Condition · Diabetic,, Vascluar, Nerve

Diabetic Foot

Diabetes can affect the feet by damaging nerves, reducing circulation, and increasing the risk of wounds and infections. Because loss of sensation may prevent patients from feeling an injury, even a small cut, blister, or area of pressure can sometimes develop into a more serious foot problem.

At Timonium Foot and Ankle Center, our doctors provide comprehensive diabetic foot care focused on prevention, early diagnosis, and treatment. Regular foot examinations can identify changes in sensation, circulation, skin, nails, and foot structure before they lead to more serious complications.

Diabetic foot care may include routine at-risk foot care, treatment of corns and calluses, management of toenail problems, diabetic shoes and inserts when appropriate, wound care, infection treatment, and evaluation of circulation and nerve function.

If you have diabetes and are experiencing a foot problem—or want to help prevent one—call our office or request an appointment online. We’ll evaluate your feet, identify your individual risk factors, and develop a plan to help protect your foot health and reduce the risk of complications.

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Call (410) 560-2777

What is diabetes?

Diabetes is a metabolic condition that causes elevated blood sugar levels. Over time, elevated blood sugar can damage nerves, blood vessels, and other tissues throughout the body. These changes can have a significant effect on the feet and increase the risk of neuropathy, poor circulation, wounds, infections, and other diabetic foot complications.

Diabetes is generally classified as Type 1 or Type 2 diabetes.

Type 1 diabetes: Type 1 diabetes is an autoimmune condition in which the pancreas produces little or no insulin. It commonly develops during childhood or adolescence, although it can occur at any age. Patients with Type 1 diabetes require insulin.

Type 2 diabetes: Type 2 diabetes occurs when the body does not use insulin effectively, known as insulin resistance. As the condition progresses, the body may also produce insufficient amounts of insulin. Type 2 diabetes is associated with several risk factors, including genetics, excess body weight, and physical inactivity. Treatment may include lifestyle changes, oral or injectable medications, and insulin when necessary.

Why are people with diabetes at risk for foot problems?

Over time, elevated blood sugar can damage both nerves and blood vessels. This increases the risk of two important conditions affecting the feet: peripheral neuropathy and peripheral arterial disease (PAD).

When loss of sensation, decreased circulation, foot deformity, and impaired healing occur together, even a relatively minor foot problem can progress to a wound or infection. Regular foot examinations, preventive care, and early treatment of problems are therefore especially important for patients with diabetes.

What is diabetic peripheral neuropathy?

Peripheral neuropathy is nerve damage that commonly affects the feet and legs in people with diabetes. Different types of nerves can be affected, resulting in changes in sensation, skin health, and muscle function.

Sensory nerve damage: Sensory nerves allow us to feel pain, pressure, temperature, and the position of our joints. When these nerves are damaged, patients may not feel a blister, burn, cut, foreign body, or other injury to the foot. An injury can therefore become significantly worse before it is noticed.
Autonomic nerve damage: Autonomic nerves help regulate sweating and moisture in the skin. Neuropathy can reduce sweating, causing the skin to become excessively dry and more susceptible to cracking. Breaks in the skin can create an entry point for bacteria and increase the risk of infection.
Motor nerve damage: Motor nerves control muscles in the foot. Nerve damage can contribute to muscle imbalance and the development of prominent bones and toe deformities. These changes can create areas of increased pressure, leading to corns, calluses, skin breakdown, and diabetic foot ulcers.

What are the symptoms of diabetic peripheral neuropathy?

Burning, tingling, or numbness in the feet
Reduced ability to feel pain, pressure, or temperature
Dry or cracked skin
Changes in balance or stability
Toe deformities, including hammertoes, mallet toes, and claw toes
Corns and calluses over areas of increased pressure
In advanced cases, significant bone and joint changes associated with Charcot foot

Peripheral neuropathy is an important risk factor for diabetic foot ulcers because an injury or area of excessive pressure may continue without causing enough pain to alert the patient. Once the skin breaks down, bacteria can enter the wound and potentially cause a serious infection.

What is peripheral arterial disease (PAD)?

Peripheral arterial disease, or PAD, occurs when narrowed or blocked arteries reduce blood flow to the legs and feet. People with diabetes are at increased risk for developing PAD.

