How diabetes and heart disease affect your feet

 

(According to the guidelines of the American Diabetes Association and the American Heart Association)

Diabetes and cardiovascular disease are closely related conditions that often occur together. According to the American Heart Association (AHA), adults with diabetes have a significantly higher risk of developing cardiovascular disease than people without diabetes. The American Diabetes Association (ADA) even considers cardiovascular disease the leading cause of death among people with diabetes.

Although most people associate heart disease with chest pain or shortness of breath, early warning signs can sometimes occur much lower in the body – in the legs.

Understanding the interaction between diabetes and cardiovascular disease is crucial for preventing serious complications.
The long-known link between diabetes and cardiovascular disease is of great importance.

The ADA Diabetes Care Standards (2024) state that chronic hyperglycemia contributes to both microvascular and macrovascular damage. This includes:

Damage to small blood vessels (microvascular complications, such as neuropathy)

Damage to larger arteries (macrovascular diseases, such as coronary heart disease and peripheral arterial disease)

Similarly, the AHA’s scientific explanation of cardiovascular disease in diabetes explains that diabetes accelerates atherosclerosis—the buildup of plaque in the arteries—which increases the risk of heart attack, stroke, and peripheral arterial disease (PAD).

When blood vessels narrow or stiffen due to plaque formation, blood flow to the lower limbs is reduced. The legs, which are furthest from the heart, are particularly susceptible to this.

Why are the feet at greater risk?

There are two important mechanisms that link diabetes, heart disease, and foot complications:

1. Peripheral neuropathy (ADA)

According to the ADA, diabetic peripheral neuropathy is one of the most common complications of diabetes. It is caused by prolonged high blood sugar levels that damage the nerves.

Possible symptoms are:

Numbness

Tingling

Burning sensation

Reduced ability to feel pain or temperature

When your sense of touch is impaired, minor injuries can go unnoticed.

2. Peripheral arterial disease (PAD)

The American Heart Association (AHA) defines peripheral arterial disease (PAD) as a manifestation of systemic atherosclerosis. PAD reduces blood flow to the legs and feet due to narrowed arteries.

Impaired blood circulation leads to:

Delayed wound healing

Increased risk of infection

Increased risk of stomach ulcers

In severe cases, tissue death (necrosis) occurs.

When neuropathy and peripheral arterial disease (PAD) occur together—a common scenario in people with diabetes—the risk of serious foot complications increases dramatically.

Warning signs in the feet that may indicate an increased risk of cardiovascular disease.

Both the ADA and the AHA emphasize the importance of recognizing vascular and neurological symptoms early.

Observe:

Cold feet or a low temperature

May indicate reduced arterial blood circulation.

• Swelling of the ankles or feet

According to the AHA, persistent swelling (edema) can be a sign of heart failure.

• Pain in the legs while walking (claudication)

The classic symptom of PAD as described in the AHA guidelines is pain that improves with rest.

• Wounds that heal slowly

The ADA advises having all foot ulcers examined immediately if they do not heal within two weeks.

• Discoloration of the skin (pale, bluish, or reddish)

May indicate reduced blood circulation.

Combined risk

The ADA reports that people with diabetes are at a significantly higher risk of lower limb amputation, especially when peripheral neuropathy and peripheral arterial disease (PAD) occur simultaneously.

The AHA further states that PAD is not only a foot problem, but a sign of widespread atherosclerosis and increases the risk of heart attack and stroke.

This means that foot symptoms can indicate a broader cardiovascular condition.

Guideline-based prevention strategies

Both organizations provide clear preventive recommendations.

ADA recommendations:

Annual comprehensive foot check

More tests for high-risk patients

Daily self-check of the feet

Strict control of blood sugar levels to reduce the progression of neuropathy.

Immediate assessment of any ulcers or infections

AHA recommendations:

blood pressure regulation

Control your cholesterol levels.

Maintain a healthy weight

Stop smoking

Exercise regularly.

These measures reduce both cardiovascular complications and complications of the lower limbs.

When should you call for immediate medical help?

Consult a doctor immediately if you suffer from:

Sudden, severe discoloration of the legs

Signs of infection (redness, warmth, pus)

Rapid swelling

Chest pain and symptoms in the legs

Newly developed, severe leg pain

According to both the ADA and AHA guidelines, early intervention significantly reduces the risk of permanent damage.

Clinical result

The feet often serve as early indicators of the overall health of the blood vessels.

The American Diabetes Association emphasizes that foot complications are preventable through early detection and appropriate treatment.

The American Heart Association emphasizes that peripheral vascular disease is a serious cardiovascular condition that must not be overlooked.

When diabetes and heart disease occur together, regular foot checks are not only a recommendation, but a necessity.

Protecting your feet is part of protecting your heart.