Diabetic neuropathy is nerve damage caused by high blood sugar over time. It most often affects the feet and legs. If your feet are numb, you may not feel a small cut, a blister, or a pebble in your shoe.

Nerve damage is the most common cause of diabetic foot ulcers. A small injury you cannot feel can turn into an open sore.

Nerve damage that has already happened usually does not reverse. You can still help slow further damage and protect your feet from wounds.

What Is Diabetic Neuropathy?

Diabetic neuropathy is nerve damage caused by diabetes. Up to half of people with diabetes have nerve damage in the feet and legs. It can affect people with type 2 diabetes and people with type 1 diabetes.

There are four main types of diabetic neuropathy:

• Peripheral neuropathy is nerve damage in the feet and legs, and sometimes the hands and arms. It is the most common type. It can cause numbness, tingling, burning, and loss of feeling.
• Autonomic neuropathy affects the nerves that control internal organs, such as the heart, stomach, and bladder. It can hide the warning signs of low blood sugar.
• Focal neuropathy affects a single nerve, most often in the hand, head, torso, or leg.
• Proximal neuropathy is rare. It affects nerves in the hip, buttock, or thigh, usually on one side. It can cause severe pain.

What Causes Diabetic Neuropathy?

Diabetic neuropathy is caused by high blood sugar and high levels of fats in the blood, such as triglycerides. Over time, both can damage nerves. High blood sugar can also damage the small blood vessels that carry oxygen and nutrients to nerves.

Certain conditions raise the risk:

• Blood sugar that stays above your target range
• Having had diabetes for many years
• Age
• Overweight or obesity
• High blood pressure
• High cholesterol
• Advanced kidney disease
• Smoking
• Drinking too much alcohol

Certain genes may also make diabetic neuropathy more likely.

Other Causes of Nerve Damage in the Feet

Several other health problems can also cause nerve damage in the feet. Doctors diagnose diabetic neuropathy only after ruling out these other causes:

• Low vitamin B12 can cause nerve damage. Long-term use of metformin can lower vitamin B12 in some people.
• Heavy alcohol use can damage nerves.
• An underactive thyroid can damage nerves.
• Kidney disease can damage nerves.
• Some cancer medicines, called chemotherapy, can damage nerves.

Do not change a prescribed medicine on your own.

What Does Neuropathy in the Feet Feel Like?

Neuropathy in the feet often feels like tingling, burning, or numbness that starts in the toes. It usually affects both feet. Up to half of people with diabetic nerve damage in the feet may have no symptoms.

Symptoms you may notice:

• Tingling or a pins and needles feeling
• Burning pain
• Shooting or deep pain
• Numbness or loss of feeling
• Strong pain from light touch
• Less ability to feel heat or cold
• Muscle weakness in the feet or legs
• Trouble with balance and more falls
• Dry and cracked skin on the feet

Symptoms are often worse at night. You may not feel pressure or a small injury.

Charcot foot is a rare problem in which the bones and tissue of the foot are damaged. It can change the shape of the foot. It may start with redness, warmth, and swelling.

If you care for someone with diabetes, check their feet each day even if they report no pain.

How Does Neuropathy Lead to Foot Ulcers?

Neuropathy can lead to foot ulcers because you may not feel the small injury that starts a sore. High blood sugar, poor circulation, and nerve damage are the main diabetes-related problems that lead to foot ulcers.

Nerve damage can also change the shape of your foot. It can make the skin on your feet dry. Pressure then builds on one part of the foot. That pressure forms thick skin called a callus. Bleeding can occur under the callus. An open sore, called an ulcer, can then form.

Walking on a numb foot with a sore can slow healing. A sore that is not treated early can become infected. Poor circulation can make it harder for a sore to heal.

In one study at two research centers in the U.S. and U.K., nerve damage helped cause the ulcer in nearly four in five people who had one. Foot ulcers come before about four in five amputations in people with diabetes. Early treatment of foot problems can greatly lower the risk of amputation.

How Do Doctors Check for Diabetic Neuropathy?

Doctors check for diabetic neuropathy with a foot exam and simple tests. They look at your feet for injuries, skin changes, and shape changes, as well as testing the following:

• Touching your toes and feet with a thin nylon strand called a monofilament to test light touch
• Touching your feet with a tuning fork to test vibration
• Checking your ankle reflexes
• Checking whether you can feel temperature changes
• Watching how you walk and testing your balance

Screening should start when you are diagnosed with type 2 diabetes. If you have type 1 diabetes, screening should start five years after diagnosis. After that, screening should occur at least once a year. Your doctor should check your feet at each office visit if you have loss of feeling or a prior ulcer.

