Understanding Diabetic Foot Care: A Practical Daily Routine

The difficulty with the diabetic foot is that the warning system is the first thing to fail. Nerve damage removes the pain that would normally make you take off a badly fitting shoe or notice a stone inside it. By the time an ulcer is found, it has often been developing for weeks.

That is why prevention in diabetes is built on looking rather than feeling. The routine below takes about five minutes a day.

The daily check

• Look at the whole foot in good light — top, sole, heel, and between every toe. Use a mirror on the floor or ask someone if you cannot see the sole
• Look for redness, blisters, cuts, cracks, callus, colour change or discharge
• Feel for warm or hard areas, and compare one foot against the other
• Check inside your footwear with your hand before putting it on — stones, grit, a folded insole, a nail head
• Check your socks when you take them off, for staining you did not feel

Washing, drying, moisturising

Wash daily in lukewarm water — test the temperature with your elbow or a thermometer, never by feel, since neuropathy makes scald injuries easy. Dry thoroughly, particularly between the toes, where trapped moisture causes fungal breakdown of the skin. Moisturise the tops and soles but not between the toes.

Nails and callus

Cut nails straight across and file the corners rather than digging into them. Do not cut callus, use corn plasters or chemical corn removers, or attempt bathroom surgery on hard skin — these are among the most common causes of the ulcer that follows. Thick callus should be reduced by a professional, because callus itself concentrates pressure and creates ulcers beneath it.

Footwear

• Never walk barefoot, indoors or outdoors — including on temple floors and hot ground
• Choose shoes with a deep, wide toe box, a firm heel counter and a cushioned sole
• Buy footwear at the end of the day, when feet are at their largest
• Break new shoes in over short periods, checking the feet after each wear
• Use custom insoles or prescribed footwear if you have deformity, previous ulceration or a partial amputation
• Replace worn shoes — a flattened sole no longer redistributes pressure

The three things that keep feet safe long-term

Glucose control slows the progression of both neuropathy and arterial disease. Stopping smoking has a larger effect on limb outcomes in diabetes than almost any single intervention. And regular professional foot review — at least annually, more often with previous ulceration or reduced sensation — catches the problems that the daily check misses.

Signs that need same-day attention

• Any new break in the skin, however small or painless
• Redness spreading up the foot or leg
• Discharge, odour, or staining on socks
• A black or blue area on a toe or the foot
• Swelling, warmth or a change in foot shape
• Fever, or blood sugars rising with no other explanation

None of this is complicated. It is simply consistent — and consistency is what keeps the majority of diabetic foot ulcers from ever forming.