Looking after your feet with diabetes

Why feet need special care

The main risk factors for a foot ulcer are loss of protective sensation (numbness), poor circulation to the feet (peripheral artery disease) and a foot deformity. A foot that cannot feel pain or pressure can be hurt without you noticing.

The guideline reports that 19–34% of people with diabetes will have a foot ulcer during their life, and that after an ulcer heals it comes back in about 40% of people within a year and 65% within 3 years. That is why prevention matters.

How often your feet should be examined

• No numbness and no poor circulation: once a year.
• Numbness or poor circulation: every 6–12 months.
• Numbness and poor circulation together, or either one with a foot deformity: every 3–6 months.
• Numbness or poor circulation plus a past foot ulcer, a past amputation or kidney failure (end-stage renal disease): every 1–3 months.

The guideline groups people by risk. A trained healthcare professional checks the feet for loss of feeling (with a 10 g monofilament, or the Ipswich Touch Test if there is none) and for signs of poor circulation.

What to do every day

• Look at both feet, including the soles and between the toes. If you cannot see your soles, use a mirror or ask someone to look.
• Wash your feet daily but do not soak them in a bath, and dry them carefully, especially between the toes. If you make wudu, the washing is done; what needs care is the drying.
• Use a moisturiser on dry skin.
• Cut toenails straight across.
• Do not use chemical corn removers or corn plasters on hard skin. Have it treated by a trained professional.
• Avoid tight socks, and avoid exposing your feet to a lot of heat or cold.

Shoes and chappals

• Choose shoes that fit the shape of your foot, with enough length, width and depth. Have the fit checked standing up, preferably at the end of the day, because numb feet cannot judge a tight shoe.
• Look inside your shoes for stones or other objects every time before you put them on.
• Wear seamless socks of natural fibres, preferably light-coloured so that a stain from a wound shows.
• If you have a foot deformity, a pre-ulcer lesion or a healed ulcer, you may need extra-depth or custom-made shoes or insoles from a trained professional. Ask at your check.

If you are at risk, the guideline says to avoid walking barefoot, in socks without shoes, or in thin-soled slippers, whether indoors or outdoors. It also warns against other open footwear that leaves the skin exposed to sharp objects; a hawai chappal is an example. Bare or thinly protected feet take more pressure under the sole and have no protection against heat or injury.

The guideline accepts that many people prefer to go without shoes at home and that shoes can be inconvenient in warm weather. It still advises against it, because the harm outweighs the comfort.

Walking and exercise

For people at low or moderate risk (numbness or poor circulation, without a past ulcer, amputation or kidney failure), the guideline says that walking an extra 1000 steps a day is likely safe for the feet. Wear proper shoes and check your skin often. It also suggests an 8–12 week foot and ankle exercise programme, preferably supervised.

When to call

• A blister, a cut, a crack, or bleeding under hard skin.
• Redness, warmth or swelling in one area of a foot.

Contact a trained healthcare professional straight away, on the same day if you can. Do not wait for your next appointment. This is general information and not a substitute for an examination or for your doctor's advice.