Diabetic Foot Care: Protecting Your Circulation

Diabetes is one of the most prevalent chronic conditions worldwide, and the feet are among the most vulnerable parts of the body for those living with this disease. Poor circulation and nerve damage caused by diabetes can lead to serious foot complications, including infections, ulcers, and in severe cases, amputation. The good news is that with proper awareness, daily care, and timely medical intervention, many of these complications can be prevented.

How Diabetes Affects Circulation

Diabetes damages blood vessels in two important ways. First, chronically elevated blood sugar levels cause the inner lining of arteries to become inflamed and damaged, a process that accelerates atherosclerosis — the build-up of fatty deposits that narrow and harden the arteries. This condition, known as peripheral arterial disease (PAD), reduces blood flow to the legs and feet.

Second, diabetes affects the smallest blood vessels (microvascular disease), impairing the delivery of oxygen and nutrients to the tissues at a cellular level. This means that even minor injuries or infections in the feet heal more slowly because the tissues do not receive adequate blood supply.

Alongside vascular damage, diabetes frequently causes peripheral neuropathy — damage to the nerves in the feet and lower legs. When sensation is reduced, patients may not feel cuts, blisters, pressure sores, or foreign objects in their shoes, allowing injuries to go unnoticed and untreated until they become serious.

Signs of Poor Blood Flow in the Feet

Recognising the early warning signs of compromised circulation can prompt you to seek help before a small problem becomes a large one. Watch for the following:

Cold feet — one or both feet feeling persistently cold to the touch, even in warm environments
Colour changes — the foot appearing pale, bluish, or reddish-purple, particularly when elevated or when pressure is applied
Weak or absent pulses — your doctor may notice reduced pulses in the foot during a physical examination
Slow-healing wounds — any cut, blister, or sore on the foot that does not show signs of healing within one to two weeks
Shiny, thin skin — the skin on the lower legs may appear smooth, shiny, and hairless due to reduced blood flow
Pain at rest — aching or burning pain in the toes or forefoot, especially at night or when lying down, that improves when you hang your feet over the edge of the bed
Numbness or tingling — though often related to neuropathy, these symptoms can also indicate vascular insufficiency

Daily Foot Care Tips for Diabetic Patients

Consistent daily foot care is the foundation of preventing diabetic foot complications. These simple habits can make a significant difference:

Inspect Your Feet Every Day

Check the tops, soles, heels, and between the toes for any cuts, blisters, redness, swelling, or changes in skin colour. If you have difficulty seeing the soles of your feet, use a mirror or ask a family member for help. Early detection of even a tiny wound can prevent it from progressing to a serious infection.

Wash and Dry Carefully

Wash your feet daily with lukewarm water and mild soap. Always test the water temperature with your elbow or a thermometer, as neuropathy may prevent you from feeling if the water is too hot. After washing, dry your feet thoroughly, paying special attention to the spaces between the toes where moisture can lead to fungal infections.

Moisturise — But Not Between the Toes

Apply a good-quality moisturiser to the tops and soles of your feet to prevent dry, cracked skin. Avoid applying moisturiser between the toes, as excess moisture in these areas can encourage fungal growth.

Wear Appropriate Footwear

Always wear well-fitting, supportive shoes — even indoors. Avoid walking barefoot, as this increases the risk of cuts and injuries that you may not feel. Check inside your shoes before putting them on to ensure there are no stones, seams, or objects that could cause pressure points. Diabetic-specific footwear with extra depth and cushioned insoles can be particularly beneficial.

Trim Nails Carefully

Cut your toenails straight across and file any sharp edges gently. Avoid cutting too close to the skin or rounding the corners, as this can lead to ingrown toenails and infection. If you have difficulty managing your nails safely, see a podiatrist regularly.

Promote Circulation

Wiggle your toes and move your ankles up and down for a few minutes several times a day. Avoid crossing your legs for prolonged periods. Stay active with regular walking or other gentle exercise as recommended by your healthcare team.

When to See a Vascular Surgeon

While your endocrinologist and primary care physician play central roles in managing diabetes, a vascular surgeon should be consulted when there are concerns about the blood supply to the feet. Specific situations that warrant a vascular assessment include:

A foot wound or ulcer that is not healing despite appropriate wound care
Rest pain in the toes or forefoot — especially pain that wakes you at night
Blackening or gangrene of the toes
Absent foot pulses on clinical examination
An abnormal ankle-brachial index (ABI) test result
Before any planned foot surgery, to ensure adequate blood flow for healing

A vascular surgeon can perform detailed investigations including duplex ultrasound and CT angiography to map the blood vessels and identify any blockages. This information is essential for planning the best approach to restore blood flow.

Treatment Options for Diabetic Vascular Disease

When poor circulation is identified, several treatment options may be considered to improve blood flow to the feet and promote wound healing:

Angioplasty and stenting — a minimally invasive procedure in which a balloon is used to open narrowed arteries, often with a small metal stent placed to keep the artery open
Bypass surgery — creating a new pathway for blood to flow around a blocked artery using either a vein graft or synthetic graft
Atherectomy — removal of plaque build-up from inside the artery using specialised devices
Medical management — optimising blood sugar control, blood pressure, cholesterol, and antiplatelet therapy to slow disease progression

The goal of vascular intervention in diabetic patients is always to restore sufficient blood flow to heal wounds, relieve pain, and preserve the limb. A multidisciplinary approach involving the vascular surgeon, endocrinologist, podiatrist, and wound care specialist typically achieves the best outcomes.

Dr. Medani works closely with diabetic care teams to provide comprehensive vascular assessment and treatment for patients with diabetic foot complications. If you or a loved one has diabetes and you are concerned about foot health or circulation, early specialist input can make a meaningful difference in preventing serious complications.