Ozempic feet: causes and how to manage it

“Ozempic feet” describes changes in the feet that can result from rapid weight loss often associated with Ozempic (semaglutide) and other GLP-1 medications. Symptoms include loose skin, prominent veins, and foot pain, and gradual weight loss, good nutrition, and supportive shoes may help prevent and manage them.

Ozempic does not specifically target the tissue and skin around the foot, so the medication itself is not to blame for the changes. Instead, the broader changes the body experiences while on Ozempic, such as rapid weight loss, can be linked to Ozempic feet.

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Rapid weight loss

Ozempic is a GLP-1 medication that slows digestion and may reduce appetite, which can help people feel fuller for longer and eat less. For some, this leads to substantial and rapid weight loss. While Ozempic is sometimes  prescribed off-label for weight loss, it is technically FDA-approved to improve blood sugar in people with diabetes. Wegovy is the version of semaglutide that’s FDA-approved for weight loss.

In a clinical trial of adults with overweight or obesity, people who took 2.4 mg of semaglutide weekly — the dose used in Wegovy — lost an average of about 15% of their body weight over 68 weeks, compared with about 2% with a placebo.

Weight loss from Ozempic does not happen in just one area of the body. It can affect the whole frame, from the head (see: “Ozempic face”) to the toes.

Loss of skin elasticity

When weight loss is rapid and significant, the body loses subcutaneous fat, the layer of tissue just under the skin. The skin may not fully recover its shape, which can leave it saggy or loose, as research on skin after massive weight loss suggests.

Gradual weight loss may give skin more time to adjust. Losing weight quickly, on the other hand, may damage elastin, the protein that helps skin stretch and snap back into place.

In a 2015 study of 30 people, skin from those who had lost a large amount of weight showed damaged elastic fibers, which may contribute to reduced elasticity and difficulty tightening after weight loss.

Age also plays a role. Elastin production naturally decreases after adulthood, which can make it harder for skin to bounce back.

Loss of collagen

Collagen, another protein that helps skin stay firm and elastic, also declines with age. Research also found that collagen fibers were significantly thinner in people who had lost a large amount of weight compared with those who had not.

Nutritional deficiencies

Reduced appetite and slower digestion can lead to fewer calories and fewer key nutrients. Nausea and vomiting, two common side effects of Ozempic, can also reduce how much a person is able to eat and, in turn, how many nutrients the body gets.

Nutritional deficiencies may also play a role, especially if weight loss is not paired with enough micronutrients, says Nayan Patel, PharmD, founder of Auro Wellness and Auro Skincare. “For example, inadequate protein, vitamin C, and zinc can impair collagen synthesis and skin repair.”

“During rapid weight loss, subcutaneous tissue, like fat, is lost, and the skin cannot keep pace,” says Neil D’Souza, MD, MHSc, a Toronto-based emergency and family medicine physician board-certified in obesity medicine. “As a result, the skin is not as tight and will have a saggy appearance.”

Some people may also notice foot discomfort because "fat cushioning is not there to absorb the impact of daily activity," Dr. D'Souza adds.  

Ozempic feet can look and feel different from person to person. Symptoms may include:

• Saggy, loose, or wrinkled skin on the feet

• Decreased fat cushioning on the feet

• More prominent veins or tendons

• Foot pain or discomfort

There is no way to completely eliminate the risk of Ozempic feet, but several steps may help reduce it.

“Optimizing lifestyle changes — such as adequate protein intake, hydration, and resistance exercises — is the basis for long-term, slow, and sustainable weight loss,” Dr. D’Souza says. These habits may also help limit saggy skin on the bottom, face, or feet, he adds.

Slower pace of weight loss

Losing weight slowly may give the skin more time to adapt. The pace of weight loss on Ozempic is not always in a person’s control, but lowering the dose may allow for more gradual weight loss.

Do not change the dose without guidance from a healthcare provider, who can determine how, if at all, to adjust dosing to address concerns about Ozempic feet without losing effectiveness.

“The key to preventing Ozempic feet is slow, steady weight loss paired with skin nourishment from the inside,” says Sahar Berjis, RD, founder of Inner Health and Wellness in California.

