How Diabetes and Heart Disease Affect Your Feet Together
(With Guidance from the American Diabetes Association and American Heart Association)
Diabetes and heart disease are closely linked medical conditions that often coexist. According to the American Heart Association (AHA), adults with diabetes are significantly more likely to develop cardiovascular disease than those without diabetes. The American Diabetes Association (ADA) even classifies cardiovascular disease as the leading cause of death among people with diabetes.
While most people associate heart disease with chest pain or shortness of breath, early warning signs can sometimes appear much lower in the body — in the feet.
Understanding how diabetes and heart disease work together to affect foot health is critical for preventing serious complications.
The Established Link Between Diabetes and Cardiovascular Disease
The ADA Standards of Care in Diabetes (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 disease such as coronary artery disease and peripheral artery disease)
Similarly, the AHA Scientific Statement on Cardiovascular Disease in Diabetes explains that diabetes accelerates atherosclerosis — the buildup of plaque inside arteries — increasing the risk of heart attack, stroke, and peripheral artery disease (PAD).
When blood vessels narrow or stiffen due to plaque buildup, circulation to the lower extremities decreases. The feet, being the farthest point from the heart, are particularly vulnerable.
Why the Feet Are at Higher Risk
Two major mechanisms connect 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 results from long-term high blood glucose levels damaging nerves.
Symptoms may include:
Numbness
Tingling
Burning sensations
Reduced ability to feel pain or temperature
When sensation is impaired, minor injuries may go unnoticed.
2. Peripheral Artery Disease (AHA)
The AHA identifies peripheral artery disease (PAD) as a manifestation of systemic atherosclerosis. PAD reduces blood flow to the legs and feet due to narrowed arteries.
Reduced blood flow leads to:
Delayed wound healing
Increased infection risk
Higher likelihood of ulcers
In severe cases, tissue death (gangrene)
When neuropathy and 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 Reflect Cardiovascular Risk
Both the ADA and AHA emphasize that early recognition of vascular and neurological symptoms is essential.
Watch for:
• Cold feet or decreased temperature
May indicate reduced arterial blood flow.
• Swelling in ankles or feet
According to the AHA, persistent swelling (edema) can be a sign of heart failure.
• Leg pain during walking (claudication)
A classic PAD symptom described in AHA guidelines — pain that improves with rest.
• Slow-healing wounds
The ADA recommends immediate evaluation of any foot ulcer that does not improve within two weeks.
• Skin discoloration (pale, bluish, or reddish tone)
May signal compromised circulation.
The Compounded Risk
The ADA reports that people with diabetes are at significantly increased risk for lower-extremity amputation, particularly when peripheral neuropathy and PAD coexist.
The AHA further states that PAD is not just a leg problem — it is a marker of widespread atherosclerosis and increases the risk of heart attack and stroke.
This means that foot symptoms may indicate broader cardiovascular disease.
Guideline-Based Prevention Strategies
Both organizations provide clear prevention recommendations.
ADA Recommendations:
Annual comprehensive foot exams
More frequent exams for high-risk patients
Daily self-inspection of feet
Tight glycemic control to reduce neuropathy progression
Immediate evaluation of any ulcers or infections
AHA Recommendations:
Control blood pressure
Manage cholesterol levels
Maintain healthy weight
Stop smoking
Engage in regular physical activity
These measures reduce both cardiovascular and lower-extity complications.
When to Seek Immediate Medical Attention
Seek urgent medical care if you experience:
Sudden severe foot discoloration
Signs of infection (redness, warmth, pus)
Rapid swelling
Chest pain with leg symptoms
New onset severe leg pain
According to both ADA and AHA guidance, early intervention significantly reduces the risk of permanent damage.
The Clinical Bottom Line
The feet often serve as early indicators of systemic vascular health.
The American Diabetes Association emphasizes that foot complications are preventable with early detection and proper management.
The American Heart Association highlights that peripheral artery disease is a serious cardiovascular condition that should not be overlooked.
When diabetes and heart disease coexist, routine foot monitoring becomes not just a recommendation — but a necessity.
Protecting your feet is part of protecting your heart.