Caring for your feet when you have diabetes

Of all the areas of the body diabetes affects, the feet are the most commonly neglected — right up until a small problem becomes a serious one. Most diabetic foot complications I see began as something trivial: a blister from a new shoe, a crack in dry skin, a toenail cut too short.

The reason small things escalate is twofold. Diabetes can damage the nerves in the feet (neuropathy), so injuries stop hurting the way they should and go unnoticed. And it can narrow the arteries supplying the feet, so wounds heal slowly and infection takes hold more easily. Neither process announces itself loudly — which is why routine, deliberate care matters so much.

Five daily habits

1. Look at your feet every day

Tops, soles, sides, and between the toes. You are looking for cuts, blisters, cracks, redness, swelling, calluses or any change in colour. If bending is difficult, use a mirror on the floor or ask a family member. The whole check takes a minute; it is the single most valuable habit on this list.

2. Wash and dry properly

Lukewarm water — test it with your hand or elbow first, because neuropathy can make dangerously hot water feel comfortable. Use mild soap, don’t soak for long periods, and dry thoroughly, especially between the toes.

3. Moisturise — but not between the toes

Daily moisturiser prevents the dry, cracked skin that opens the door to infection. Skip the web spaces between toes, where trapped moisture encourages fungal infection instead.

4. Trim nails straight across

Not too short, and without rounding the corners into the skin. If your nails are thickened, curved or hard to reach, have them trimmed professionally rather than fighting them yourself.

5. Never go barefoot — and choose shoes carefully

Well-fitted shoes with room for the toes, no rough internal seams, and clean, cushioned (ideally seamless) socks. At home, wear supportive slippers rather than walking barefoot. Ill-fitting footwear is one of the most common causes of diabetic foot ulcers I see.

Massages, spas and pedicures — a cautious word

Patients often ask whether foot massages are safe. Sometimes they are: if you have no open wounds, normal sensation, good circulation and no history of foot complications, a gentle massage by a therapist who knows about your diabetes is usually reasonable.

The caution exists because the things that make massage risky — numbness, poor circulation, slow healing — are precisely the things diabetes can cause without obvious symptoms. Spa staff are not trained to assess a diabetic foot, and deep pressure, hot foot baths, or sharp pedicure instruments can cause injuries that go unnoticed. If you have any numbness, previous foot wounds, or simply haven’t had your feet assessed, it is worth doing that before making spa treatments a routine.

What professional foot care adds

Beyond the daily routine, clinic-based care is about early detection: checking sensation, examining pressure areas, safely managing calluses and difficult nails, dressing slow-healing areas, and — importantly for vascular patients — assessing the blood supply to the foot. Good blood-glucose control remains the foundation underneath all of it, because sustained high sugar levels drive both the nerve damage and the poor healing.

When to seek help promptly

A wound that hasn’t started healing within a few days, redness or warmth spreading around any break in the skin, new numbness or tingling, or pain in the feet or calves when walking — these all warrant early review. In a foot with reduced sensation or circulation, days matter. Timely assessment of the blood supply, and restoring it where it is compromised, is often the difference between a wound that heals and one that threatens the limb.

References

1. Rehman ZU, Khan J, Noordin S. Diabetic foot ulcers: contemporary assessment and management. Journal of the Pakistan Medical Association. 2023;73(7):1480–1487.
2. Lim JZ, Ng NS, Thomas C. Prevention and treatment of diabetic foot ulcers. Journal of the Royal Society of Medicine. 2017;110(3):104–109.