Key takeaways:
Foot pain is common in people who have diabetes. It is commonly caused by damage to the nerves, called diabetic neuropathy.
Well-managed blood sugar levels can lower the risk of developing diabetic foot pain. Keeping a healthy weight and stopping smoking can help lower the risk, too.
Regular foot checks and exams are important for anyone with diabetes, to avoid complications like foot ulcers and foot injuries.
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Featuring Sandra Arévalo, RDN, Minisha Sood, MD, William Spielfogel, MD | Reviewed by Mera Goodman, MD, FAAP
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Diabetes is a common and serious condition. It can impact almost every part of the body, and your legs, feet, and even toes are no exception.
Diabetes-related foot pain (also called diabetic foot neuropathy) is a complication of diabetes. It happens to people with both Type 1 and Type 2 diabetes. The longer you have diabetes and the higher your blood sugar levels run, the more likely it is you will develop foot pain or discomfort in the future.
Here’s what you need to know about diabetic foot pain, including symptoms, treatment, prevention, and more.
How does diabetes affect the health of my feet?
When you have diabetes, high glucose levels in the blood can damage nerves and blood vessels. Because the nerves and blood vessels supplying the feet are so long and delicate, the feet —and especially the toes — often get affected first. Damage to the nerves and blood vessels in the feet causes two separate but related problems.
Together, they are responsible for the typical diabetic leg pain and other diabetic foot complications that people with diabetes experience.
Peripheral neuropathy
This is the name for damage to any nerves outside the brain and spinal cord. When it happens in the feet and legs, peripheral neuropathy causes pain, numbness, and other problems related to balance and foot stability.
Peripheral artery disease
This is when damage to blood vessel walls causes blood vessels to become stiff and narrow. This can lower blood flow to the feet, which, in turn, leads to:
Breakdown of the skin, making it more prone to damage and infection
Slower healing of injuries and greater risk of infection, ulcers, and gangrene
What does foot pain from diabetes feel like?
The most common diabetic foot symptoms include:
Tingling: This is a “pins-and-needles” kind of sensation. It feels similar to when your foot falls asleep.
Pain or higher sensitivity: This is pain or sensitivity to what are normally not painful things. It could be pain from bed sheets brushing against your feet or feeling like certain socks are uncomfortable or painful to wear.
Numbness or weakness: Nerves help you feel, and they tell your muscles to work. If you’re noticing that you don’t feel when you step on an object or cut your feet, this can be a sign of nerve damage.
Slow-healing injuries: Healthy blood vessels carry immune cells to wounds to help fight infections and repair the damaged tissue. If blood circulation is poor, which can happen in diabetes, those wounds take longer to heal. You’re also more likely to injure your feet if you have numbness.
What should I do if I have diabetic foot pain symptoms?
If you notice any unusual sensations or pain in your feet or hands, schedule an appointment with a healthcare provider. They’ll do a quick test to see if your feet can feel properly. It involves your provider brushing a soft piece of nylon (called a monofilament) along different areas of your feet as you keep your eyes closed and say “yes” every time you think you feel it.
If you have diabetes, your provider will likely perform this test at least once a year to catch nerve problems early and help stop them from getting worse. They may also suggest that you meet with a foot doctor (podiatrist).
Your healthcare provider could ask you to have additional tests done if they think you do have nerve damage. But these tend to be more invasive and are not recommended on a regular basis.
What are some risks if I don’t get treatment?
Diabetes-related foot pain is more than just pain; it’s a warning sign from your body. This type of nerve pain can lead to complications if you don’t see a healthcare provider and get treated.
Below are some of the problems that can come from untreated diabetes nerve pain:
Dry, cracked skin: This may not sound too bad, but when your skin is too dry, your risk of getting skin infections goes up. If this happens, plain petroleum jelly or unscented hand creams can help.
Calluses: This is an area of thickened skin that has less feeling. People with diabetes get calluses faster and more often than those without diabetes. You can use a pumice stone daily to help keep them at a minimum. If they get really thick, a provider can cut or shave them down. Never attempt to do this at home as it can lead to infections.
Ulcers: These are sores that happen to some people with diabetes due to poor blood circulation. All ulcers (no matter how small) need to be seen by a provider. The longer you go without seeing one, the more likely it is that it will become infected. Infected ulcers can spread and cause you to lose your foot or leg.