Adequate circulation is essential for delivering oxygen and nutrients to the tissues and allowing wounds to heal. When circulation is significantly reduced, wounds may heal slowly or fail to heal, increasing the risk of infection, tissue loss, and amputation.

What are the symptoms of peripheral arterial disease?

Leg cramping with activity: Pain or cramping in the legs while walking that improves with rest is known as intermittent claudication.
Delayed wound healing: Cuts, sores, or ulcers may take longer than expected to heal.
Rest pain: More advanced PAD can cause pain in the foot even while resting, particularly at night. Some patients experience temporary relief by placing the foot in a dependent position.
Skin and temperature changes: The foot may appear pale or discolored or feel cooler than expected.
Gangrene: Severe loss of circulation can result in tissue death, known as gangrene.

What is a diabetic foot ulcer?

A diabetic foot ulcer is an open wound or area of skin breakdown that commonly develops from repetitive pressure, friction, injury, or a combination of these factors.

Peripheral neuropathy can prevent a patient from feeling the injury or pressure that caused the wound. Poor circulation may then make it more difficult for the wound to heal. Foot deformities, prominent bones, corns, and calluses can further increase pressure and contribute to ulcer formation.

Diabetic foot ulcers require prompt evaluation because an open wound provides an entry point for bacteria and can lead to infection involving the skin, soft tissue, or bone.

How can people with diabetes prevent foot ulcers, infections, and amputations?

Preventive foot care is one of the most important ways to reduce the risk of serious diabetic foot complications.

Regular diabetic foot examinations: Patients with diabetes should have a comprehensive baseline foot examination. The frequency of follow-up visits depends on neuropathy, circulation, previous ulcers, foot deformity, and other individual risk factors.
Daily foot inspections: Check the tops and bottoms of the feet, heels, toes, and areas between the toes for cuts, blisters, redness, swelling, drainage, cracks, or other changes.
Professional at-risk foot care when appropriate: Patients with qualifying risk factors benefit from professional nail care and treatment of corns and calluses as home care on high risk feet can lead to complications including infection and in some cases, limb loss.
Supportive footwear and avoiding barefoot walking: Properly fitted, supportive shoes can help protect the feet and reduce areas of excessive pressure. Barefoot walking should be avoided, particularly when neuropathy is present, because injuries may occur without being felt.
Check shoes before wearing them: Patients with neuropathy should inspect the inside of their shoes for stones, foreign objects, damaged linings, or other potential sources of pressure or injury.
Keep the skin moisturized: Apply a moisturizing cream or lotion regularly to help prevent excessive dryness and cracking, which can create an entry point for bacteria. Avoid applying moisturizer between the toes, where excessive moisture can increase the risk of fungal infection and skin breakdown.
Control foot and leg swelling when present: Persistent swelling can place additional stress on the skin and contribute to skin breakdown and delayed wound healing. The underlying cause of swelling should be evaluated, and compression therapy may be recommended when appropriate based on circulation and the patient's medical condition.
Maintain good blood sugar control: Following the diabetes treatment plan established with your medical team can help reduce the risk of long-term complications.
Exercise regularly when medically appropriate: Physical activity can help with blood sugar management and overall cardiovascular health. Exercise may need to be modified when neuropathy, PAD, wounds, or other foot problems are present.
Avoid burns: Patients with neuropathy should use caution with heating pads, hot water, fireplaces, and other sources of heat because reduced sensation may prevent them from recognizing a burn.
Do not smoke: Smoking damages blood vessels and can further increase the risk of poor circulation and delayed wound healing.
Maintain regular medical care: Diabetes management may involve your primary care physician, endocrinologist, podiatrist, ophthalmologist, vascular specialist, nephrologist, and other specialists depending on your individual needs.
Take medications as directed: Medications for diabetes and associated medical conditions should be taken according to the instructions of your treating physicians.

When should a person with diabetes see a podiatrist?

Patients with diabetes should establish regular podiatric care based on their individual risk factors. Patients with neuropathy, poor circulation, previous foot ulcers, significant foot deformities, or other high-risk findings may require more frequent examinations and preventive foot care.

