Diabetic foot: warning signs, daily checks and when to get help

If you live with diabetes, your feet need more attention than most people's. Diabetes can quietly damage the nerves and blood vessels in the feet, so a small cut or blister can go unnoticed, heal slowly and become serious. Simple daily checks and regular foot reviews exist to catch those problems early. This guide covers the warning signs, how to check your feet, what your foot risk level means, and how quickly different problems should be seen.

Call 999 or go to A&E if your foot is changing colour, going very pale or blue, especially with new numbness or pain. That is the advice from NHS inform.

Why does diabetes affect the feet?

Two things go wrong, and they often happen together.

Nerve damage. The NHS says diabetes, type 1 and type 2, is the most common cause of peripheral neuropathy in the UK. Over time, high blood sugar damages the nerves. The most common pattern affects the longest nerves first, so symptoms usually start in the feet.

Reduced blood supply. High blood sugar can also damage blood vessels. The NHS explains that a reduced blood supply means fewer infection-fighting cells reach the skin of the feet, so wounds take longer to heal and can lead to gangrene. NHS inform adds that circulation to the feet is also affected by smoking, high blood pressure, high cholesterol and a history of heart disease or stroke.

Put together, a numb foot can be injured without you feeling it, and a foot with poor circulation struggles to repair the damage. The NHS notes that if you have numb feet it is easy to cut yourself by stepping on something sharp, or to develop a blister from badly fitting shoes and keep walking on it until it becomes an ulcer. The NHS lists foot ulcers and infections among the long-term complications of diabetes that can sometimes lead to amputation.

What are the warning signs of a diabetic foot problem?

Diabetic neuropathy symptoms

The NHS lists the main symptoms of peripheral neuropathy as:

• numbness and tingling in the feet or hands
• burning, stabbing or shooting pain
• loss of balance and co-ordination
• muscle weakness, especially in the feet

NHS inform describes two forms. Painful nerve damage can feel like burning, pins and needles, aching or toothache in the foot, and is often worse in bed at night. Painless nerve damage is a loss of feeling, and you may not notice it until a clinician tests your feet. The NHS advises seeing a GP about early symptoms such as pain, tingling or loss of feeling in the feet.

Signs that need an urgent call today

NHS inform advises contacting your podiatrist or GP urgently if you have:

• a hot, red, swollen foot, which may look discoloured on black or brown skin
• new damage to the skin of your foot, such as cuts, sores or breaks in the skin
• a change in the shape of your foot
• new pain in your foot, especially if you already have painless nerve damage

If your podiatrist or GP practice is closed, call 111. NHS inform also says to phone 111 if you have a new foot problem together with a fever, shivering, nausea, vomiting or feeling generally unwell. The NHS separately advises seeing a GP about a cut or ulcer on your foot that is not getting better, and a GP or diabetes nurse about blisters or cracked skin on your feet.

Diabetic foot ulcer symptoms

The NHS describes a diabetic foot ulcer as an open wound or sore on the skin that is slow to heal. Because the foot may be numb, an ulcer can be painless, so looking matters more than feeling. Watch for any break in the skin, and for the skin around a wound becoming red, hot or swollen.

How should you check your feet every day?

A daily check takes a couple of minutes. NHS inform recommends that you:

• check your feet every day, using a mirror to see the soles
• look for any cuts, skin breaks or hard skin
• apply moisturising cream to stop the skin becoming too dry
• keep your toenails short, cut and filed if you can
• avoid letting the skin between your toes stay too moist, as this can lead to athlete's foot
• speak to your podiatrist if you notice any problems

If you cannot see or reach your feet easily, ask a family member or carer to help. NHS inform also points people to Diabetes UK's guidance on testing the feeling in your feet at home.

What does your foot risk level mean?

The NICE guideline on diabetic foot problems (NG19) says every adult with diabetes should have their foot risk assessed when diabetes is diagnosed and at least once a year after that. The clinician removes shoes, socks and dressings and examines both feet for nerve damage (using a 10 g monofilament), poor circulation, ulcers, callus, infection or inflammation, deformity, gangrene and Charcot arthropathy.

