Diabetes Foot Care

Overview

Diabetes foot care is the everyday habit of checking and protecting your feet when you have diabetes. Over time, high blood sugar can damage the nerves and blood vessels in your feet. Nerves carry feeling and help you sense pain, heat and cold. Blood vessels carry blood that heals cuts and fights infection. When these are damaged, a small problem like a blister or a stubbed toe can go unnoticed and turn into a serious wound. Good foot care means catching small problems early, before they become big ones.

Yes. Foot problems are one of the most common complications of diabetes. Many people with diabetes develop some loss of feeling in their feet over the years, and foot ulcers (open sores that are slow to heal) affect a meaningful number of people at some point in their lives. The good news is that regular checks and simple daily habits greatly lower the risk.

Anyone with type 1 or type 2 diabetes can be affected, including children and young people, though problems are more common in people who have had diabetes for a long time. Risk is higher if your blood sugar has been high over the years, if you smoke, if you have high blood pressure or high cholesterol, if you have had a foot ulcer or amputation before, or if you have foot shape changes, poor eyesight, kidney problems, or trouble reaching your feet.

Symptoms

Common symptoms

• Numbness or loss of feeling in the feet or toes, sometimes described as 'walking on cotton wool'
• Tingling, pins and needles, burning or stabbing feelings, often worse at night
• Feet that feel very cold, or sometimes unusually hot
• Dry, cracked skin, especially around the heels
• Hard skin, calluses or corns that build up in one spot
• Sores, blisters or cuts that are slow to heal
• Changes in the shape of your foot, such as a high arch or curled toes
• Redness, swelling, warmth or unusual colour on part of the foot
• Thick or discoloured toenails, or athlete's foot that keeps coming back
• Pain in the legs or feet when walking that eases with rest (a sign of reduced blood flow)

Symptoms in children

• Children and young people with diabetes usually have healthy feet, but the same daily checks and yearly foot exams still matter
• Children may not notice small problems or may find it hard to explain odd feelings in their feet
• Blisters, cuts and ingrown toenails from sports, tight shoes or barefoot play are the usual issues
• Learning foot-check habits early makes them easier to keep for life

Symptoms in older adults

• Poor eyesight or trouble bending down can make it hard to see and reach your feet, so a mirror, family member or carer can help
• Skin gets thinner and drier with age, so cracks and pressure damage can appear more easily
• Hard skin and corns may build up faster, especially over bony areas
• Other health conditions and some medicines can affect healing
• Problems may appear with little or no pain because nerve damage is more common with longer-standing diabetes

Causes

Main causes

• High blood sugar over time damages nerves (called neuropathy), so you lose feeling and may not notice injuries
• High blood sugar also damages blood vessels, so less blood reaches the feet and wounds heal more slowly
• Reduced feeling means small injuries from shoes, stones, heat or sharp objects go unnoticed and get worse
• Foot shape changes can create pressure points where hard skin builds up and skin breaks down
• Infection takes hold more easily when healing is slow and the body's defences are affected by high blood sugar

Risk factors

• Having had diabetes for many years
• Blood sugar levels that have been high over time
• Smoking, which narrows blood vessels
• High blood pressure and high cholesterol
• A previous foot ulcer or amputation
• Bunions, hammer toes, flat feet or other foot shape changes
• Poor eyesight, or difficulty bending to see your feet
• Kidney disease or other long-term health conditions
• Drinking a lot of alcohol
• Walking barefoot, wearing tight or ill-fitting shoes, or standing for long periods
• Not having regular foot checks

When to see a doctor

See a doctor urgently if:

• You notice a new sore, blister or ulcer on your foot
• A wound is not healing, or is getting bigger, redder or more painful
• Any redness, swelling, warmth or pus in your foot
• You have a foot injury and cannot feel it properly
• Your foot changes shape suddenly, or becomes red and swollen without injury
• You have a cut or puncture wound, even a small one, especially if you stepped on something barefoot

Book a routine appointment if:

• Once a year for your diabetes foot check, or more often if your healthcare team advises it
• If you have numbness, tingling or burning in your feet
• If hard skin, corns or thick toenails build up — see a podiatrist (a foot specialist) rather than cutting them yourself
• If your shoes no longer fit well or rub
• If you cannot see, reach or feel your feet properly and need help with checks
• If you have athlete's foot or nail problems that keep coming back

Diagnosis

Your healthcare team checks your feet by looking, feeling and testing. This is usually done at least once a year, and is often called your 'diabetic foot check'. The person checking will look at the skin, nails and shape of each foot, feel the pulses in your feet, test how well you can feel light touch and vibration, and ask about your shoes and any problems you have noticed. Based on what they find, they will tell you whether your feet are at low, moderate or high risk, and how often you should be checked.

Tests that may be done

• Looking closely at the skin, nails, toes and shape of both feet, including between the toes
• Checking the pulses in your feet and ankles to judge blood flow
• A light-touch test, often using a soft nylon strand, to check for loss of feeling
• A vibration test, often using a tuning fork, to check nerve function
• Checking your shoes and socks for fit and anything rubbing
• Sometimes a blood-flow test such as an ankle-brachial index, which compares blood pressure in your arm and ankle
• Sometimes swabs or scans if there is a wound or suspected infection

What to expect at your appointment

The foot check is quick and painless, usually taking a few minutes. You will be asked to take off your shoes and socks. Your clinician will tell you what they find, whether you are at higher risk, and whether you need to see a podiatrist more often. Take your usual shoes with you so they can be checked too. It helps to bring a list of any foot problems you have noticed since your last check.

