Diabetic Foot Care: A Daily Routine That Prevents Ulcers
Foot complications are among the most preventable and most damaging consequences of diabetes. The problem is not that injuries are unusual, it is that damaged nerves remove the pain that would normally make you notice them.
Why feet are vulnerable
Three processes combine. Peripheral neuropathy dulls sensation, so a blister, a stone in the shoe or a hot surface goes unfelt. Peripheral arterial disease reduces blood flow, so a wound that does form heals slowly. Impaired immunity at high glucose levels lets minor infections progress quickly into deep tissue.
A small, painless break in the skin can become an ulcer within days and reach bone within weeks.
The daily check
Once a day, ideally at the same time, take five minutes:
- Look at the top, sole, heel and between every toe. Use a mirror on the floor, or ask someone, if you cannot see the sole comfortably.
- Look for redness, blisters, cracks, cuts, colour change, swelling or discharge.
- Feel for warm patches. Localised warmth often precedes visible ulceration.
- Check nails for ingrowing edges and for fungal thickening.
- Check between the toes for softened white skin, which indicates fungal infection.
If your eyesight is limited, this check is a task to delegate rather than skip.
Washing and moisturising
Wash daily in lukewarm water. Test the temperature with your elbow or a thermometer, never your foot, because neuropathy makes scalding easy. Do not soak, which softens skin and encourages breakdown.
Dry thoroughly, especially between the toes. Apply a plain moisturiser such as urea-based cream or petroleum jelly to the tops and soles, but not between the toes, where moisture promotes fungal growth.
Nails and hard skin
Cut nails straight across and file the corners rather than cutting down into them. If nails are thick, discoloured or difficult to reach, have a podiatrist or trained nurse do it.
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Do not use corn caps, salicylic acid plasters, blades or pumice aggressively on calluses. Chemical corn removers cause chemical burns in insensate feet. Calluses do need attention, because they concentrate pressure and ulcers form underneath them, but that attention should be professional debridement.
Footwear
Footwear causes a large share of ulcers:
- Never walk barefoot, indoors or outdoors, and not on hot sand or tiles
- Shake out and inspect the inside of both shoes before every wear
- Choose a deep, wide toe box with no internal seams over the toes
- Buy shoes in the evening, when feet are largest
- Break new shoes in over an hour a day for the first week, checking the skin afterwards
- Avoid flip-flops with a toe post, which abrades the skin between the toes
- Wear seamless, non-constricting socks and change them daily
If your foot shape has changed, if you have had a previous ulcer, or if you have lost sensation, custom insoles or prescription footwear are a medical intervention rather than a comfort purchase.
Annual and interim assessment
Ask for a foot examination at least once a year, including testing sensation with a 10 g monofilament and checking foot pulses. People with neuropathy, deformity or a previous ulcer need review every three to six months.
What counts as urgent
Contact a doctor the same day for:
- Any new break in the skin that is not healing, however small
- Redness spreading from a wound, or red streaks up the foot or leg
- Swelling, warmth or discharge
- A foul smell
- Black or dark tissue
- Fever with any foot wound
- Sudden pain, coldness or pallor in the foot, which may indicate an arterial blockage
- A hot, swollen foot after minor trauma, which can be a Charcot fracture and needs immobilisation
Do not wait for an appointment slot. Delay is the single strongest predictor of amputation.
Background control
Glucose control, blood pressure control, lipid management and stopping tobacco all improve nerve function and circulation. Smoking is particularly damaging here, since it worsens the arterial disease that determines whether a wound can heal at all.
This is general guidance. If you already have neuropathy, arterial disease or a previous ulcer, your care should be directed by a diabetes foot clinic or podiatrist.