The reason diabetic foot problems become serious is not that they are aggressive. It is that they do not hurt. Nerve damage removes the warning signal, and a small injury progresses unnoticed until it is a large one.
Foot complications are among the leading causes of hospital admission in people with diabetes, and the majority of serious outcomes are preventable with routine checks and prompt attention to small problems.
Why feet specifically
Three processes combine, and each makes the others worse.
- Peripheral neuropathy — high glucose over time damages the nerves that carry sensation. A blister, a stone in the shoe, or a burn from a hot water bottle produces no pain, so nothing prompts you to look
- Reduced circulation — narrowed vessels mean less blood reaches the tissue, so wounds heal slowly and infection is harder to clear
- Impaired immune response — elevated glucose blunts the response to infection, so what starts superficial can move deeper
Add the fact that feet are enclosed in shoes all day and carry the entire body’s load, and the pattern makes sense.
The daily check
Once a day, at a consistent time. It takes under five minutes.
- Look at the tops, soles, heels and sides of both feet
- Check between every toe, where moisture and fungal infection collect
- Use a mirror on the floor, or ask someone, if you cannot see the soles comfortably
- Look for cuts, blisters, redness, swelling, cracks, colour change, or anything that was not there yesterday
- Feel for warm patches — localised heat can be the first sign of a problem developing under the surface
Daily habits that prevent problems
- Wash daily in lukewarm water — test the temperature with your elbow or a thermometer, not your foot, because neuropathy makes scalds easy
- Dry thoroughly, especially between the toes. Retained moisture there causes most fungal problems
- Moisturise the tops and soles but not between the toes — dry skin cracks, and cracks are entry points, but moisture between toes causes the opposite problem
- Cut nails straight across and file the edges rather than cutting down the corners, which causes ingrown nails
- Never treat corns or calluses yourself with blades or over-the-counter acid removers. Both cause wounds. This is a job for a foot care professional
- Never walk barefoot, indoors or out. Most puncture injuries happen at home
Shoes and socks
Footwear causes a large share of diabetic foot injuries.
Shop for shoes late in the day when feet are at their largest. Choose a wide, deep toe box with room to move your toes. Break new shoes in gradually — an hour at first — and check your feet afterwards. Run a hand inside the shoe before every wearing, because a small stone or a folded insole causes real damage when you cannot feel it.
Socks should be seamless where possible, moisture-wicking rather than heavily absorbent, and changed daily. Avoid anything with tight elastic at the top.
The annual foot examination
People with diabetes should have a comprehensive foot assessment at least annually, and more often with existing neuropathy, circulation problems, foot deformity or previous ulceration. That examination tests sensation, checks pulses, assesses foot shape and reviews footwear — things a daily self-check cannot cover.
If you have not had one in the past year, ask. It is a short assessment that changes management, and it is the single most reliable thing that catches problems before you can feel them.
The underlying lever
Everything above is damage limitation. The measure that reduces the risk of neuropathy developing in the first place is glycaemic control over years. It is slower and less visible than a daily foot check, and it does more.
