Looking after your feet with diabetes: daily checks, footwear and the annual foot check

Why do feet need extra care with diabetes?

Diabetes can damage the nerves in the feet, which reduces feeling; this is called neuropathy. Diabetes can also affect the circulation to the feet. Diabetes UK says that if feeling has been lost, a person may not notice an injury to the foot. Sources note that smoking reduces blood flow to the feet.

What does a daily check involve?

Diabetes UK advises looking at the feet before putting socks on in the morning and again before bed. NHS sources describe looking at the tops, soles, heels and between the toes, using a mirror or asking someone for help if the feet cannot be seen. The signs listed include redness, swelling, blisters, cracks, broken skin and colour changes. NHS sources also describe washing the feet daily, drying them well between the toes, and moisturising dry skin. NHS sources describe moisturising dry skin but avoiding the gaps between the toes.

What do shoes and socks have to do with it?

Diabetes UK says shoes and socks that are too tight, too loose or that rub can cause problems. It advises checking inside and outside footwear before putting it on. UK sources describe changing socks daily and choosing natural fibres such as cotton or wool, without holes or thick seams. NHS sources say people at high risk should not cut their own toenails unless a podiatrist advises it.

What is the annual foot check?

Diabetes UK says a trained professional should check bare feet as part of the annual diabetes health check, and that the check is free on the NHS. The check looks at sensation and at blood flow in the feet. The result places a person in a low, moderate or high risk category for foot problems. Diabetes UK says that people at low risk may move to a check every other year, while those at moderate risk usually keep having yearly checks. NICE has a guideline on preventing and managing diabetic foot problems.

When should foot changes be reported, and to whom?

Sources advise prompt contact with a GP, podiatrist or diabetic foot team about a hot, red, swollen foot, new damage to the skin, a change in foot shape, new pain, or a cut that is slow to heal. NHS sources describe seeking help the same day for signs of infection such as redness, swelling, oozing or a bad smell, and NHS Inform says to call NHS 111 for new foot problems with fever, shivering or feeling generally unwell. A foot that is changing colour or going very pale or blue, especially with new numbness or pain, is described as an emergency: call 999 or go to A&E. When the GP practice or podiatrist is closed, the route is NHS 111.