Amputations: If the complications listed above are not treated properly, they can all become infected. Skin infections can cause the skin and muscle tissues to die. Once this happens, it can’t be fixed. The only way to stop the infection from continuing to spread is by amputating the infected limb.
What can I do to manage diabetes-related foot pain?
Unfortunately, once you have diabetes-related foot pain, it can’t be cured. Healthcare providers can only try to prevent it from getting worse.
Here are five things you can do at home to help manage your diabetes-related foot pain and prevent complications:
1. Check your feet
Check the bottoms of your feet every morning when you wake up and every night before you go to bed. Look for cuts and wounds and anything else unusual.
2. Wear shoes around the house
When you have diabetic foot pain, you can’t always feel when you step on things. Wearing shoes helps to prevent cuts and injuries.
3. Follow up with your healthcare provider
It’s important to attend your regular healthcare appointments. Not only will your provider be able to perform foot exams, but they can catch problems earlier on so you don’t end up with serious complications.
4. Maintain a healthy diet and exercise routine
Just because diabetes-related foot pain isn’t reversible doesn’t mean it can’t be improved. Following a healthy diet and exercising regularly helps keep blood glucose levels within range and can improve blood flow to stop diabetic foot disease from getting worse. Exercising can even improve some symptoms of nerve pain.
Exercising or moving your body doesn’t have to be complicated. A brisk walk around your neighborhood can do the trick. Water aerobics is an alternative safe exercise for people who have trouble going for walks. Remember to consult your healthcare provider and dietitian before starting any new diet or exercise plan.
5. Stop smoking
In the same way that smoking increases the risk of heart disease and strokes when you have diabetes, it also raises the risk of diabetic foot disease. Stopping smoking helps to improve blood flow to your feet and your organs and lowers your risk of health complications —in your feet and beyond.
If you’re having trouble quitting smoking, it’s worth bringing this up to your healthcare provider, as they can recommend treatments and support groups that are right for you.
What are treatment options for diabetic foot pain?
Along with taking the steps above, you should talk to your healthcare provider if your foot pain is too much to bear. Diabetes-related foot pain is treated with medications that target nerve pain as well as medications for pain in general. Here are some of the most commonly recommended ones:
Pregabalin (Lyrica): Pregabalin is one of a select few FDA-approved medications to treat diabetes-related nerve pain. This is typically taken 2 to 3 times a day.
Duloxetine (Cymbalta): Duloxetine is another FDA-approved medication for diabetes-related foot pain. It provides the same amount of pain relief as Lyrica and only needs to be taken once a day. It also treats depression, so it can be useful if you need to treat both conditions.
Gabapentin (Neurontin): Gabapentin provides some pain relief, but it isn’t considered to be a first-choice medication for foot pain from diabetes.
Amitriptyline (Elavil): Amitriptyline is an older medication that was used for years to treat all sorts of nerve pain, including nerve pain from diabetes. But it’s not recommended as often because it doesn’t work as well as other options and can cause a lot of side effects (especially if you’re over 65).
Topical lidocaine and capsaicin: Topical gels and creams like lidocaine and capsaicin are available over the counter and are best for small areas of pain. They’re usually only suggested if you have very mild symptoms or if you can’t tolerate the side effects from oral medications.
In case you were wondering about popular over-the-counter pain relievers like acetaminophen (Tylenol), ibuprofen (Motrin, Advil), and naproxen (Aleve), it’s important to know that these won’t work for foot pain from diabetes. They don’t improve nerve pain, and, worse, they can cause side effects.
Can I prevent diabetes-related foot pain?
The best way you can prevent or manage diabetic foot pain is by managing your diabetes as best as you can. Remember, high sugar levels are what causes the nerve pain. By managing your blood sugar levels through diet, exercise, and medications, you’re taking steps to prevent the various complications of diabetes.
The bottom line
Diabetic foot pain is a nuisance and can also be a sign of worsening diabetes. Daily self foot exams and regular foot exams with your doctor are an important part of managing diabetes.
To keep your foot pain from worsening, work with your healthcare provider to get your blood sugars in your target range. If your foot pain persists despite lifestyle changes, there are medications that can help.
References
American Diabetes Association. (n.d.). Peripheral neuropathy.
Cohen, K., et al. (2015). Pharmacological treatment of diabetic peripheral neuropathy. Pharmacy and Therapeutics.
GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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