How Diabetes Can Affect Your Feet and Ankles

Caring for patients with diabetes is one of the most important parts of my practice. In my experience, many patients understand that diabetes affects blood sugar, but they do not fully appreciate how deeply it can affect the feet and ankles. I spend time with every diabetic patient explaining exactly why daily foot care matters and what to watch for, because early awareness can prevent very serious complications down the road.

The two main ways diabetes affects the feet are through the nerves and through the blood vessels. Elevated blood sugar over time can damage the small nerves that carry sensation, a condition we call peripheral neuropathy. It can also damage and narrow blood vessels, reducing circulation to the feet. Together, these changes create a situation where injuries are harder to feel and harder to heal, which is a risky combination.

Neuropathy often starts subtly. Patients may notice tingling, burning, or a pins-and-needles sensation in their toes or the bottoms of their feet. Over time, these symptoms can progress to numbness, which sounds like a relief compared to pain but is actually more dangerous. When a patient cannot feel a small cut, blister, or stone in their shoe, the injury can grow into a much larger problem before it is discovered.

Reduced circulation compounds the problem. Healthy blood flow delivers oxygen, nutrients, and immune cells to injured tissue. When blood flow is limited, even a small wound can struggle to heal. I have seen patients whose blisters or cracks lingered for weeks because their circulation simply could not support the normal healing process. That is why vascular evaluation is a routine part of diabetic foot care in my office.

Diabetic foot ulcers are one of the most serious concerns we manage. These are open wounds, often on the bottom of the foot or toes, that develop from pressure, friction, or small injuries. Without quick and appropriate treatment, ulcers can become deeper, become infected, and in severe cases threaten the limb. I treat these aggressively with offloading, wound care, and sometimes imaging to check for underlying bone infection.

Infections deserve their own mention because they behave differently in patients with diabetes. The immune response is often less robust, which means bacteria can spread more quickly and with fewer warning signs. Redness, warmth, drainage, odor, or fever in connection with a foot wound all warrant same-day attention. I would much rather see a patient for a false alarm than miss an infection in its early stages.

Charcot foot is a less commonly discussed but very serious complication. It occurs when neuropathy allows bones in the foot to break and collapse without the patient feeling the pain that would normally prompt them to stop walking. The result can be severe deformity if it is not caught early. I watch for unexplained swelling, warmth, and redness in one foot of a diabetic patient, because those can be early signs of Charcot that need urgent intervention.

Daily self-inspection is the single most effective habit I teach my diabetic patients. I recommend looking at the tops, bottoms, and between the toes of both feet every day, using a mirror if needed. Patients are looking for cuts, blisters, calluses, discoloration, swelling, or anything new or unusual. Catching a problem on day one rather than day fourteen often makes the difference between a quick fix and a long road to recovery.

Proper footwear is another cornerstone of diabetic foot health. Shoes should fit well, have a roomy toe box, and offer good cushioning and support. Socks should be seamless and moisture wicking. Walking barefoot is something I strongly discourage, even at home, because a small injury from a dropped object or splinter can start a cascade that is hard to stop. Many of my patients qualify for therapeutic diabetic shoes through their insurance.

I also perform comprehensive diabetic foot exams at least once a year, and more often for patients with advanced disease. I check sensation with a monofilament, assess pulses, evaluate skin and nails, and look for any deformities that could become pressure points. These exams are quick, painless, and often covered by insurance for diabetic patients. They are one of the best investments a patient can make in their long-term health.

Good overall diabetes management is a huge part of foot health. Keeping blood sugar in a healthy range, maintaining healthy blood pressure, managing cholesterol, and not smoking all help protect the small vessels and nerves in the feet. I work closely with the primary care physicians of my patients and endocrinologists because foot care is most effective when it is part of comprehensive diabetes care.

When problems do arise, I believe in fast, coordinated care. My office is equipped to perform wound care, debridement, imaging, and offloading on site. For complex cases, I work with vascular surgeons, infectious disease specialists, and wound care centers in the Houston area to give patients every possible resource. The speed and quality of that team response often determines the outcome.

I want my diabetic patients to feel empowered, not frightened. Yes, diabetes carries real risks for the feet, but daily habits and consistent care dramatically reduce those risks. I have patients who have lived with diabetes for decades with healthy, comfortable feet because they were diligent and proactive. That is my goal for every diabetic patient who walks through my door.

About the Author

Dr. Chandana Halaharvi, DPM, is a double board-certified foot and ankle surgeon and the founder of Thrive Foot and Ankle in Pearland, TX. Her expert insights have been featured in EatingWell. She treats patients from across the greater Houston area, including Pearland, Sugar Land, Friendswood, League City, Missouri City, and surrounding communities.

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