Diabetic Foot Care: Why It Matters and What to Do

Foot care might not be the first thing people think about when managing diabetes — but it should be. Foot problems are one of the most serious complications of diabetes in the UK, responsible for more hospital admissions than any other diabetic complication.

The good news is that with the right knowledge and regular care, the vast majority of serious diabetic foot problems are preventable. This guide explains why diabetes affects the feet, what to look out for, and how to protect your foot health.

Why does diabetes affect the feet?

Diabetes affects the feet through two main mechanisms:

Peripheral neuropathy — nerve damage

High blood glucose levels over time can damage the nerves that supply sensation to the feet and lower legs. This is called peripheral neuropathy. When this happens, you may lose the ability to feel pain, heat, cold or pressure in your feet normally.

This sounds less serious than it is. Pain is the body’s warning system — it tells you something is wrong. Without it, a small blister, a cut from a badly fitting shoe, or a hot surface can cause significant injury without you noticing. By the time the wound becomes visible and large enough to be obvious, it may already be infected.

Peripheral arterial disease — poor circulation

Diabetes also accelerates the build-up of fatty deposits in blood vessel walls (atherosclerosis), reducing blood flow to the legs and feet. Poor circulation means that even minor wounds heal slowly or not at all, and infection can take hold more easily.

When neuropathy and poor circulation occur together — which they often do in people with long-standing diabetes — even a small foot injury can escalate into a serious wound that is very difficult to treat.

The scale of the problem

The statistics are sobering. In England, around 7,000 amputations are performed each year as a result of diabetic foot complications — that’s approximately 135 a week. The vast majority of these amputations are preceded by a foot ulcer, and many could be prevented with better foot care and earlier intervention.

This is not intended to alarm — it is intended to convey how important regular foot checks are for people with diabetes.

Daily foot care for people with diabetes

A daily foot check takes no more than 5 minutes and can make a significant difference. Here’s what to do:

Check your feet every day

Look carefully at both feet — top, sole, heel and between the toes. You’re looking for:

• Any cuts, grazes, cracks or blisters
• Redness, swelling or warmth — signs of inflammation or infection
• Changes in skin colour — pallor, bluish or very red areas
• Any new areas of callus or hard skin
• Changes to nail condition — thickening, discolouration, in-growing
• Any sores or ulcers that are slow to heal

If you have difficulty seeing the soles of your feet, use a mirror on the floor, ask a family member to help, or take a photo with your phone.

Wash feet daily

Wash your feet in lukewarm water — not hot. Test the temperature with your elbow or a thermometer, not your foot, as neuropathy means you may not be able to accurately judge how hot water is.

Dry thoroughly, particularly between the toes. Moisture between the toes encourages fungal infections and skin breakdown.

Moisturise daily

Apply a good moisturiser to the tops and soles of the feet to keep skin supple and prevent cracking. Do not apply moisturiser between the toes — this area needs to stay dry.

Nail care

Cut nails straight across, never shorter than the end of the toe, and file sharp edges gently. If your nails are thickened, difficult to cut or you have reduced sensation in your feet, have them cut by a podiatrist rather than attempting to do it yourself.

Footwear

Always wear well-fitting shoes with enough room in the toe box. Avoid shoes that rub or pinch. Check inside shoes before putting them on — a small stone, a rough seam or a crumpled lining can cause a pressure sore that you won’t feel developing.

Never walk barefoot — not even indoors. A small cut or injury on a tile or a piece of debris on the floor can go unnoticed and become a serious problem.

Socks

Wear clean, moisture-wicking socks every day. Avoid socks with tight elastic tops that restrict circulation, or socks with thick seams over the toes. Seamless socks are ideal.

Annual NHS diabetic foot checks

Everyone with diabetes should be offered an annual foot check by their GP practice or diabetes care team. This check assesses:

• Sensation — using a thin monofilament or tuning fork to test nerve function
• Circulation — feeling the pulses in the foot and sometimes using a Doppler device
• Skin and nail condition
• Foot shape and pressure distribution

Based on this assessment, your feet will be classified as low, moderate or high risk. The higher your risk category, the more frequently you should be seen by a podiatrist.

Don’t wait for your annual check to raise any concerns — if you notice any change in your feet, seek advice promptly.

Seeing a podiatrist with diabetes

People with diabetes should have regular access to a podiatrist — either through NHS podiatry services or privately. A podiatrist can:

• Perform detailed foot assessments including vascular and neurological checks
• Safely treat corns, calluses and nail problems without the risks associated with self-treatment
• Monitor for changes over time
• Prescribe custom orthotics to redistribute pressure and protect vulnerable areas
• Provide wound care and ulcer management
• Advise on appropriate footwear

If you have diabetes and have not had a professional foot assessment recently, booking an appointment with a podiatrist is one of the most valuable things you can do for your long-term health.

When to seek urgent medical attention

The following require prompt — same-day — medical attention. Don’t wait for a routine appointment:

• Any wound on the foot that is not healing, or appears to be getting worse
• Redness, warmth or swelling around a wound or any area of the foot
• A wound with discharge or an unpleasant smell — possible signs of infection
• A sudden change in the colour of the foot — particularly a bluish or very pale appearance
• A new area of skin breakdown or ulceration
• Fever alongside any foot wound

Contact your GP, diabetes care team, or NHS 111 immediately if you notice any of these. A diabetic foot infection can progress very rapidly and early treatment is critical.

Reducing your overall risk

Good blood glucose management is the most important thing you can do to reduce the risk of diabetic complications, including foot problems. Work with your diabetes care team to keep your HbA1c within your target range. Stopping smoking, managing blood pressure and cholesterol, and maintaining a healthy weight all help protect the circulation to your feet.

This article is for general information only and does not constitute medical advice. If you have diabetes and any concerns about your feet, please contact your GP or diabetes care team promptly. Always consult a qualified, HCPC-registered practitioner for diagnosis and treatment.