Diabetes often announces itself quietly, but the damage it causes to our blood vessels can be far from silent. Among the many complications it brings, peripheral arterial disease (PAD) is one of the most overlooked-and yet one of the most revealing. While high blood sugar gradually injures blood vessels, one of the earliest and most revealing signs of this damage often appears in the legs. This is why clinicians commonly say,“the foot is the index of the heart.” The blood vessels in the feet can quietly reflect the same blockages and narrowing that may be developing in the coronary arteries.

Peripheral arterial disease (PAD) is not a rare complication restricted to a few. In India, studies have shown that nearly 30% of people living with diabetes have either symptomatic or silent PAD. What makes it particularly concerning is the persistence of a myth that diabetes affects only the smaller blood vessels of the foot. In reality, macrovascular disease-blockages in the larger arteries-is equally, if not more, prevalent, and is a major contributor to non-healing ulcers and amputations.

A foot ulcer that refuses to heal for more than four weeks should never be ignored. It is often a red flag indicating compromised blood flow. A simple clinical examination can reveal the absence of foot pulses, prompting further vascular evaluation. Early detection is critical because once PAD is diagnosed, effective treatments-including angioplasty or bypass surgery-can restore blood supply and prevent catastrophic outcomes.

The troubling truth is that almost 80% of diabetes-related amputations begin with a small ulcer that could have been avoided. Simple preventive steps-daily foot inspection, avoiding barefoot walking, and wearing well-fitted footwear-can significantly reduce the risk. In many cases, these habits make the difference between healing and long-term disability.

Dr Manish Yadav, Senior Consultant, Interventional Radiology, KIMSHEALTH Hospital, Trivandrum

“The feet often speak before the heart does. When a patient develops a non-healing ulcer or complains of leg pain while walking, these are not minor issues-they can be the first signs of significant blockages in major arteries. Detecting PAD early allows us not only to save the limb but also to uncover hidden heart disease. In many ways, every diabetic foot is a message urging us to look deeper, act faster, and protect the patient's overall cardiovascular health,” says Dr Manish Yadav Senior Consultant-Interventional Radiology at KIMS HEALTH Hospital , Trivandrum, highlighting the urgency of awareness.

India's growing burden of diabetes, even in rural areas, reflects a broader lifestyle shift: declining physical activity and rising sedentary behaviour. Reintroducing movement into daily routines is not merely advisable; it is essential. A goal of 10,000 steps a day, as recommended by the WHO, is a powerful yet achievable step toward protecting vascular health.

For every person living with diabetes, the message is clear: maintain strict blood sugar control, embrace an active lifestyle, and make foot care a non-negotiable daily routine. Regular annual evaluations of the heart, kidneys, eyes, and feet can identify complications early. And when the feet show changes-loss of sensation, discoloration, infection, or ulceration-seeking prompt medical care can protect not just the limb, but life itself.

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