When nerves stop sending the message
Your nerves carry messages from your feet to your brain: pressure, heat, pain. Diabetic neuropathy is nerve damage caused by diabetes. Over time, high blood glucose and high levels of blood fats can damage your nerves.1 Diabetes is the leading cause of peripheral neuropathy in the U.S.,30 and about one-third to one-half of people with diabetes have it.2
It usually starts in the feet, the nerve endings farthest from the brain.30 Your feet may feel burning, tingling like pins and needles, numb, painful or weak, often worse at night.3 You may also have trouble sensing pain or temperature.4 Symptoms can develop quickly over days or slowly over months and years.40
How common it is
Why a numb foot is a foot at risk
Pain is a warning system. When you lose feeling in your feet, you may not feel a pebble in your sock or a blister on your foot. These can lead to cuts and sores, and cuts and sores can become infected.16 Diabetes can also lower blood flow in the feet, which makes it hard for a sore or infection to heal.17
How a small injury becomes a serious one
Why reduced feeling changes everything, following the NIDDK description.
Feeling fades
High blood glucose and fats damage nerves, and feeling in the feet is lost.116
An injury goes unnoticed
A pebble in a sock or a blister goes unfelt and becomes a cut or sore.16
Healing is slow
Lower blood flow makes it hard for a sore or infection to heal.17
Serious infection
Sores and infections can lead to the loss of a toe, foot or part of the leg.6
Left alone, sores and infections can lead to the loss of a toe, foot or part of the leg.6 Neuropathy also affects balance and makes falls more likely.7
The daily check, and everyday foot care
You may have foot problems but feel no pain. Checking your feet each day helps you spot problems early. A good habit is to check each evening when you take off your shoes, including between your toes.18 If bending is hard, use a mirror or ask someone else to look.19
- Cuts, sores or red spots.20
- Swelling or blisters.20
- Ingrown toenails, where the edge of the nail grows into the skin.20
- Warm spots.20
Wash your feet in warm, not hot, water, and test it with a thermometer or your elbow: 90° to 95°F is safe. Do not soak.21 Powder between the toes, and keep lotion off that skin.22 Leave corns to a professional rather than cutting them or using corn plasters.23 Trim nails straight across.24
Wear shoes and socks at all times, even indoors, and check inside your shoes before you put them on.25 With nerve damage you may burn your feet and not know it, so never use a hot water bottle or heating pad on them.26 Stay active with things that are easy on your feet, such as walking or swimming; and if you smoke, know that it lowers blood flow to your feet.27
Daily foot care, and why each step matters
| Habit | How | Why it matters |
|---|---|---|
| Look at your feet | Each evening, including between the toes. Use a mirror or ask someone.1819 | You may have foot problems but feel no pain.18 |
| Wash in warm, not hot, water | Test with a thermometer (90° to 95°F is safe) or your elbow. Do not soak.21 | Numb feet can burn without you knowing.26 |
| Keep skin soft, toes dry | Lotion on tops and bottoms; powder, not lotion, between the toes.22 | Moisture between the toes might cause an infection.22 |
| Leave corns to a professional | Do not cut them or use corn plasters or liquid removers.23 | These can damage the skin and cause an infection.23 |
| Trim nails straight across | Not into the corners. A foot doctor can do it if you cannot see, feel or reach your feet.24 | Helps prevent cuts and ingrown nails.24 |
| Shoes and socks, always | No bare feet, even indoors. Check inside shoes first.25 | You could step on something and not feel it.25 |
At least once a year, get a thorough foot exam, including a check of the feeling and pulses in your feet.28
The yearly exam, and other causes worth checking
If you have diabetes, get a thorough exam of the feeling in your feet and legs at least once a year.8 It may use a tuning fork to check vibration and a thin nylon strand, a monofilament test, to check touch.9 Take off your shoes and socks at every visit so your team remembers to look.28
Diabetes is not the only cause. Blood tests can rule out thyroid problems, kidney disease or low vitamin B12.10 Alcohol use disorder, smoking and a lack of B12 can all damage nerves,40 and some medicines occasionally cause neuropathy.31 Low B12 itself can make hands and feet numb or tingly, and metformin might lower B12 levels.39 If that is the cause, metformin can be continued with B12 supplementation.11
What changes the outlook
The foundation is managing diabetes: blood glucose, blood pressure and cholesterol. Staying close to your goal numbers can keep nerve damage from getting worse.12 MedlinePlus puts it simply: controlling your blood sugar every day is the best way to protect your feet.34 Healthy eating and exercise help too.32
What changes the outlook, and what does not
Protects nerves and feet
Eases symptoms only
Be honest about what treatment can do. Prescribed nerve-pain medicines help the pain but do not change the nerve damage.13 Over-the-counter painkillers may not work well for most nerve pain.14 Diabetes experts have not made special recommendations about supplements.15 Some cases improve when the underlying cause is treated; in some people the damage may be permanent.36 The sooner it is diagnosed, the better the chance of limiting it.37
The clinic's approach
Numb feet and foot wounds are related but different problems. Neuropathy is nerve damage: you stop feeling injuries.15 Ulcers and gangrene are wounds and tissue death, made worse by poor blood flow and infection.176 The clinic whose documents inform this site, the Pakistan Institute of Medical Advancement in Karachi, focuses on the second: avoiding amputation.