Your doctor may also order blood tests to rule out other causes, such as thyroid problems, kidney disease, or low vitamin B12. In some cases, your doctor may order a nerve test that measures how fast signals travel along nerves.

Can Diabetic Neuropathy Be Reversed?

Diabetic neuropathy in the feet usually cannot be reversed once it has developed. No current treatment is approved to repair the nerve damage. Blood sugar control can still help prevent or slow it. Some less common types of diabetic neuropathy often get better over time.

Nerve problems found at an early stage may be easier to change than long-standing damage. Even so, an expert review found that a full return of feeling has not been proven.

What Blood Sugar Control Can and Cannot Do

Lowering your blood sugar can prevent or delay nerve damage in type 1 diabetes. A large study followed 1,441 people ages 13 to 39 with type 1 diabetes. Close blood sugar control lowered the share who developed nerve damage. After five years, about one in 20 people with close control had nerve damage. About one in eight people with usual care had it.

In type 2 diabetes, tighter blood sugar control may slightly slow nerve damage. It does not repair nerve loss that has already occurred.

Very low blood sugar targets can carry risks, such as severe low blood sugar and weight gain. Your care team sets your target range with you.

Nerve Damage That Can Get Better

Some less common types of diabetic neuropathy often get better over time:

• Focal neuropathy that is not caused by a trapped nerve often improves within weeks or months. Most people recover even without treatment.
• Proximal neuropathy often improves over months or years. Most people recover within a few years. In many cases, some symptoms do not go away completely.

In one study of people with type 1 diabetes, a working pancreas transplant helped nerves carry signals better. Their nerve exam results improved only slightly. Diabetes care guidelines reserve a pancreas transplant for some people with type 1 diabetes, such as those who also need a kidney transplant. After a transplant, people must take medicines that weaken the immune system for life. These medicines can have side effects.

What Weight Loss and Exercise Studies Show

Studies of weight loss and exercise show mixed results for diabetic nerve damage. In one large study of adults with type 2 diabetes and overweight or obesity, a weight-loss program improved nerve symptoms. The benefit lasted for a time after the program ended. Most nerve exam results were no better than in the comparison group.

One small, short study of supervised exercise found less pain and better symptom scores. Reviews of exercise studies found some benefits. The strength of this evidence is low.

Can a Large Drop in A1C Bring On Nerve Pain?

A large drop in average blood sugar over a few months can bring on nerve pain in some people. This condition is called treatment-induced neuropathy. Although it’s considered rare, it may be more common than once believed. It can cause new burning pain. It can also affect the nerves that control internal organs.

One study looked at people seen at a nerve clinic. It counted cases that began within eight weeks of an A1C drop of two or more points over three months. The risk was higher with larger drops in A1C.

Do not change your diabetes treatment on your own to avoid it. If you notice new burning pain after a large drop in your A1C, tell your care team.

How Is Diabetic Nerve Pain Treated?

Treatment can ease diabetic nerve pain, but it does not repair the nerve damage. Options include:

• Prescription medicines for nerve pain
• Physical therapy, which can help improve your strength and balance
• A bed cradle, a device that keeps sheets and blankets off your legs and feet while you sleep

The FDA has approved pregabalin, duloxetine, and a capsaicin 8% patch for diabetic nerve pain. A health professional applies the patch in a clinic. Gabapentin and some older antidepressants are also used to treat this pain.

Opioid pain medicines generally are not recommended for diabetic nerve pain except in rare situations. An extended-release form of the opioid tapentadol is approved for severe, ongoing diabetic nerve pain that isn’t controlled with other treatments.

Several spinal cord stimulators are FDA-approved for diabetic nerve pain in the legs and feet. They are implanted devices that send electrical signals to the spinal cord. They are approved to reduce pain, not to repair nerve damage.

The American Diabetes Association says vitamin, mineral, and herbal supplements have no proven benefit for people with diabetes unless they have a deficiency. A four-year trial of one supplement, alpha-lipoic acid, missed its main goal. Some other scores were better with the supplement. Serious health problems were more common in the supplement group. Talk with your doctor before trying any supplement.

How Can You Slow Neuropathy and Protect Your Feet?

