Diabetes can lead to significant complications affecting the nervous system and the lower limbs, primarily through a condition known as diabetic neuropathy. Over time, high blood sugar levels can damage the delicate nerve fibres throughout the body, most commonly starting in the feet and legs. Because nerves are responsible for transmitting pain, temperature, and touch sensations, this damage can lead to a loss of feeling or, conversely, persistent and debilitating pain. When combined with reduced blood circulation, these nerve issues create a high risk for foot ulcers and infections that may be difficult to heal. In the United Kingdom, foot health is considered a critical priority in diabetes care, with a strong emphasis on daily self-checks and professional annual screenings to prevent serious outcomes.
What We’ll Discuss in This Article
- The biological causes of diabetic neuropathy.
- Different types of nerve damage including sensory and autonomic.
- Common symptoms like tingling, numbness, and burning pain.
- The development of diabetic foot ulcers and the risk of infection.
- Charcot foot and structural changes in the lower limbs.
- Daily foot care routines and the importance of professional podiatry.
Understanding Diabetic Neuropathy
Diabetic neuropathy is the clinical term for nerve damage caused by prolonged exposure to high blood glucose. The exact biological mechanism involves a combination of metabolic and vascular factors. High sugar levels interfere with the nerves’ ability to send signals and also damage the walls of the tiny blood vessels (capillaries) that supply the nerves with oxygen and nutrients. Without a consistent blood supply, the nerves begin to malfunction or die.
There are several forms of neuropathy, but peripheral neuropathy is the most common among those with diabetes. It typically follows a “stocking and glove” pattern, meaning symptoms start in the toes and feet before progressing up the legs, and later affecting the fingers and hands. According to the NHS, nearly 50 percent of people with diabetes will experience some degree of nerve damage during their lifetime. Maintaining blood sugar levels within the target range is the most effective way to slow the progression of this damage.
Sensory and Motor Nerve Complications
Nerve damage in the feet is often categorised by the type of nerve fibre affected. Sensory neuropathy affects the nerves that allow you to feel pain, pressure, and temperature. This is particularly dangerous because it can lead to “loss of protective sensation.” If you cannot feel a pebble in your shoe or a blister forming, the injury can worsen significantly before you notice it. Conversely, some people experience “positive” symptoms, where the damaged nerves send incorrect signals to the brain, resulting in tingling (pins and needles), sharp shooting pains, or a persistent burning sensation that is often worse at night.
Motor neuropathy affects the nerves that control the small muscles in the feet. When these nerves are damaged, the muscles can become weak or out of sync, leading to changes in the shape of the foot. This can cause the toes to claw or the arches to drop, creating new pressure points on the skin. Over time, these pressure points can develop thick calluses, which are often the precursors to foot ulcers. Professional foot care from an NHS podiatrist is essential for managing these structural changes and ensuring that footwear fits correctly to avoid skin breakdown.
Autonomic Neuropathy and Skin Health
Diabetes also affects the autonomic nerves, which control involuntary functions such as sweating and oil production in the skin. When these nerves are damaged in the feet, the skin can become extremely dry, cracked, and brittle. Dry skin is more prone to developing fissures, which act as entry points for bacteria.
Furthermore, autonomic neuropathy can affect blood flow regulation in the lower limbs. While some people experience reduced circulation (peripheral arterial disease), others may have increased blood flow to the bones, which can lead to a rare but serious complication called Charcot foot. In Charcot foot, the bones become weak and can fracture or dislocate without the person feeling any pain due to their sensory loss. This leads to significant swelling and a change in the foot’s shape, often described as a “rocker-bottom” appearance. If you notice a foot that is red, hot, or swollen, even without pain, you must seek urgent medical attention.
The Risk of Foot Ulcers and Infection
The combination of nerve damage and poor circulation creates a “perfect storm” for the development of diabetic foot ulcers. An ulcer is an open sore or wound that typically occurs on the bottom of the foot or the tip of a toe. Because of the reduced blood flow, the body’s natural healing processes are slowed, and white blood cells struggle to reach the site of the injury to fight off bacteria.