Adequate hydration and nutrition

Prioritizing high-quality proteins at every meal may help, and vitamins A, D, and E are also among the micronutrients studied for skin health.

Berjis says to “load up on vitamin C (citrus, strawberries, bell peppers), zinc (pumpkin seeds, chickpeas), and healthy fats (avocados, flaxseed, walnuts) to protect the skin barrier.”

This is particularly important for people taking Ozempic for type 2 diabetes, since the condition can impair the skin barrier. When that happens, dryness and cracks may set in, causing or worsening foot discomfort.

Gastrointestinal side effects and appetite changes from Ozempic can make it harder to get enough skin-friendly nutrients. A healthcare provider knowledgeable in nutrition, such as a Ro-affiliated healthcare provider, or a registered dietitian can build an eating plan that fits individual needs and goals.

Staying well hydrated matters too. Drinking more water may improve skin hydration, and a review of hydration research suggests it may reduce skin dryness, though the evidence is limited.

Support your feet

Shoes with cushioned insoles may help absorb shock with each step, according to lab testing of sport shoes.

Supportive footwear may also help reduce stress and fatigue in the feet, says Lindsey Hudson, MSN, APRN, NP-C, CDCES, a nurse practitioner specializing in diabetes management at Your Health.

Together, these effects can help ease the discomfort of Ozempic feet and let you put your best foot forward — literally — during treatment.

Strength training may also help. Building and maintaining muscle, particularly around and above the ankle, may help limit muscle loss and changes to the feet as weight is lost, Hudson says.

Stick with a skincare routine 

Not every skin change is preventable, but a consistent skincare routine may help support the feet. Options include:

• Use sunscreen daily. Sun exposure can lead to premature skin aging, age spots, wrinkles, and even skin cancer. “Sun damage accelerates collagen degradation and increases skin laxity,” Patel says. The Skin Cancer Foundation recommends using sunscreen with an SPF of 30 or higher on exposed skin, including the tops of the feet, and reapplying every two hours or after swimming or sweating.

• Apply moisturizer. Moisturizer hydrates skin from the outside in, which complements drinking enough water. “Thick emollients like urea-based creams help restore the skin barrier and improve texture,” Patel says. Moisturizing may also temporarily soften the look of wrinkles by plumping skin with hydration.

• Give your feet a massage. Foot massage may temporarily improve blood flow to the feet, according to a small study of people with type 2 diabetes and neuropathy (nerve damage). Patel recommends daily foot massages, even a quick rub when applying moisturizer, or using foot rollers to stimulate blood flow and support tissue repair.

Talk to a healthcare provider, such as a dermatologist, before starting new skincare products or treatments.

When Ozempic feet involve mainly sagging or wrinkled skin, they are not typically cause for alarm. “Ozempic feet are just a wake-up call to support your body more intentionally,” Berjis says.

Pain or discomfort is a reason to talk to a healthcare provider.

According to Hudson, it is a good idea to see a healthcare provider if:

• Your wrinkles are accompanied by swelling, pain, or changes in color.

• You have dry or cracked skin, calluses, or sores that will not heal.

• You develop foot pain or discomfort, or have difficulty walking.

• You see a persistent rash.

For people with diabetes, it is especially important to share even small changes in the feet with a healthcare provider. Diabetes can increase the risk of diabetic neuropathy, peripheral artery disease (reduced circulation), infections, and ulcers.

People with diabetes should also inspect their feet daily and have a comprehensive foot exam at least once a year.

Check for free

Sagging skin, more prominent veins, or foot pain can be unsettling for people taking Ozempic. The essentials:

• Despite its name, Ozempic feet is not caused by the medication itself. The changes are linked to rapid weight loss, which can occur with Ozempic and other GLP-1 medications.

• Some changes related to weight loss may not be avoidable, but certain habits may help limit them. These include nutritious eating, strength training, supportive shoes, and a skincare routine.

• Slowing the pace of weight loss may give skin more time to adjust. Anyone concerned about Ozempic feet can talk to a healthcare provider about whether adjusting the dose makes sense.

• Pain, sores that will not heal, or diabetes are reasons to talk to a healthcare provider. Ozempic feet are usually considered a cosmetic concern, but a healthcare provider can make sure nothing else is going on.