You can help slow further nerve damage and lower the risk of foot wounds with steady diabetes care and daily foot care.

Steps That Slow Nerve Damage

These steps can help keep nerve damage from getting worse:

• Keep your blood sugar in your target range.
• Take your medicines as prescribed.
• Keep your blood pressure and cholesterol in the range your care team advises.
• Do not smoke.
• If you drink alcohol, have no more than one drink a day if you are a woman or two if you are a man.
• Stay active with foot-friendly exercise, such as walking, swimming, or cycling.
• Keep your weight in a range that is healthy for you with a meal plan and regular activity.

Foot Care for Numb Feet

These foot care steps can help prevent sores and infection. If you care for someone with diabetes, you can help with the daily checks.

• Check your feet every day, including between the toes. If you cannot see the bottoms, use an unbreakable mirror or ask a family member for help. Look for blisters, cuts, bruises, cracks, redness, and swelling.
• Wash your feet daily in warm, not hot, water. Do not soak your feet. Test the water with your elbow or a thermometer. It should be 90 to 95 degrees Fahrenheit.
• Dry your feet well, especially between the toes. Do not put lotion between the toes. You may moisturize the tops and bottoms to prevent cracking.
• Trim toenails straight across.
• Wear clean socks that fit well and are not tight.
• Wear shoes and socks at all times, even indoors. Never walk barefoot. Check the inside of your shoes for pebbles or rough spots before you put them on. Wear shoes that fit well, and break in new shoes slowly.
• Protect your feet from heat. Do not use heating pads or hot water bottles on numb feet. Wear shoes on hot pavement, and use sunscreen on the tops of your feet.
• Put your feet up when you sit. Wiggle your toes for a few minutes several times a day.
• Do not remove corns or calluses yourself. Do not use over-the-counter corn removers. See a foot doctor for corns or calluses.
• Have a foot doctor check your feet at least once a year, and more often if you have nerve damage.
• Ask your care team whether you need special shoes. They are recommended for people at high risk, including people who have lost feeling in their feet. Medicare Part B may help pay for special shoes if you qualify.

When Should You Call a Doctor?

Call your doctor right away if you notice signs of nerve damage or a foot problem that is not healing. Do not wait for pain if your feet are numb.

Report these signs:

• A cut, blister, or bruise on your foot that does not heal after a few days
• Skin that is red, warm, or painful
• A callus with dried blood inside
• Burning, tingling, weakness, or pain in your hands or feet that makes daily tasks or sleep hard
• Loss of feeling for light touch or for heat or cold
• A change in the shape of your foot or toes
• Hair loss on the lower leg and foot, or color and temperature changes
• Yellow and thick nails or signs of athlete's foot
• An ingrown nail or an infected corn
• Leg pain or cramping with activity
• A foot that is warm, red, and swollen, which can be a sign of Charcot foot
• Changes in digestion, urination, or sexual function
• Dizziness or fainting

Get emergency care right away if a foot infection turns black and smells bad. This can be a sign of gangrene.

Questions to Ask Your Doctor

You can bring these questions to your next visit:

• Do I have nerve damage in my feet?
• How often should my feet be checked?
• Could another cause, such as low vitamin B12, be adding to my symptoms?
• Which pain treatments fit my health and other medicines?
• Should I see a foot doctor or a physical therapist?
• Do I need special shoes or inserts to protect my feet?

Frequently Asked Questions

What Are the First Signs of Neuropathy in Your Feet?

The first signs of neuropathy in your feet are often tingling, burning, or numbness that starts in the toes. You may also feel less able to sense light touch, heat, or cold. Many people have no symptoms at first.

When Does Neuropathy Start in People With Diabetes?

Neuropathy in people with diabetes often starts after many years with the disease. At least one in 10 people with type 2 diabetes may already have it when they are diagnosed. About half of people with type 2 diabetes have it after 10 years.

Can Diabetic Neuropathy Be Reversed if It Is Caught Early?

Whether diabetic neuropathy can be reversed if it is caught early is still debated. Early nerve problems may be easier to change than long-standing damage. An expert review found that a full return of feeling in the feet has not been proven.

What Makes Neuropathy Worse?

High blood sugar that stays above your target range over time makes neuropathy more likely to get worse. Smoking and heavy drinking also raise the risk of nerve damage. In rare cases, a large, fast drop in A1C can bring on new nerve pain.

