GLP-1 Agonists in Footcare: Benefits, Risks and Clinic Monitoring for Diabetic and Weight Loss Clients
GLP-1 medications are changing diabetes and weight management. For footcare clinics, that matters. Better blood glucose control and weight loss can reduce long-term risk, but changing body weight, footwear fit, skin condition and neuropathy symptoms can also change the way feet behave day to day.
This article is for information only and does not replace medical advice from a prescriber, diabetes team or urgent care service.
Why GLP-1 medications now matter in footcare
GLP-1 receptor agonists, such as semaglutide, liraglutide and dulaglutide, mimic incretin hormones that help regulate blood glucose, appetite and gastric emptying. Tirzepatide is a related dual GIP and GLP-1 treatment and is often discussed alongside them in weight-loss services.
These treatments are now supported across both NHS pathways and private healthcare settings for selected patients with type 2 diabetes or obesity. NICE has recommended semaglutide for some adults living with obesity through specialist weight management services, and tirzepatide has also been assessed for weight management in eligible patients (NICE, 2023; NICE, 2024).
The evidence base is strong for metabolic outcomes. Large trials show meaningful improvements in weight and blood glucose with semaglutide and tirzepatide in people with obesity, with or without diabetes (Wilding et al., 2021; Jastreboff et al., 2022). Cardiovascular outcome trials in diabetes have also shown benefits for some GLP-1 receptor agonists in reducing major cardiovascular events (Marso et al., 2016).
In footcare, the key point is this: GLP-1 treatment may improve the risk profile, but it does not remove the need for diabetic foot screening.
The potential benefits for feet
Good diabetes footcare starts with reducing the drivers of tissue damage. Long-term high blood glucose is linked with peripheral neuropathy, vascular disease, infection risk and delayed wound healing. Improving glycemic control can help reduce diabetes complications over time, especially when paired with blood pressure, lipid and smoking management (UK Prospective Diabetes Study Group, 1998).
Weight loss can also help the feet in practical ways. Less body weight may reduce load through the heel, midfoot and forefoot. For some clients, this can ease pressure-related symptoms such as plantar heel pain, metatarsal overload and recurrent callus. Improved mobility may also support circulation, joint function and balance.
For clients with type 2 diabetes, GLP-1 medications may support:
Better HbA1c control when used as part of a wider diabetes plan
Weight reduction, which can reduce mechanical stress on the feet
Improved cardiovascular risk in some patient groups
More confidence with activity, if nausea and fatigue are well managed
That said, there is no good reason to describe GLP-1 treatment as a direct “foot treatment.” It is not a cure for neuropathy, peripheral arterial disease, ulceration or poor footwear mechanics. Foot risk still needs to be assessed on its own merits.
The footcare risks that can be missed
The most obvious side effects of GLP-1 medications are gastrointestinal, including nausea, vomiting, constipation or diarrhea. Footcare clinics may not manage those effects directly, but they can see the consequences. Reduced intake, dehydration and fatigue can affect activity levels, skin quality and self-care routines.
There are also foot-specific issues to watch.
Shoe fit can change after weight loss. Feet may become narrower, less padded or less swollen. A shoe that once fitted well may start to slip at the heel or create rubbing over the toes. By contrast, some clients increase walking as weight drops, which can expose old biomechanical problems.
Pressure patterns can shift. Weight loss changes gait, cadence and loading. A client with neuropathy may not feel new pressure under the metatarsal heads, over a bunion or around a toe deformity.
Rapid glycemic improvement can alter nerve symptoms. Treatment-induced neuropathy has been described after rapid improvement in glucose control, causing acute neuropathic pain and autonomic symptoms in some people (Gibbons and Freeman, 2015). This is not unique to GLP-1 treatment, but it is relevant when glucose levels change quickly.
Risk may be hidden by success. When weight and HbA1c improve, clients may assume their feet are “safe.” Yet established neuropathy, reduced pulses, previous ulceration, deformity or chronic kidney disease still place someone in a higher-risk category.
A lower weight or better HbA1c is encouraging, but a foot with lost protective sensation remains a high-risk foot.
What clinics can monitor during routine appointments
A footcare clinic does not need complex equipment to add value. Basic diabetic checks, carried out consistently and documented clearly, can identify changes early and guide referral.
