foot complication risk is direct and well-established. The DCCT and UKPDS trials demonstrated that keeping HbA1c near target — ideally below 7% — significantly reduces the development and progression of neuropathy and vascular disease.

Practically, this means:

  • Better blood sugar control slows the progression of neuropathy — and in early stages, some improvement in nerve function is possible
  • Hyperglycemia impairs wound healing biochemically; good control improves the immune response and wound repair
  • Patients who are in poor glycemic control at the time of a foot infection or surgery face significantly higher complication rates and slower recovery

Podiatric care works best as part of a coordinated team approach alongside your primary care provider or endocrinologist. We communicate with your care team when findings warrant it.