Prompt evaluation is recommended for:

An open wound or ulcer
New redness, warmth, or swelling
Drainage, pus, or bleeding
A blister, cut, or puncture wound
A burn
An ingrown toenail or other painful nail problem
A new or rapidly developing callus
New discoloration of a toe or foot
Sudden swelling or change in the shape of the foot
Signs of infection
Any foot injury in a patient with significant neuropathy or poor circulation

Patients with diabetic neuropathy should not rely on pain to determine whether a foot problem is serious. Significant wounds, infections, fractures, and other injuries can sometimes occur with little or no pain.

Diabetic Foot Care at Timonium Foot and Ankle Center

At Timonium Foot and Ankle Center, our doctors provide comprehensive diabetic foot evaluations and preventive care based on each patient's individual risk factors. The examination may include assessment of circulation, sensation, skin and nail health, foot structure, areas of abnormal pressure, and previous or current wounds.

When problems are identified, treatment is directed at the underlying cause and may include professional at-risk foot care, wound care, pressure reduction, supportive footwear, diabetic shoes when appropriate, custom orthotics, treatment of infection, vascular referral, or other treatment based on the patient's diagnosis.

The goal of diabetic foot care is not simply to treat problems after they occur, but to identify risk factors early and help prevent wounds, infections, and other serious complications.

Podiatrist examining the foot of a patient with diabetes

Patient stories

"I have severe nerve damage in both my feet from Type II Diabetes. I also suffer with other foot and ankle problems from the disease and at one point almost lost part of my left foot. Thankfully, Dr. Stewart was able to save my foot and prevent me from losing my leg."

Bonita Mays

"Dr. Stewart saved my leg. I had a bug bite that got infected. I went to Express Care and they told me to put warm compression on it and gave me an antibiotics. This was on a Friday. On Monday I went to see Dr. Stewart for a regular appointment and he saw my leg. He landed the bite and gave me a stronger antibiotics. I went back each week for a month and it gradually got better. Thanks to Dr. Stewart for saving my leg and not having to go to the hospital. I would highly recommend Dr. Stewart for any problems with your feet and legs. Thank you Dr. Stewart."

Jane Jenkins

Read all Patient Stories

Diabetic Foot, answered

Why is diabetic foot care important for people with diabetes?

Diabetes can affect the nerves, circulation, skin, and joints of the feet. Reduced sensation may make it difficult to feel cuts, blisters, or pressure points, while poor circulation can slow healing. Regular diabetic foot care helps identify problems early, reduce the risk of wounds and infection, and preserve long-term foot health. Early treatment is one of the most effective ways to prevent serious complications.

How often should someone with diabetes have a foot exam?

Everyone with diabetes should have a comprehensive foot examination at least once a year. Patients with peripheral neuropathy, poor circulation, foot deformities, a history of ulcers, or other risk factors may benefit from more frequent evaluations. Our doctors will recommend an examination schedule based on your individual risk.

What happens during a diabetic foot exam?

A diabetic foot examination includes an assessment of circulation, nerve function, skin and nail health, foot structure, areas of abnormal pressure, and footwear. Our doctors evaluate for numbness, poor circulation, corns and calluses, foot deformities, swelling, wounds, and early signs of skin breakdown. Early detection allows many problems to be treated before they become serious. Additional testing or specialist referral may be recommended when needed.

What are the warning signs of a diabetic foot ulcer or infection?

Contact our office promptly if you notice redness, warmth, swelling, drainage, an open sore, increasing pain, a new or rapidly developing callus, skin discoloration, foul odor, bleeding, or any wound that is not healing. Patients with diabetic neuropathy may not experience pain even when a serious infection or ulcer is developing, making daily foot inspections and regular foot examinations especially important.

What should I do if I develop a cut, blister, or sore on my foot?

Wash the area gently with soap and water, apply a clean dressing, and avoid additional pressure on the area. Because even small wounds can progress quickly in patients with diabetes, you should contact our office promptly for evaluation. Early treatment can help reduce the risk of infection and other serious complications.

Can diabetes cause foot pain?

