A “diabetic foot problem” is any pathology of the foot below the ankle in a person with diabetes caused by peripheral neuropathy and/or peripheral arterial disease (PAD). It includes callus, ulceration, soft‑tissue infection, osteomyelitis and Charcot neuro‑osteoarthropathy (NICE NG19).
Early recognition, standardised documentation and timely referral to the multidisciplinary foot service are essential to reduce the risk of limb loss and systemic complications.
Why the diabetic foot is vulnerable
Chronic hyperglycaemia promotes non‑enzymatic glycation (advanced glycation end products) that impairs tissue repair and contributes to vascular and neural injury.
Peripheral neuropathy:
Loss of protective sensation predisposes to unrecognised trauma and repetitive pressure injury.
Autonomic neuropathy leads to dry, fissured skin that breaks down easily.
Motor neuropathy causes foot deformities (claw toes, pes cavus, rocker‑bottom) that concentrate pressure and cause callus and ulceration.
Peripheral arterial disease reduces perfusion and impairs wound healing; the combination of neuropathy and ischaemia explains the high risk of infection, poor healing and tissue loss.
Clinical presentation - what to look for
History:
Diabetes type and duration, recent glycaemic control, prior ulcers or amputations, smoking, cardiovascular and renal disease.
Onset and course of the lesion, any trauma, and systemic symptoms (fever, rigors, reduced mobility).
Typical findings:
Reduced or absent protective sensation (may be painless).
