Diabetic Foot Care: Daily Checks, Footwear, Warning Signs and Ulcer Prevention

Foot problems are among the most serious and most preventable complications of diabetes. Over years, high blood sugar can damage the nerves in the feet (neuropathy) and narrow the arteries that supply them (peripheral arterial disease). A person with numb feet may not feel a blister, a thorn or a burn, and a wound that gets less blood heals slowly. A small sore can progress to an ulcer, infection and, in the worst cases, amputation. The good news is that most of these outcomes can be prevented with simple daily habits.

Who is at highest risk?

• People with numbness, tingling, burning pain or loss of feeling in the feet
• Poor circulation: cold feet, leg pain on walking, absent foot pulses
• Foot deformities such as bunions, hammer toes or flat feet
• Previous foot ulcer or amputation
• Long-standing diabetes, smoking, kidney disease or poor eyesight
• Poorly controlled blood sugar

Daily foot routine

1. Look at your feet every day, including soles, heels and between toes. Use a mirror or ask a family member if you cannot see well. Look for cuts, blisters, redness, swelling, cracks, ingrown nails, corns or colour change.
2. Wash daily in lukewarm water with mild soap. Test the temperature with your elbow or a thermometer, not your foot, since numb feet can be scalded.
3. Dry carefully, especially between the toes, because moisture encourages fungal infection.
4. Moisturise dry skin on the top and soles, but not between the toes.
5. Check inside shoes before wearing them for stones, nails or rough seams.
6. Wear clean, dry socks without tight elastic or thick seams. Cotton or wool blends are better than nylon.

Nail and skin care

• Cut toenails straight across after washing, when they are soft, and file sharp edges. Do not cut deeply into the corners.
• If you cannot see or reach your feet, or have thick or fungal nails, have a health professional cut them.
• Never trim corns, calluses or warts with blades, and do not use medicated corn plasters or chemical removers.
• Treat athlete's foot early with an antifungal cream recommended by your doctor.

Shoes and socks

• Choose shoes that fit well, with a wide toe box, soft leather or breathable upper and cushioned sole. Buy shoes in the afternoon when feet are slightly swollen.
• Avoid pointed toes, high heels, sandals with thongs between the toes, and tight or hard shoes.
• Break in new shoes gradually.
• Never walk barefoot, including at home, on the beach, in the garden or on hot pavement.
• People with deformities or previous ulcers may need special therapeutic footwear or insoles prescribed by a specialist.

Avoid injury

• Do not use hot water bottles, heating pads or sit very close to fires or heaters.
• Keep feet away from hot sand and hot floors.
• Do not soak feet for long periods.
• Take care when gardening, farming or walking in paddy fields. Wear protective footwear, as cuts and soil exposure raise infection risk.
• Stop smoking, which seriously reduces blood flow to the feet.

Control the underlying diabetes

Keeping blood sugar, blood pressure and cholesterol in range slows nerve and blood-vessel damage. Aim for the HbA1c target your doctor sets (see our HbA1c test guide). Regular exercise, such as walking in good shoes, improves circulation, and weight loss reduces pressure on the feet.

Warning signs: see a doctor the same day

• A cut, blister, sore or ulcer that does not improve in a day or two
• Redness spreading up the foot or leg, warmth, swelling, or pus
• Foul smell or discharge
• A foot that is suddenly red, hot, swollen and has no pain (possible Charcot foot)
• Black or blue skin, or a toe that turns pale, cold or dark
• New numbness, burning, or sharp pain, especially at night
• Pain in the calves when walking that settles with rest
• Fever or feeling unwell with a foot wound

Do not try to treat foot ulcers at home with herbal pastes, powders or home remedies, as these can worsen infection. Do not delay, because infection in a diabetic foot can spread quickly.

What happens at a foot check

Your doctor or nurse will look at the skin, check pulses, test sensation using a 10 g monofilament or tuning fork, and assess deformities and footwear. People at higher risk may be referred to a podiatrist, vascular surgeon or diabetic foot clinic. Ulcers are treated with pressure off-loading, wound dressing, antibiotics when infected and, where needed, improving blood supply.

Tips for families and carers

Check the feet of older relatives who cannot see them. Help them with nail care, shoes and moisturiser. Encourage a yearly foot check and attend appointments.

When to see a doctor

Ask for a foot examination at diagnosis and at least every year after. See a doctor if you have symptoms of nerve damage, any foot wound, or changes in skin colour or temperature. See our general guide to early symptoms of diabetes.

References

• International Working Group on the Diabetic Foot: guidelines on prevention and management
• American Diabetes Association: Standards of Care in Diabetes, retinopathy, neuropathy and foot care
• NICE guideline NG19: diabetic foot problems