Diabetic foot care: protecting your feet
Diabetes can damage the nerves in your feet so that a cut, blister or burn causes no pain — which means an injury can become a deep ulcer before you notice it. Checking both feet every day, wearing something on your feet indoors and out, and having any wound seen within 24 hours are what prevent the sequence that ends in amputation. In Pakistan this matters more than in colder countries, because walking barefoot indoors is normal and summer floors get hot enough to burn a foot that cannot feel heat.
Diabetologist & General Physician · MBBS
Diabetes damages feet in two ways at once. High glucose over years injures the small nerves, so the foot stops reporting pain, and it narrows the arteries, so what blood does reach the foot carries less of what a wound needs to heal. A person can stand on a nail, walk on it all day, and only find it when they take off the shoe.
The daily check
This takes about a minute and is the single most effective thing you can do. Do it at the same time each day so it becomes habit — many people do it after wudu, which already involves washing and looking at the feet.
- Look at the top, the sole, the heel and between every toe. Use a mirror on the floor if you cannot bend, or ask someone.
- Feel for hot spots, hard lumps or soft boggy areas.
- Look for colour changes: redness, blue or black patches, or unusual pallor.
- Check for cracks in the heel and for anything moist or smelly between the toes.
- Dry carefully between the toes — moisture there causes fungal infection, which opens the skin.
Why barefoot is the local risk
In most Pakistani homes, shoes come off at the door. That is normal and nobody is going to change it — but a numb foot on a courtyard floor in June is a burn waiting to happen, and stepping on a stray pin on a bedroom floor produces no pain to warn you. Household slippers, worn indoors, are a genuine medical intervention here, not a lifestyle suggestion.
Shoes
- Buy shoes in the late afternoon, when feet are at their largest.
- There should be a thumb's width between the longest toe and the end of the shoe.
- Check inside the shoe with your hand every time before putting it on — a small stone or a folded sock does real damage to a foot that cannot feel it.
- Break new shoes in slowly: an hour on the first day, then check your feet.
- Avoid chappals with a thong between the toes if you have neuropathy; they rub a spot you will not feel.
- Wear socks that have no thick seam, and change them daily.
Nails and skin
Cut nails straight across rather than curved down at the corners, which is what produces ingrown nails. File the edges rather than digging into them. Moisturise the tops and soles of the feet — but never between the toes, where the extra moisture encourages fungal growth.
What the annual foot check involves
Everyone with diabetes should have their feet examined at least once a year, and more often if there is already nerve damage or poor circulation. The check is quick and painless.
| Test | What it shows |
|---|---|
| 10 g monofilament | Whether the foot can feel light pressure — the standard test for protective sensation |
| Tuning fork (128 Hz) | Whether vibration sense is lost, often the earliest change |
| Foot pulses | Whether blood supply to the foot is adequate |
| Skin and nail inspection | Calluses, deformity, fungal infection, early ulceration |
| Footwear inspection | Shoes causing pressure points |
Warning signs that need urgent attention
Common questions
Still not sure what to do?
Reading about a symptom only goes so far. A doctor who can ask you questions and examine you will get further in ten minutes than any article can.
