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Background Each year, over 340,000 diabetic patients across the world travel to Saudi Arabia for the Hajj pilgrimage. As they carried out important rituals, several complications might be encountered, particularly foot lesions. We’ve been therefore interested, through this study, in the assessment of podiatric risk in diabetic pilgrims. Methods A prospective longitudinal study was conducted in the region of Sousse, Tunisia. The evaluation of diabetic patients preparing for the pilgrimage was conducted in two phases, before and after the pilgrimage. Results Forty-three diabetic patients planning to perform pilgrimage were included in the study. Post-pilgrimage clinical exams revealed hyperkeratosis (96.8%) and superficial fungal infections (61.3%) as the most common podiatric lesions. Foot ulcers attributed to trauma from walking were found in 7% of patients. Our data showed a significant association between foot ulcer risk and lower total cholesterol (p=0.02), HDL cholesterol (p=0.02), LDL cholesterol (p=0.01), as well as higher triglyceride levels (p=0.04) only in univariate analysis. Other diabetes-related risk factors did not show significant correlations. Conclusion Given the increased risk of foot lesions in diabetic pilgrims, a thorough assessment and tailored management based on individual risk levels are essential before, during, and after the pilgrimage.