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Diabetic Neuropathy (Diabetic Foot Disease)

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What Is Diabetic Neuropathy (Diabetic Foot Disease)?

Diabetic foot disease — or diabetic neuropathy — refers to circulatory and nerve problems affecting the feet of those with diabetes.

Some of these diabetic foot problems may include:

  • Nerve damage
  • Poor circulation
  • Foot ulcers
  • Diabetic foot infections
  • Inflammations

Causes and risk factors of diabetic neuropathy

Diabetes itself does not inevitably lead to diabetic foot disease. Chronic high blood sugar levels, demonstrated by hemoglobin A-1 C levels higher than eight over many years, lead to nerve damage to the feet.

Among those with diabetes, your risk for diabetic neuropathy is greater if you:

  • Have type 1 diabetes
  • Have type 2 diabetes
  • Are older than 40 years of age
  • Are a man
  • Have high blood sugar levels

Diabetic foot disease complications

Diabetes can damage your nerves and reduce blood flow to your feet. This may make it harder to notice if you have sustained some sort of minor foot injury, like a blister or a sore.

A minor injury can escalate to a more serious diabetic foot infection, which may require amputation.

Because of this, those with diabetes are 25 times more likely to lose a leg than those without the disease.

Why choose UPMC Orthopaedic Care for diabetic foot disease treatment?

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Diabetic Neuropathy Symptoms and Diagnosis

Diabetic neuropathy — or diabetic foot disease — can evolve over time or, in some cases, even just years after an initial diagnosis of diabetes.

Because of the nature of the disease, some of the minor symptoms can progress into more serious problems.

Diabetic neuropathy (foot disease) symptoms

Most people with diabetic foot disease do not feel a great deal of pain.

More common diabetic foot disease symptoms may include:

  • Swelling of the feet
  • Redness of the feet concentrated in areas of pressure
  • Blisters
  • Sores
  • Tingling or burning sensation
  • Weakness in muscles
  • Sharp pain
  • Cramps

Diagnosing diabetic foot disease

The American Diabetes Association (ADA) recommends a yearly total foot exam for all those with diabetes.

Your doctor or other specialist can conduct the exam. He or she will check for bone skin imperfections and abnormalities, which are often precursors to diabetic foot disease or diabetic neuropathy.

To confirm a diagnosis of diabetic foot disease, your doctor will fully review your:

  • Symptoms
  • Medical history
  • Results of a number of tests and exams

Tests for diabetic neuropathy

Common tests for monitoring or diagnosing diabetic foot disease include:

  • X-rays: Help doctors monitor the progression of diabetic foot disease by watching the changes in bone structure and health over time
  • Magnetic resonance imaging (MRI) and ultrasounds: Offer a look into soft tissues of the foot
  • Bone scans/indium scans: Use nuclear medicine techniques, like white blood cell marking, to assess the presence of a bone infection
  • Filament tests: Use a monofilament to measure the foot's sensitivity to touch
  • Nerve condition tests: Measure the ability of the legs and feet to conduct electrical signals
  • Quantitative sensory tests: Measure nerve responses to changing vibrations and temperatures
  • Electromyography (EMG) tests: Evaluate the electrical signals that the foot muscle discharges 

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Diabetic Neuropathy Treatment and Management

Treatment goals for diabetic foot disease

Since diabetic foot disease has no known cure, treatments at UPMC Orthopaedic Care aim to:

  • Slow the progression
  • Preserve and restore function to the foot
  • Manage and prevent related complications
  • Relieve pain

Our doctors use a range of treatments in cases of diabetic foot disease or diabetic neuropathy, including:

  • Medications
  • Nonsurgical treatments
  • Surgery


Medications for diabetic foot disease may include pain relievers, like anti-seizure medications, and antidepressants.

While these medications are often used for treating other conditions, they have been proven to help with nerve pain.

Nonsurgical treatments for diabetic foot disease

The two most common nonsurgical treatments are casting and custom shoes.

Casting can help protect the foot and ankle bones while reducing swelling.

During casting treatment for diabetic neuropathy:

  • You will likely use crutches, walkers, or even wheelchairs.
  • Your doctor will change your casts often to monitor the foot's shape.

Custom shoes can help:

  • Fit the shape of a diabetic foot.
  • Decrease the risk of further health problems like foot ulcers.

Surgery for diabetic neuropathy

Orthopaedic experts at UPMC often advise surgical treatment methods for patients that:

  • Are at a greater risk of getting foot ulcers.
  • Have not had success using nonsurgical treatment options for their diabetic foot disease.

Some of the more common surgical strategies for diabetic foot disease include:

  • Muscle lengthening
  • Bone shaving
  • Fusion of bones
  • Repositioning of bones
  • Amputation, in cases of severe infection

Benefits and risks of diabetic foot disease treatment

Treatments for diabetic foot disease, when implemented quickly, can be effective in preserving and even restoring function. For that reason, it's vital for all people with diabetes to regularly monitor their feet and control sugar intake.

Following any sort of surgery for diabetic foot disease, you will have to avoid all weight bearing activities for about three months.

Failure to follow doctors' orders of this rest period can lead to further problems and related complications.

Learn more about diabetic neuropathy treatments

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