Treatment

Treatment depends on what is found. For most people, the main 'treatment' is prevention: daily checks, well-fitting shoes, good blood sugar control, and regular professional foot checks. If a problem such as a wound, hard skin, infection or poor circulation is found, your care team will treat it and may refer you to a podiatrist (foot specialist) or a specialist foot clinic. Keeping blood sugar, blood pressure and cholesterol in a healthy range helps your feet heal and protects your nerves and blood vessels.

Self-care at home

• Check both feet every day, including the tops, soles, heels and between the toes. Use a mirror or ask for help if you cannot see them well.
• Wash your feet daily in warm (not hot) water, dry them carefully, especially between the toes, and moisturise dry skin — but not between the toes.
• Never walk barefoot, even indoors, to avoid cuts and stepping on sharp objects.
• Wear well-fitting shoes and check inside them with your hand before putting them on, for stones, rough seams or objects.
• Break in new shoes slowly, a short time each day, to avoid blisters.
• Cut toenails straight across and file the edges — or ask a podiatrist if you have numbness, poor eyesight or circulation problems.
• Do not cut corns, calluses or hard skin yourself, and do not use corn plasters or strong remedies — these can damage the skin.
• Avoid direct heat on your feet, such as hot water bottles, electric blankets, heaters or sitting too close to a fire — you may not feel burns.
• Choose seamless socks that fit well and change them daily.
• Keep your blood sugar, blood pressure and cholesterol in the range your team recommends, and get help to stop smoking if you smoke.
• Take your shoes and socks off at every appointment so your feet can be checked.

Medical treatments

Your healthcare team may clean and dress a wound, remove hard skin or damaged tissue, and give you special footwear or a cast to take pressure off a sore area (this is called 'offloading'). If there is an infection, your doctor may prescribe medicine to treat it. You may be referred to a podiatrist, a diabetes foot clinic or a vascular (blood vessel) specialist. Treatment always works best alongside good blood sugar control and daily foot checks. Your team will explain the options and agree a plan with you.

When is surgery considered?

Surgery is only needed for some people. It may be used to drain or clean a deep infection, to improve blood flow when narrowed arteries are stopping a wound from healing, or to correct a foot shape that keeps causing pressure sores. In the most serious cases, where tissue has died and cannot be saved, an amputation may be needed — but this is far less common when problems are caught early.

Living with this condition

Living with diabetes means making foot checks part of your everyday routine, like brushing your teeth. Many people find it easiest to check their feet at the same time each day, for example after a bath or before bed. Keep a small mirror, a good light and a moisturiser nearby. Pay attention to how your shoes feel — if a shoe rubs, stop wearing it. Tell your dentist, podiatrist and GP that you have diabetes, and ask for your foot check every year.

Lifestyle tips

• Keep blood sugar, blood pressure and cholesterol within the range your team recommends
• Stay active with something you enjoy, such as walking, swimming or cycling
• If you smoke, ask for help to stop — this is one of the best things you can do for your circulation
• Limit alcohol, which can affect blood sugar and nerve health
• Wear shoes that fit properly and suit the activity you are doing
• Check your feet before and after exercise, especially after long walks or new activities
• Keep your toenails tidy and see a podiatrist if you have any doubts

Diet and exercise

Eating a balanced diet and staying active help keep your blood sugar steadier, which protects your nerves and blood vessels. You do not need a special diet — small, steady changes work best, such as more vegetables, whole grains and lean protein, and fewer sugary drinks and highly processed snacks. When it comes to exercise, choose shoes that fit well and check your feet afterwards for blisters, redness or rubbing. If you have a foot wound or have been told to rest a foot, ask your care team what activity is safe for you.

Mental health and emotional wellbeing

Having diabetes can feel like a lot to manage, and worrying about your feet is common. Some people feel anxious about every mark or twinge, and others feel worn down by the daily routine. These feelings are understandable and worth talking about. Tell your healthcare team how you feel — practical support, such as help with shoe fitting, podiatry, or a plan that fits your life, often makes a big difference. If you ever feel you cannot cope, please contact a crisis support line in your country or your local emergency number right away. You do not have to manage alone.

Prevention

Most serious foot problems can be prevented or caught early. The key steps are daily foot checks, well-fitting shoes, never walking barefoot, good blood sugar and blood pressure control, not smoking, and a professional foot check at least once a year. If you have been told your feet are at higher risk, you may be seen more often — this is a sensible extra safeguard, not a sign that something is wrong.

Vaccines

Keep up with the vaccines your healthcare team recommends for people with diabetes, such as the yearly flu vaccine and other routine vaccines offered in your area. Ask your GP or pharmacist which ones are right for you.

Screening programmes

Have your diabetes foot check at least once a year, or more often if your team advises. Your check may include a simple blood-flow test and a feeling test. Ask your team when your next check is due and whether you should also see a podiatrist.

Complications

If left untreated

• Foot ulcers — open sores that are slow to heal and can become infected
• Infection that spreads into the skin, bone or deeper tissues
• Gangrene — tissue death caused by poor blood flow, which can lead to amputation
• Charcot foot — a serious condition where the bones of the foot weaken and the foot changes shape
• Long-term pain, reduced mobility and difficulty walking
• More time in hospital and more time off work

Long-term outlook

The outlook is good when problems are found early. Most foot ulcers heal with the right care, and many serious complications are avoided altogether by daily checks and regular foot exams. If you have already had a foot problem, your team will help you protect your feet going forward. Ask questions, keep your appointments, and get anything new checked quickly — small actions make a real difference.

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