What Are the Newest Treatments for Neuropathy in the Feet?

The newest treatments for neuropathy in the feet include implanted spinal cord stimulators for nerve pain. The FDA approved several of them for diabetic nerve pain in the legs and feet between 2021 and 2024. No current treatment is approved to reverse diabetic nerve damage.

How Long Can You Live With Diabetic Neuropathy?

How long you can live with diabetic neuropathy has no single answer. Nerve damage that affects heart rate and blood pressure is linked with a higher risk of death. Foot ulcers are also linked with a higher risk of death.

What Are the Final Stages of Diabetic Neuropathy?

In the final stages of diabetic neuropathy, nerve damage in the feet can take away the feeling that protects them from injury. It can lead to foot ulcers that come back, Charcot foot, infection, and a higher risk of amputation.

Sources

• What Is Diabetic Neuropathy: NIDDK What Is Diabetic Neuropathy?, 2018; CDC Your Feet and Diabetes, 2024; CDC Nerve Damage, 2024; NIDDK Autonomic Neuropathy, 2018; Pop-Busui et al., Diabetes Care, 2017
• Causes and Risk Factors: NIDDK What Is Diabetic Neuropathy?, 2018; CDC Nerve Damage, 2024; ADA Standards of Care, Section 12, 2026; NIDDK Peripheral Neuropathy, 2018
• Symptoms in the Feet: NIDDK Peripheral Neuropathy, 2018; MedlinePlus Diabetes and Nerve Damage, 2025; CDC Nerve Damage, 2024; ADA Standards of Care, Section 12, 2026; NIDDK Diabetes and Foot Problems, 2017
• Foot Ulcers: ADA Standards of Care, Section 12, 2026; IWGDF Practical Guidelines, 2023; NIDDK Diabetes and Foot Problems, 2017; MedlinePlus Diabetes Foot Ulcers, 2026; Armstrong et al., JAMA, 2023; CDC Your Feet and Diabetes, 2024; Reiber et al., Diabetes Care, 1999
• Diagnosis and Screening: ADA Standards of Care, Section 12, 2026; NIDDK Peripheral Neuropathy, 2018; MedlinePlus Diabetes and Nerve Damage, 2025
• Reversal and Blood Sugar Control: ADA Standards of Care, Section 12, 2026; Sloan et al., J Peripher Nerv Syst, 2026; DCCT Research Group, Ann Intern Med, 1995; Pop-Busui et al., Diabetes Care, 2017; Ismail-Beigi et al., Lancet (ACCORD), 2010
• Types That Improve: NIDDK Focal Neuropathies, 2018; NIDDK Proximal Neuropathy, 2018; Navarro et al., Ann Neurol, 1997; ADA Standards of Care, Section 9, 2026
• Weight Loss and Exercise: Look AHEAD Research Group, Diabetologia, 2017; Kluding et al., J Diabetes Complications, 2012; ADA Standards of Care, Section 12, 2026
• Treatment-Induced Neuropathy: Gibbons and Freeman, Brain, 2015; Pop-Busui et al., Diabetes Care, 2017
• Pain Treatment: ADA Standards of Care, Section 12, 2026; NIDDK Peripheral Neuropathy, 2018; Price et al., Neurology, 2022; Pregabalin label, 2025; Duloxetine label, 2026; Capsaicin 8% patch label, 2026; Ziegler et al., Diabetes Care (NATHAN 1), 2011; Tapentadol ER (Nucynta ER) label, 2025; ADA Standards of Care, Section 5, 2026
• Spinal Cord Stimulators: FDA PMA P130022/S039, 2021; FDA PMA P840001/S469, 2022; FDA PMA P010032/S189, 2023; FDA PMA P030017/S357, 2023; FDA PMA P190002/S019, 2024
• Slowing Damage and Foot Care: NIDDK What Is Diabetic Neuropathy?, 2018; CDC Your Feet and Diabetes, 2024; NIDDK Diabetes and Foot Problems, 2017; ADA Standards of Care, Section 12, 2026; ADA Standards of Care, Section 5, 2026
• When to Call a Doctor: CDC Nerve Damage, 2024; CDC Your Feet and Diabetes, 2024; NIDDK Diabetes and Foot Problems, 2017
• Life Expectancy: ADA Standards of Care, Section 12, 2026; Armstrong et al., JAMA, 2023

This article is for general information only and is not medical advice. If you have symptoms or questions about your care, talk with your health care team.