If an ulcer becomes infected, it can spread rapidly to the surrounding tissue (cellulitis) or even to the bone (osteomyelitis). In the UK, diabetic foot complications are a leading cause of hospital admissions. The NICE NG19 guideline emphasizes that any new foot wound in a person with diabetes should be treated as a potential emergency. Early intervention with specialized wound dressings, off-loading (taking weight off the foot), and antibiotics is vital for preventing the infection from progressing to a stage where amputation might be considered.
Daily Self-Care and Professional Screening
Because many foot complications are painless, the burden of detection falls on visual inspection. Every person with diabetes should perform a daily foot check, looking for redness, swelling, blisters, cuts, or changes in the nails. Using a mirror can help you see the soles of your feet if your mobility is limited. It is also important to avoid walking barefoot and to check inside your shoes for any sharp objects or rough edges before putting them on.
| Daily Foot Care Step | Clinical Reason |
| Visual Inspection | To catch painless injuries or changes early |
| Wash and Dry Carefully | To prevent fungal infections between toes |
| Moisturise (not between toes) | To prevent skin cracking and fissures |
| Check Footwear | To ensure no rubbing or pressure points |
| Never Walk Barefoot | To prevent accidental cuts or burns |
In addition to self-care, every person with diabetes in the UK is entitled to a professional foot screen at least once a year as part of their annual review. During this check, a healthcare professional will use a monofilament (a thin plastic wire) to test the sensation in different areas of your foot and a Doppler ultrasound to check the strength of your pulses. This assessment categorises your feet as low, increased, or high risk, which determines how often you should be seen by a specialist podiatry team.
Conclusion
Diabetes affects the nerves and feet primarily through peripheral neuropathy, leading to a loss of sensation, persistent pain, and structural changes. These issues, combined with poor circulation, create a high risk for foot ulcers and infections that can be difficult to treat. Regular self-inspections and annual professional screenings are essential for early detection and the prevention of serious complications like Charcot foot. By maintaining stable blood sugar and following a disciplined foot care routine, the majority of diabetes-related foot issues can be avoided. If you experience severe, sudden, or worsening symptoms, call 999 immediately.
What should I do if I find a small cut on my foot?
Wash the area with clean water, apply a sterile dressing, and contact your GP or podiatry clinic within 24 hours to ensure it is managed correctly.
Why shouldn’t I use corn plasters if I have diabetes?
Corn plasters contain acid that can damage the delicate skin of a person with diabetes, potentially leading to an ulcer; always have calluses or corns treated by a professional podiatrist.
Can nerve pain from diabetes be cured?
While the nerve damage itself is often permanent, the pain can be effectively managed with specific medications prescribed by your doctor and by keeping your blood sugar stable.
How often should I see a podiatrist?
In the UK, you should have a professional check at least once a year, but if you are classified as “high risk,” you may be seen every few weeks or months.
Is it safe to cut my own toenails?
If you have good sensation and vision, you can cut your nails straight across, but if you have neuropathy, it is safer to have a professional or a trained foot care assistant do it.
Why does my nerve pain get worse at night?
This is a common experience in neuropathy; it may be due to fewer distractions at night or changes in body temperature that affect nerve signaling.
Can I still wear fashionable shoes?
You should prioritize shoes that are deep, wide, and have a fastening like laces or Velcro to prevent rubbing; a podiatrist can advise on specific brands that are “diabetes-friendly.”
Authority Snapshot
This article examines how diabetes impacts nerve and foot health to provide patients with evidence based guidance for preventative care. It has been written by Dr. Rebecca Fernandez, a UK trained physician with an MBBS and extensive experience in cardiology, internal medicine, and emergency care. Dr. Fernandez has managed thousands of patients with chronic metabolic conditions and has a deep understanding of the multidisciplinary approach required for diabetic foot salvage. Her clinical focus is on early intervention and patient education, strictly following the latest 2026 NHS and NICE guidance to prioritize medical accuracy and patient safety.
