Quick answer. Diabetes can damage foot nerves and blood vessels, leading to ulcers that may go unnoticed and, if neglected, to serious infection or amputation; early screening, daily foot care and prompt multidisciplinary treatment prevent most of these outcomes.
Diabetic foot problems happen when long-term high blood sugar damages the nerves (neuropathy) and the blood supply to the feet. Reduced sensation means small cuts, blisters or pressure sores can go unnoticed, while poor circulation slows healing, so a minor wound can become a serious ulcer.
This is one of the most important reasons to control diabetes well. The good news is that with regular foot screening, good footwear and early treatment, a large proportion of diabetes-related amputations can be prevented.
At a glance
| Sign or symptom | Possible meaning | Action |
|---|---|---|
| Numbness, tingling or burning in feet | Peripheral neuropathy (loss of protective sensation) | Arrange foot screening; check feet daily |
| Cuts, blisters or sores you didn't feel | Reduced sensation; risk of ulcer | See a doctor or podiatrist promptly |
| A wound or ulcer not healing | Poor circulation and/or infection | Seek medical review without delay |
| Redness, warmth, swelling, pus or odour | Possible infection | Urgent / same-day medical attention |
| Black or darkened skin on toes/foot | Possible gangrene | Emergency – go to A&E |
How diabetes affects the feet
Two main problems combine to put diabetic feet at risk:
- Peripheral neuropathy: Nerve damage reduces sensation, so you may not feel a stone in your shoe, a blister or a burn. It can also cause foot deformity and abnormal pressure points.
- Peripheral arterial disease: Narrowed or blocked leg arteries reduce blood flow, so wounds heal slowly and infections are harder to clear.
Together, these mean a small injury can progress to an ulcer and infection before it is noticed.
Diabetic foot ulcers
A foot ulcer is an open wound, often on the sole or over a pressure point. Ulcers are common and are a leading cause of hospital admission in people with diabetes, and many non-traumatic lower-limb amputations begin as a foot ulcer.
Ulcers need prompt, proper care: pressure offloading, wound cleaning and dressing, treating any infection, controlling blood sugar, and assessing the blood supply. Never try to manage a deep or infected ulcer at home alone.
When is it an emergency?
Seek urgent or emergency medical care if you have diabetes and notice:
- Spreading redness, warmth, swelling, pus or a foul smell from a wound
- Fever or feeling generally unwell with a foot wound
- A wound exposing deeper tissue, or a sudden cold, pale or very painful foot
- Black or darkening skin on the toes or foot (possible gangrene)
These can indicate serious infection or a critical loss of blood supply, which are limb- and life-threatening and need same-day assessment, often at a hospital.
Screening and prevention
Prevention is the most effective strategy. In Singapore, diabetic foot screening is offered at polyclinics and clinics, often using a simple 10-gram monofilament test to detect loss of protective sensation. General guidance includes:
- Have your feet screened regularly (commonly every 6-12 months, or more often if high risk)
- Check your feet daily, including the soles and between the toes (use a mirror if needed)
- Keep blood sugar, blood pressure and cholesterol well controlled, and stop smoking
- Wear well-fitting shoes; never walk barefoot
- Moisturise dry skin, cut nails carefully, and treat corns or calluses professionally
Multidisciplinary care in Singapore
Complex diabetic foot wounds are best managed by a multidisciplinary team. In Singapore, limb-salvage and programmes such as DEFINITE care bring together vascular surgeons, podiatrists, endocrinologists, wound and infectious-disease specialists, and nurses across primary and tertiary care.
This coordinated approach, with early referral of non-healing wounds to a tertiary centre, has been shown to lower amputation rates and improve outcomes. If you have a diabetic foot wound, ask your doctor about referral to such a team.
When to see a doctor or podiatrist
If you have diabetes, see a healthcare professional if you notice any new wound, blister, ulcer, change in foot shape, persistent numbness, or skin colour or temperature changes. Do not wait for pain, because neuropathy can mask it. Early review is simple and can prevent a small problem from becoming a major one.
How to prepare for a foot screening
A diabetic foot screening is quick and painless, so there is little you need to do in advance. Wear shoes and socks that are easy to remove, and try to attend with feet that are clean and dry. If you usually wear orthotics or special insoles, bring them so the clinician can check how they fit. It helps to jot down any recent problems beforehand: areas of numbness or tingling, wounds that were slow to heal, changes in foot shape, or shoes that have started to rub. Bring a list of your current medicines and, if you have one, a recent record of your blood sugar control.
What to expect at the appointment
The clinician will look at both feet, including the soles and the spaces between the toes, checking the skin, nails, shape and any pressure marks. Sensation is usually tested with a 10-gram monofilament, a soft nylon strand pressed against several points on the sole; you simply say when you feel it. Circulation may be assessed by feeling the pulses in the feet or using a small handheld Doppler. Based on these findings, your feet are graded as low, moderate or high risk, which decides how often you should be reviewed and whether you need referral to a podiatrist or a specialist team.
Daily foot care at home
- Inspect both feet every day, using a mirror or asking a family member to check the soles if you cannot see them.
- Wash with lukewarm water, dry gently and thoroughly, especially between the toes, and apply moisturiser to dry areas but not between the toes.
- Cut nails straight across and file sharp edges rather than digging into the corners.
- Always check inside your shoes for stones or rough seams before putting them on, and never walk barefoot, even at home.
- Choose well-fitting, enclosed footwear and break in new shoes slowly.
Costs and subsidies
Diabetic foot screening is part of routine diabetes care at polyclinics and is generally low-cost, and subsidies may apply depending on your eligibility. If you hold a CHAS card or are a Pioneer or Merdeka Generation member, you may receive further support for chronic disease care. Because schemes and amounts change, confirm what applies to your situation with the clinic before your visit.
Common questions
How often should my feet be screened?
Many people are screened every 6 to 12 months, but if you are high risk, have neuropathy or have had an ulcer before, you may need checks more often. Your care team will advise the right interval for you.
I have no pain in my feet, so are they fine?
Not necessarily. Nerve damage can remove the warning sign of pain, so a serious problem may be present without discomfort. This is exactly why daily checks and regular screening matter.
Can I treat a corn or callus myself?
If you have diabetes, do not cut or use medicated corn plasters yourself, as this can cause wounds that are slow to heal. Have hard skin managed by a podiatrist.
Related guides
- Best Vascular & Vein Clinics in Singapore — our editorial shortlist
- Varicose veins
- Leg swelling
- Aortic aneurysm
Sources
- HealthHub – Diabetic Foot Care
- SingHealth – Complex Diabetic Foot Wounds (Multidisciplinary)
- Singapore General Hospital – Podiatry
- NHS – Type 2 diabetes and foot problems
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