Its documents propose a five-product regimen and ozone therapy as a way to save legs, and describe conventional treatment as having failed.414243 Wanting to keep a leg is entirely reasonable. The question is which care makes that more likely.
The clinic's approach to diabetic foot wounds, and what the evidence shows
Each card gives the clinic's own words first, then independent evidence.
Saving legs from amputation in diabetic gangrene with EDTA, lumbrokinase, chlorine dioxide, calcium hypochlorite and DMSO
Proposed instead of standard careEvidence points the other way- Where the clinic says this
- Brochure set, page 6, "Diabetic Gangrene Saving Amputation".41
- The clinic's stated rationale
- The page argues that seven decades of conventional treatment have been "unsuccessful".42 The Urdu brochure reports "hundreds of legs" saved but gives no records.44
- Evidence and limitations
- Gangrene and ulcers that do not get better with treatment can lead to amputation, which surgeons may perform to stop a dangerous infection spreading.51 Standard ulcer care removes dead tissue, takes pressure off the wound, and can take weeks to months.454647 For the products listed: drinking chlorine dioxide is, in the FDA's words, the same as drinking bleach,49 and the FDA warns that unproven chelation can delay proven care and cause kidney failure.50 ProperHealth found no NIH or FDA evaluation of lumbrokinase for gangrene.
- What this means for you
- A foot wound with diabetes needs a clinician or podiatrist promptly, and right away if it is not healing after a few days or looks infected. Wanting to avoid amputation is reasonable: ask about every option, but do not let an unproven regimen delay wound care.
Ozone therapy to clear germs in foot ulcers and gangrene "on which no antibiotic works"
Proposed instead of standard careRegulator safety warning- Where the clinic says this
- Urdu trifold brochure, side 2 (ProperHealth translation).43
- The clinic's stated rationale
- Ozone is described as the "best antibacterial" and as reactivating "dead cells", so that wounds heal quickly.43
- Evidence and limitations
- U.S. federal regulation describes ozone as a toxic gas with no known useful medical application.48 Diabetes lowers blood flow to the feet, which is one reason infected ulcers heal slowly.17 Dead tissue is removed by a clinician, not reactivated.45
- What this means for you
- Signs of infection in a foot (spreading redness, warmth, swelling, pus, fever) need care the same day.
Standard ulcer care is slower and less dramatic than the brochure's promise: dead tissue is removed by a podiatrist, pressure is taken off the wound with special shoes, a brace or a cast, and healing can take weeks to months.454647 Finding and treating foot problems early lowers the chance of serious infection.6
A historical perspective: Dr. Majid Ali
“The common symptoms (usually first appearing in feet, legs, and hands) include burning, tingling, numbness, throbbing, pulsating, and pain.”
— Dr. Majid Ali, 6 March 2015
Dr. Ali's description of the symptoms matches current guidance closely.3 He also treated neuropathy as a signal about metabolic control rather than an isolated nerve problem, and that connection is mainstream: managing diabetes can keep the damage from getting worse.12
Most of his other neuropathy writing is treatment material. The record quoted above goes on to a remedy list that includes peroxide soaks and chelation. Elsewhere he wrote that insulin neuropathy could be reversed with natural remedies, and proposed ozone. The sources used here do not support those remedies; pain treatments ease the pain but do not change nerve damage.13
What to do this week
Look at both feet tonight
Tops, soles, heels and between the toes. Use a mirror or ask someone.1819
Tie the check to taking off your shoes
Checking each evening when you take off your shoes is an easy way to remember.18
Test bath water with a thermometer or your elbow
90° to 95°F is safe. Numb feet cannot judge heat.21
Check inside your shoes before every wear
The lining should be smooth and free of pebbles.25
Book your yearly foot exam
At least once a year if you have diabetes. Take off your shoes and socks at every visit.28
When to get help now
Each warning sign cites the official guidance behind it. The wording still needs pharmacist sign-off.
- A cut, blister or sore on a foot that does not start to heal after a few days, or skin on the foot that becomes red, warm or painful (signs of infection) — call your health care provider right away.5253
- A foot that is red, hot and swollen, skin turning black, a bad smell, or fever — call your health care provider right away.5455
- A cold, pale or blue foot, or sudden severe pain in the foot or calf — get emergency care now.5657
- Sudden numbness or weakness, especially on one side, or with face drooping or trouble speaking — call 911.5859
- Numbness that spreads quickly, or legs that keep getting weaker — seek medical help right away. Loss of bladder or bowel control — call 911.6061
- Numbness in the groin, buttocks or inner thighs with back pain — contact your provider right away. With leg weakness or loss of bladder or bowel control — call 911.6263
Every numbered marker links to the exact passage it rests on. Check the sources.