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 RiskBoth 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) ️️ Continue on the next page ️️
