Diabetic neuropathy and foot pain: what to do and when to get checked

What is diabetic neuropathy?

Diabetic neuropathy is nerve damage linked to diabetes, and the nerves in the feet and legs are the ones most often affected.^[1] CDC estimates that about half of all people with diabetes have some kind of nerve damage.^[1] ADA notes that up to 50.0% of people with diabetic nerve damage in the feet and legs may have no symptoms.^[2]

ADA also notes that nerve damage in someone with diabetes is not always caused by diabetes. Other causes worth ruling out include alcohol, some medicines, low vitamin B12 (especially in people who have taken metformin for a long time), thyroid problems and kidney conditions.^[2]

This guide covers what neuropathy can feel like, which changes need prompt care, what a foot exam involves and what daily foot care looks like. It cannot tell you whether you have neuropathy.

What does diabetic foot pain feel like?

Nerve pain from diabetes is often described as burning or tingling, and ADA notes these are among the most common early symptoms.^[2] CDC lists numbness, tingling or pain, and notes that some people have no symptoms.^[1] Nerve damage can also make it harder to feel pain, heat or cold.^[1] ADA adds that it can affect balance and lead to falls.^[2]

Losing feeling matters because pain is how the body warns you. CDC notes that if you cannot feel pain in your feet, you may not notice a cut, blister or sore, and small problems can become serious if they are not treated early.^[1]

ADA notes that nerve pain can affect sleep, mobility and mood.^[2] If it is affecting yours, that is worth saying at your next appointment.

What about diabetes leg pain?

Pain or cramping in the legs, buttocks, thighs or calves during physical activity is on CDC's list of symptoms to see a doctor about right away.^[1] ADA lists leg tiredness and cramping during walking as possible signs of reduced blood flow to the legs, which is checked during a foot exam.^[2]

When do I need to get my feet checked right away?

CDC lists foot and leg changes that need to be seen right away, without waiting for your next appointment:^[1]

• Pain in your legs, or cramping in your buttocks, thighs or calves during physical activity.
• Tingling, burning or pain in your feet.
• Loss of the sense of touch, or of the ability to feel heat or cold well.
• A change in the shape of your feet over time.
• Loss of hair on your toes, feet and lower legs.
• Dry, cracked skin on your feet.
• A change in the color and temperature of your feet.
• Thickened, yellow toenails.
• Fungal infections such as athlete's foot between your toes.
• A blister, sore, ulcer, infected corn or ingrown toenail.

ADA's standards treat any open wound, or unexplained swelling, redness or warmth, as a reason for urgent referral.^[2] ADA singles out a warm, swollen, red foot in someone with neuropathy, even without an injury or open wound, as needing prompt assessment for Charcot foot, a condition affecting the bones and joints of the foot.^[2] CDC notes that catching problems early and treating them right away greatly lowers the risk of amputation.^[1]

What happens at a diabetes foot exam?

ADA's 2026 Standards of Care recommend a comprehensive foot exam at least once a year.^[2] The exam includes:^[2]

• A look at the skin and the shape of the feet.
• A sensation test with a 10-gram monofilament, or a light-touch test called the Ipswich touch test, plus at least one other test such as pinprick, temperature or vibration.
• A check of the pulses in your legs and feet.

ADA recommends checking for nerve damage from the time type 2 diabetes is diagnosed, and from 5 years after a type 1 diagnosis, then at least once a year.^[2] People who have lost feeling, or who have had an ulcer or amputation, are advised to have their feet inspected at every visit.^[2] CDC also recommends having your feet checked at every primary care visit.^[1]

You might say: "My toes have felt numb at night for a few weeks. Can you check my feet today?" This is an illustrative prompt, not a quote from a real patient. Use your own words and choose how much you want to share.

What does daily foot care involve?

CDC's foot care guide describes a daily routine for people with diabetes:^[1]

1. Check your feet every day for cuts, redness, swelling, sores, blisters, corns, calluses or changes to the skin or nails. Use a mirror or ask someone to help.
2. Wash your feet in warm, not hot, water. Do not soak them.
3. Dry them completely, and apply lotion to the tops and bottoms but not between the toes.
4. Never go barefoot, even indoors. Check inside your shoes for pebbles or rough linings.
5. Wear well-fitting shoes with socks, and break new shoes in slowly.
6. Trim toenails straight across and smooth sharp edges with a nail file.
7. Leave corns and calluses alone, and do not use over-the-counter removers.

CDC also suggests putting your feet up when sitting and wiggling your toes several times a day to keep blood flowing.^[1] ADA recommends specialized therapeutic footwear for people at high risk of foot ulcers, including those who have lost feeling.^[2]

According to CDC, keeping blood sugar in your target range as much as possible is one of the most important ways to prevent nerve damage or stop it getting worse, and not smoking helps blood flow to the feet.^[1]

What treatments are used for painful neuropathy?

Treatment for painful neuropathy aims to ease the pain, because ADA notes that no current treatment reverses the nerve damage itself.^[2]

ADA's 2026 standards recommend four groups of medicines as first options for nerve pain: gabapentinoids, serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants and sodium channel blockers.^[2] Combinations can add relief.^[2] An 8.0% capsaicin patch is FDA-approved for this pain.^[2] ADA advises against opioids, including tramadol and tapentadol, except in rare circumstances, because of the risk of harm.^[2] ADA also notes guidance from the American Academy of Neurology to treat sleep and mood problems alongside the pain.^[2]

Which option fits depends on your health and your other medicines, so this is a conversation for your care team.

Where can I find support with foot and nerve changes?

The right support depends on whether you need a foot check soon, help with daily foot care, or support with pain that affects sleep and mood. Compare diabetes resources to see what each service offers and where it is available. Explore diabetes patient questions for illustrative ways to describe what you are feeling. ADA's foot health page has more on looking after your feet. The mama health app is one place to ask about your condition and get answers grounded in medical science and the experience of others living with diabetes. Learn more about its diabetes support.