SHAREABLE RESOURCE: The “Diabetic Foot”

Diabetes affects much more than blood sugar. Over time, high blood sugar can damage the nerves in the legs and feet: a condition called diabetic peripheral neuropathy. This nerve damage is extremely common among people with diabetes, and it plays a major role in what many people refer to as “diabetic foot problems.” Neuropathy often starts quietly or with varying clinical signs and symptoms. Some individuals report tingling, burning, or numbness, whereas others experience sharp, stabbing pain. For many, the greater concern isn’t pain but loss of sensation (1,2). When your feet can’t “feel,” it becomes harder to sense the ground, judge where your body is in space, or detect small injuries. That’s why people with neuropathy are more likely to develop foot ulcers, balance problems, and an increased risk of falls. HOW NEUROPATHY CHANGES MOVEMENT AND BALANCE Healthy nerves constantly send messages between your feet, muscles, and brain to help you stand, walk, and stay steady. When nerves are damaged, information travels more slowly or is distorted (3). Research on people with diabetic neuropathy shows several common movement changes: Reduced sensation and awareness of the ground underneath their feet. Changes in walking patterns, such as shorter steps, slower speed, or a wider stance. Less stable balance, especially when standing on one leg, turning, or walking in dim lighting. Greater “variability” in walking, meaning each step may be slightly different than the last, which increases fall risk. These changes do not mean someone cannot be active; they signal to the body that it is working harder to maintain balance and coordination. WHY FALLS AND INJURIES BECOME MORE LIKELY Because the feet are numb or less responsive, small balance disturbances can feel bigger. People may trip and fall more easily, catch their toes on the ground, or lose balance during everyday tasks such as stepping off a curb, walking in a crowd, or getting up from a chair (4). When sensation is reduced, people may not notice blisters, cuts, or pressure areas, which can develop into ulcers if left untreated. The good news: movement-related problems are not a sign that everything is “just going downhill.” They signal that the nervous system and muscles need support, attention, and appropriate activity (5). MOVEMENT AND EXERCISE REALLY CAN HELP A powerful message from growing research is that exercise and movement training can make a real difference (6). Even though neuropathy involves nerve damage, the body can still learn, adapt, and improve function. Programs that have shown benefits include: Balance exercises—practicing standing on both feet, weight shifting, single-leg support (as appropriate), and controlled movements can improve steadiness. Gait training—practicing safe walking with attention to posture, step cadence and length, and confidence helps reduce variability and improve control. Strengthening—especially for the legs, hips, ankles, and core, to support better movement control. Tai Chi or other mind-body exercise—research has shown Tai Chi and similar slow, controlled movement training can improve balance, confidence, and stability. Aerobic exercise—like cycling, walking, or swimming, which supports circulation, overall health, and quality of life. Specific to this population, consistency matters more than intensity. Even small improvements in balance and gait can lead to fewer falls and more independence. PRACTICAL TIPS FOR DAILY LIFE People with diabetic neuropathy don’t need to avoid movement. They need to move smarter and safer. Check your feet daily. Look for redness, swelling, blisters, or cuts. Use a mirror or seek assistance if needed. Wear supportive footwear. Avoid walking barefoot. Choose shoes with cushioning, proper fit, and protection. Make your home safer. Improve lighting, reduce clutter, secure rugs, and consider grab bars in the bathrooms. Take your time. Sudden movements and rushing increase the risk. Seek professional advice and care. A podiatrist, physical therapist, or qualified allied health professional can help monitor foot health and guide safe activity. For more information on how clinical exercise physiologists can play a role in diabetes care, please see (7). WHEN TO SEEK HELP? Contact a qualified allied health professional (8) if you notice: Increasing numbness, burning, or pain. New balance problems or frequent near falls. Foot wounds that don’t heal. Swelling, redness, or warmth in the foot. Sudden change in walking ability. The earlier these issues are addressed, the better the outcomes. A HOPEFUL PERSPECTIVE AND SUMMARY Diabetic peripheral neuropathy can feel frustrating, frightening, or discouraging, especially when it affects movement and independence. But many people living with neuropathy continue to walk, exercise, travel, and live active lives. With the right combination of blood sugar management, daily foot care, safe movement, and professional guidance, it is possible to maintain—and even improve—function, balance, and confidence. Movement is not the enemy. In fact, movement is medicine for the nervous system, muscles, circulation, and overall well-being.