A Daily Foot Care Routine That Prevents Diabetic Foot Ulcers

Most diabetic foot ulcers do not begin dramatically. They begin with a shoe that rubbed, a pebble that was not felt, a callus that was trimmed at home, or a small crack in dry heel skin. Neuropathy removes the pain that would normally make a person stop and look. The routine below exists to replace that missing alarm with a deliberate one.

The daily five minutes

• Look at both feet 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.
• Feel for hot spots and cold patches, and compare one foot with the other.
• Wash with lukewarm water — tested with your elbow or a thermometer, never by foot — and dry thoroughly, especially between the toes.
• Moisturise the heel and sole, but never between the toes, where damp skin invites fungal infection.
• Shake out and inspect the inside of each shoe with your hand before putting it on.

Footwear rules that matter more than any cream

International guidance from the IWGDF and NICE is consistent: appropriate footwear is one of the most effective preventive measures available in a neuropathic foot. Practically, that means closed shoes with a deep toe box and a cushioned sole, worn with seamless socks; new shoes broken in over short periods with a foot check afterwards; and no barefoot walking, indoors or outdoors, ever.

This last rule causes the most friction in Indian households, where removing footwear indoors and at places of worship is normal. The workable compromise is a dedicated pair of indoor slippers with a firm sole kept at the door, and washable indoor footwear for temple visits. Hot floors, tiles in summer, and stray grit are the usual injury sources, and all three are avoided by having something on the foot.

What never to do at home

• Do not cut corns or calluses yourself, and do not use over-the-counter corn removers or acid plasters.
• Do not soak feet for long periods — it softens and macerates skin.
• Do not use hot water bottles, heating pads or hot sand on numb feet.
• Do not cut nails down the sides; cut straight across and file the edges.
• Do not ignore a blister because it does not hurt. Painlessness is the risk, not the reassurance.

Signs that need a same-week appointment

• Any break in the skin, however small, that has not started healing within a couple of days.
• New redness, warmth or swelling over part of the foot.
• A callus with a dark spot underneath — often bleeding under thickened skin.
• Discharge or a smell from a wound, or a wound probing deeper than it looks.
• New numbness, burning at night, or a sudden change in foot shape.

A foot that is red, warm and swollen without an obvious wound in a person with neuropathy needs urgent assessment, because infection and Charcot changes both present that way and both are time-critical.

The checks that should happen at clinic, not at home

Annual foot screening in diabetes should include testing sensation, feeling pulses, and assessing foot shape and footwear — this is standard in NG19 and in the IWGDF guidance. Where pulses are reduced, an arterial assessment follows, because a neuropathic ulcer in a leg with poor blood flow behaves entirely differently and needs the circulation addressed to heal.

Why blood sugar sits behind all of it

Glycaemic control affects nerve function, infection risk and healing speed simultaneously. It is not a competing priority to foot care; it is what makes foot care work. HbA1c targets are individual, and worth agreeing explicitly with your physician rather than assuming.

The point of the routine

Ulcers that are found on day one are usually managed with offloading, dressings and antibiotics. Ulcers found on day thirty are the ones that involve bone, theatre and, sometimes, amputation. Five minutes a day is what separates the two.