World Diabetes Day falls on Saturday, 14 November. Ahead of it, The Straits Times published my letter in its Forum section, online on 12 November 2026 and in the print edition on 13 November. It is about the complication of diabetes that is easiest to see and most often missed. The letter is reproduced below, followed by answers to the questions patients most often ask about it.
The letter
World Diabetes Day falls on Nov 14. The International Diabetes Federation notes that up to half of people with Type 2 diabetes already have a complication by the time they are diagnosed. For many, the federation says, the first sign of diabetes is a complication.
As a vascular surgeon, I believe that one complication that is easiest to see and most often missed is in the foot.
Diabetes dulls the nerves, so a blister, a cut or a badly fitting shoe is not felt. It also narrows the arteries of the legs so less blood reaches the skin and a small wound struggles to heal. Nerve damage and poor blood flow can cause foot ulcers and may lead to amputation.
The warning signs are not dramatic. A sore on the foot that does not get better, toes that look pale or dusky, or feel cold compared with the other foot. Other signs include pain in the calf on walking that eases with rest, or pain in the foot at night that eases when the leg hangs down. All these point to poor circulation, which can be measured in minutes and, in many cases, treated.
So, my practical tip is this: If you have diabetes, look at your feet every day, or ask someone to. At your regular diabetes review, ask your doctor to feel the pulses in your feet, on the top of the foot and behind the inner ankle bone. And a foot wound that is not healing should be taken seriously.
Early action on diabetes is usually taken to mean earlier diagnosis. It should also mean acting early on foot issues.
Andrew Choong
First published in The Straits Times Forum, 12 November 2026 (print edition 13 November 2026).
Why the feet?
Diabetes damages the body in two ways that meet in the foot. It dulls the nerves, so a blister, a cut or a badly fitting shoe is not felt and goes unattended. It also narrows the arteries of the legs, so less blood reaches the skin and a small wound struggles to heal. Nerve damage and poor blood flow together are what turn a minor injury into a foot ulcer, and an ulcer that will not heal is the usual road to amputation. The condition is explained on the diabetic foot and wound care page.
What are the warning signs of poor circulation?
They are quiet rather than dramatic: a sore on the foot that does not get better; toes that look pale or dusky, or feel cold compared with the other foot; pain in the calf on walking that eases with rest; or pain in the foot at night that eases when the leg hangs down over the side of the bed. Each of these points to narrowed leg arteries, which is called peripheral arterial disease.
What is the pulse check, and who should do it?
Two arteries can be felt through the skin of the foot: one on the top of the foot and one behind the inner ankle bone, in the same way a pulse is felt at the wrist. Feeling them takes under a minute and needs no equipment. The doctor who manages your diabetes, usually your GP or polyclinic doctor, can do it at your regular diabetes review. If a pulse is weak or absent, the next step is a simple measurement of blood pressure at the ankle and, where needed, a duplex ultrasound scan of the leg arteries. Both are painless and take minutes.
Can poor circulation in the legs be treated?
In many cases, yes. Treatment starts with the basics that protect the arteries: blood sugar, blood pressure and cholesterol control, stopping smoking, and walking. Where a narrowing or blockage is stopping a wound from healing, many can now be opened from inside the artery through a small puncture, using balloon angioplasty or a stent, and some need a bypass. What is right for a particular person depends on the findings, which is why the assessment comes first.
What should I do now?
If you have diabetes, look at your feet every day, or ask someone to do it for you. At your next diabetes review, ask your doctor to feel the pulses in your feet. Treat a foot wound that has not healed within a couple of weeks as something to be seen promptly, not watched for a month. Spreading redness, fever, a black toe or severe pain need urgent care: call 995. If you have been told your circulation is poor, or would like a second opinion on a foot wound that is slow to heal, details are on the contact page. This letter and my other published pieces are listed on the press page.
Watch the video: Diabetes, artery health and foot care. Related reading: why circulation belongs in the conversation about slow-healing foot wounds (Medical Channel Asia) and when to see a vascular specialist.