A practical review may include:
Check | What it can show |
Skin inspection | Callus, fissures, pressure marks, infection, wounds or color change |
Nail and toe review | Trauma, ingrown nails, fungal change or rubbing from footwear |
10 g monofilament test | Loss of protective sensation |
Vibration testing | Large-fiber nerve function, often using a tuning fork |
Pulse check | Dorsalis pedis and posterior tibial artery presence |
Footwear review | Fit, wear pattern, depth, seams and pressure points |
Deformity and gait screen | Bunions, claw toes, Charcot changes, overload and instability |
Diabetic foot guidance stresses the value of regular foot examination, risk stratification and prompt referral when red flags appear (Boulton et al., 2008; NICE, 2015).
Urgent referral is needed for ulceration, spreading infection, suspected ischemia, sudden swelling, heat or shape change suggesting Charcot neuroarthropathy, or new tissue breakdown in a person with diabetes.
Where prescription orthoses can help
Prescription orthoses can be useful when weight loss, neuropathy, deformity or activity changes alter loading through the foot. They should be selected for the clinical problem, not simply because a client is taking a GLP-1 medication.
Orthotic support may help to:
Offload painful or high-pressure areas
Reduce recurrent callus formation
Improve stability in suitable footwear
Support plantar heel pain or midfoot strain
Accommodate deformity, such as bunions or claw toes
Lower friction when paired with appropriate shoes and socks
For a client with diabetes, orthoses must be reviewed carefully. Too much correction, hard edges or poor shoe depth can create new pressure. Follow-up matters, especially when body weight is changing quickly.
A sensible approach is to check the skin after any new device is issued, review footwear fit, and adjust as weight, swelling or walking habits change.
Take Home Information for Patients
When considering GLP-1 agonists, it's essential to understand that they are part of a broader picture regarding your health risks. Research indicates that these medications can provide significant benefits, including weight loss, improved glucose control, and reduced cardiovascular risks for certain people. While these advantages can help alleviate some long-term pressures on your feet, they do not substitute for regular diabetic foot checks.
Effective foot care is straightforward and should include the following steps: discussing any changes to your medications, checking your foot sensation and circulation, inspecting your skin and footwear, documenting any risks, and using prescribed orthotic support if necessary.
If you are utilizing NHS or private services for weight loss and diabetes management, it is crucial to celebrate your metabolic improvements while remaining vigilant about your foot health.
References
Boulton, A.J.M., Armstrong, D.G., Albert, S.F., Frykberg, R.G., Hellman, R., Kirkman, M.S., Lavery, L.A., LeMaster, J.W., Mills, J.L., Mueller, M.J., Sheehan, P. and Wukich, D.K. (2008) ‘Comprehensive foot examination and risk assessment’, Diabetes Care, 31(8), pp. 1679–1685.
Gibbons, C.H. and Freeman, R. (2015) ‘Treatment-induced neuropathy of diabetes’, Current Diabetes Reports, 15(9), article 66.
Jastreboff, A.M., Aronne, L.J., Ahmad, N.N., Wharton, S., Connery, L., Alves, B., Kiyosue, A., Zhang, S., Liu, B., Bunck, M.C. and Stefanski, A. (2022) ‘Tirzepatide once weekly for the treatment of obesity’, New England Journal of Medicine, 387, pp. 205–216.
Marso, S.P., Daniels, G.H., Brown-Frandsen, K., Kristensen, P., Mann, J.F.E., Nauck, M.A., Nissen, S.E., Pocock, S., Poulter, N.R., Ravn, L.S., Steinberg, W.M., Stockner, M., Zinman, B., Bergenstal, R.M. and Buse, J.B. (2016) ‘Liraglutide and cardiovascular outcomes in type 2 diabetes’, New England Journal of Medicine, 375, pp. 311–322.
National Institute for Health and Care Excellence (NICE) (2015) Diabetic foot problems: prevention and management. NICE guideline NG19.
National Institute for Health and Care Excellence (NICE) (2023) Semaglutide for managing overweight and obesity. Technology appraisal guidance TA875.
National Institute for Health and Care Excellence (NICE) (2024) Tirzepatide for managing overweight and obesity. Technology appraisal guidance.
UK Prospective Diabetes Study Group (1998) ‘Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes’, The Lancet, 352(9131), pp. 837–853.
Wilding, J.P.H., Batterham, R.L., Calanna, S., Davies, M., Van Gaal, L.F., Lingvay, I., McGowan, B.M., Rosenstock, J., Tran, M.T.D., Wadden, T.A., Wharton, S., Yokote, K., Zeuthen, N. and Kushner, R.F. (2021) ‘Once-weekly semaglutide in adults with overweight or obesity’, New England Journal of Medicine, 384, pp. 989–1002.
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