NICE then places people in one of four groups:

Risk level	What it means	How often NICE suggests reassessment
Low	No risk factors except callus alone	Once a year, at the diabetes review
Moderate	Deformity, nerve damage or peripheral arterial disease	Every 3 to 6 months
High	A previous ulcer or amputation, renal replacement therapy such as dialysis, or a combination of risk factors	Every 1 to 2 months, or every 1 to 2 weeks if there is immediate concern
Active diabetic foot problem	An ulcer, infection, severe loss of blood supply, gangrene, or a suspected acute Charcot foot	Needs referral straight away (see below)

NICE says people at moderate or high risk should be referred to a foot protection service, led by a podiatrist with specialist training in diabetic foot problems. That service should see new referrals within 2 to 4 weeks for high risk and 6 to 8 weeks for moderate risk. If you do not know your risk level, ask at your next diabetes review.

How quickly should a diabetic foot problem be seen?

NICE NG19 sets clear timings.

Immediately, through acute hospital services, for problems that threaten the limb or life. NICE's examples are:

• an ulcer with fever or any signs of sepsis
• an ulcer with poor blood supply to the limb
• concern about a deep-seated soft tissue or bone infection, with or without an ulcer
• gangrene

Within 1 working day for all other active diabetic foot problems. NICE says the person should be referred to the multidisciplinary foot care service or the foot protection service, and triaged within 1 further working day. It also counts an unexplained hot, swollen foot with a change in colour, with or without pain, as an active problem that needs this route.

In practice, that means an active foot problem should not wait for your next routine appointment. Standard NHS care for a diabetic foot ulcer, according to NICE, includes taking pressure off the foot, controlling infection, restoring blood supply where possible, removing dead tissue and appropriate dressings, all coordinated by the foot care team.

Can hyperbaric oxygen therapy help a diabetic foot ulcer?

Hyperbaric oxygen therapy (HBOT) means breathing concentrated oxygen in a pressurised chamber. Because low oxygen in the tissues is one reason diabetic foot wounds stall, it has been studied as an addition to standard care. The results are mixed, and UK guidance is clear.

• NICE advises against routine use. NG19 says hyperbaric oxygen therapy should not be offered to treat diabetic foot ulcers unless as part of a clinical trial. NHS England's 2024 consultation guide lists diabetic foot ulcers among the conditions for which it does not routinely commission HBOT.
• A short-term signal that faded. A 2015 Cochrane review included 10 trials with 531 people with diabetic foot ulcers. Pooled data from 5 trials with 205 people showed more ulcers healed at 6 weeks with HBOT, but this benefit was not evident at one year. There was no statistically significant difference in major amputation in 5 trials with 312 people. The authors said flaws in the trials meant they were not confident in the results.
• Specialist bodies read it differently. The US Undersea and Hyperbaric Medical Society includes selected problem wounds on its indications list, with its best evidence in infected diabetic foot ulcers with poor blood supply, treated in hospital chambers at 2.0 ATA or more.

The right path for a diabetic foot problem is your diabetes foot team, not a private chamber. HBOT Medics' single-person chamber runs at 1.5 ATA, which is not the protocol used in these trials, and we do not present HBOT as a treatment for diabetic foot ulcers. If you have an active foot problem, contact your podiatrist, GP or foot protection service today.

Our page on non-healing wounds explains how we think about slow wounds alongside proper wound care. Who HBOT is not suitable for and our chamber page explain screening and pressure, and what hyperbaric oxygen therapy is covers the basics.

The short version

Look at your feet every day, using a mirror for the soles. Know your foot risk level and keep your annual review. A hot, red, swollen foot, a new cut or sore, or a change in foot shape needs an urgent call to your podiatrist or GP, or 111 when they are closed. A foot that turns very pale or blue needs 999. Your diabetes foot team is the right place for any active problem.