Yes. Diabetes can contribute to foot pain in several ways, including nerve damage (peripheral neuropathy), poor circulation, joint changes, tendon disorders, and increased pressure from foot deformities. Because many different conditions can cause foot pain, a comprehensive examination is important to determine the underlying cause and recommend the most appropriate treatment.

Can diabetes affect circulation in the feet?

Yes. Diabetes can contribute to peripheral arterial disease, reducing blood flow to the feet and slowing wound healing. Symptoms may include cold feet, cramping with walking, slow-healing wounds, or changes in skin color. Our doctors evaluate circulation as part of every diabetic foot examination and may recommend additional vascular testing when appropriate.

What does diabetic neuropathy feel like?

Diabetic peripheral neuropathy may cause numbness, tingling, burning, sharp pains, or a "pins and needles" sensation in the feet. Some patients experience increased sensitivity, while others gradually lose protective sensation altogether. Because neuropathy can make it difficult to feel injuries, routine foot examinations and daily self-inspections are essential.

Can I trim my own toenails and calluses if I have diabetes?

Many patients with diabetes can safely trim their own toenails if they have good vision, flexibility, circulation, and sensation. However, patients with neuropathy, poor circulation, thick or difficult-to-cut nails, or difficulty reaching their feet should have nail care performed professionally. Corns and calluses should not be cut with razors or other sharp instruments or treated with over-the-counter acid products, particularly in patients with neuropathy or poor circulation, because this can cause wounds and infection.

What shoes should people with diabetes wear?

People with diabetes should wear properly fitted shoes that provide adequate support, cushioning, and protection without creating pressure points. Tight shoes, worn-out footwear, and walking barefoot increase the risk of blisters, calluses, wounds, and infection. Our doctors can recommend appropriate footwear based on your foot structure, activity level, and risk factors.

When are diabetic shoes or custom inserts recommended?

Diabetic therapeutic shoes and custom inserts may be recommended for patients with peripheral neuropathy, foot deformities, prominent bones, previous ulcers, or areas of increased pressure. Their purpose is to redistribute pressure, reduce friction, and help lower the risk of skin breakdown and ulcer formation.

How can I prevent diabetic foot ulcers?

The best way to reduce your risk is through prevention. Inspect your feet every day, wear properly fitting shoes, avoid walking barefoot, keep the skin moisturized to help prevent dryness and cracking, and keep your blood sugar under good control. Swelling of the feet or legs should also be evaluated and appropriately managed when present. Seek prompt evaluation for any new blister, cut, callus, pressure area, or wound. Regular examinations by a podiatrist can identify problems early and help prevent wounds, infection, hospitalization, and, in severe cases, amputation.

Why do people with diabetes develop foot ulcers?

Diabetic foot ulcers usually develop because of a combination of peripheral neuropathy, increased pressure, foot deformities, poor circulation, and repetitive trauma. Since patients with neuropathy often cannot feel injuries, even a small blister or callus can progress into a serious wound if left untreated. Early recognition and pressure reduction are critical to preventing complications.

When should someone with diabetes see a podiatrist?

Patients with diabetes should establish routine foot care before problems develop. You should schedule an evaluation if you experience numbness, burning, foot pain, calluses, nail problems, deformities, changes in skin color, swelling, or any wound or blister. Early treatment often prevents more serious complications.

Will Medicare cover diabetic foot care?

Having diabetes does not automatically qualify Medicare patients for at risk foot care. Medicare may cover certain diabetic foot care services for patients who have risk factors and meet specific medical criteria. Coverage may include routine foot care for qualifying patients. Our office can help determine your eligibility and explain your coverage options.

Why choose Timonium Foot and Ankle Center for diabetic foot care?

Preventing diabetic foot complications begins with early detection and personalized care. Our doctors perform comprehensive diabetic foot evaluations to identify problems before they become serious. Whether you need routine preventive care, treatment for a painful condition, custom orthotics, or advanced wound care, every recommendation is based on your individual risk factors, diagnosis, and long-term foot health goals.

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Protect your feet with regular diabetic care

Request an appointment today to receive an accurate diagnosis and a personalized treatment plan for your foot or ankle condition. New patients are welcome, and Medicare and most insurance plans are accepted.

Request an Appointment Call (410) 560-2777