Massage therapy · Kitchener–WaterlooDiabetic (Charcot) Foot

Diabetes is a common condition in which blood sugar levels are too high. Diabetic foot problems are a major health concern and a common reason for people with diabetes to be admitted to hospital (American Academy of Orthopaedic Surgeons, n.d.).

Most foot problems in people with diabetes come from damage the disease does to the small blood vessels. Poor blood supply to the nerves reduces feeling in the feet (nerve damage, called diabetic neuropathy), so cuts and other injuries may not be felt. Poor blood supply to the skin also makes wounds harder to heal (American Academy of Orthopaedic Surgeons, n.d.). One of the most serious problems that can result from nerve damage is Charcot arthropathy (Charcot foot), which can change the shape of the foot and cause disability (American Academy of Orthopaedic Surgeons, n.d.).

Treatment options are available for this condition, but the most effective treatment is prevention. For people with diabetes, good blood sugar control and careful daily checks of the feet are essential to overall health and to preventing foot problems (American Academy of Orthopaedic Surgeons, n.d.).

Diabetic Foot Anatomy

Warning Signs and When to Get Help

• The earliest sign is often swelling of the foot, which can happen without any obvious injury. You may first notice that your shoe no longer fits. Redness and warmth can also occur in the early stages, and these signs may be mistaken for an infection (American Academy of Orthopaedic Surgeons, n.d.).
• If you have diabetes and your foot becomes red, warm or swollen, or changes shape, contact your family doctor, nurse practitioner or diabetes foot team urgently, the same day if you can. NICE guidance says people with suspected Charcot foot should be referred to a specialist foot care service within 1 working day (National Institute for Health and Care Excellence, 2019). You may be advised to keep weight off the foot until you have been assessed.
• Call 911 or go to the emergency room at your nearest hospital if you have a foot ulcer and a fever or feel very unwell (signs of a serious infection), or if skin on your foot is turning black (gangrene) (National Institute for Health and Care Excellence, 2019).

Treatments you may want to discuss with your family doctor, nurse practitioner or diabetes foot team

Tips

• Follow the instructions from your healthcare team about when it is safe to put weight back onto the affected foot (American Academy of Orthopaedic Surgeons, n.d.).
• The sooner the condition is diagnosed and treated, the better the end result is likely to be (American Academy of Orthopaedic Surgeons, n.d.).
• Check your feet every day and keep your blood sugar levels under control (American Academy of Orthopaedic Surgeons, n.d.).
• Be on the lookout for swelling, redness, warmth, a wound or any other change to the foot that you haven't noticed before, and see your doctor as soon as possible if you notice one (American Academy of Orthopaedic Surgeons, n.d.).
• Wear strong, supportive, full-coverage footwear to help prevent wounds and injuries (American Academy of Orthopaedic Surgeons, n.d.).

Charcot foot is managed by your diabetes foot team, and protecting the foot while the bones heal comes first. Your team decides how long you're in a cast or boot and when you can put weight through the foot. I work inside those limits and need your team's okay before we start any hands-on treatment.

Please bring any X-ray or scan reports and notes from your medical team to your first visit. They're an important part of planning safe treatment for you.

Because feeling in the foot is reduced, I use lighter pressure there, keep any warm or cool applications mild (at home, always test the water with your hand first so you don't scald a foot that can't feel heat properly), and never work on or near an ulcer or open sore. If I notice a new red, warm or swollen area, we stop and you contact your team the same day.

While the Foot Is Protected

• Work on the hips, low back and other leg, and the shoulders and arms if you're on crutches
• Hip and knee exercises if your team allows them, plus relaxation and breathing
• Home visits if getting to the clinic is hard

Back on Your Feet

1. American Academy of Orthopaedic Surgeons (n.d.) Diabetic (Charcot) foot. OrthoInfo. Available at: https://www.orthoinfo.org/diseases--conditions/diabetic-charcot-foot/ (Accessed: 7 October 2026).
2. National Institute for Health and Care Excellence (2019) Diabetic foot problems: prevention and management (NG19). Available at: https://www.nice.org.uk/guidance/ng19/chapter/Recommendations (Accessed: 7 October 2026).