Diabetic Foot Care and Preventing Ulcers

Once protective sensation is gone, your feet stop reporting injury. Foot care stops being hygiene advice at that point and becomes the thing that prevents amputation.

The mechanism nobody explains

A normal foot reports a stone in the shoe, a seam rubbing, a blister forming. You shift your weight without thinking about it. That constant unconscious correction is what protects the tissue.

Neuropathy removes it. Pressure continues unrelieved because nothing tells you to move, tissue breaks down from the inside, and the first sign is often a wound that is already established. Add reduced circulation and it heals badly; add reduced immunity from high glucose and it becomes infected.

That is the whole pathway from numbness to amputation, and almost every step of it is preventable.

Daily, without exception

• Look at your feet every day — tops, soles, between every toe, and the heels. Use a mirror on the floor or ask someone. If you cannot see or reach them, this is the single most important thing to arrange help for.
• Never go barefoot, indoors included. Most injuries happen at home.
• Check inside your shoes with your hand before putting them on, every time. A stone or a folded insole will not be felt.
• Test water temperature with your elbow or a thermometer, never your foot.
• No heating pads, hot water bottles or hot soaks. Burns on insensate feet are common, serious and entirely avoidable.
• Moisturize the soles and heels but not between the toes, where dampness macerates skin.
• Cut nails straight across. If you cannot see well or reach comfortably, have it done rather than risking it.

Footwear

Shoes should be fitted late in the day when feet are largest, with a thumb’s width beyond the longest toe and a toe box deep enough that nothing touches the top. Seamless socks, changed daily. Break new shoes in over an hour or two at a time and inspect the feet afterwards — new shoes are a classic cause of a first ulcer.

Where the foot shape has changed — clawed toes, a collapsed arch, prominent pressure points — off-the-shelf shoes stop being adequate and custom accommodation is worth arranging.

What should be checked professionally

At minimum annually, and more often once sensation is reduced: monofilament testing for protective sensation, vibration sense, pulses and skin inspection. Nerve conduction testing where the diagnosis or severity is uncertain.

If you have lost protective sensation you are in a higher-risk group and the interval should shorten. Ask what your risk category is — it determines how often you should be seen, and most patients have never been told theirs.

To be assessed, call (314) 310-5577 or text (314) 886-5902. We are at 12174 Natural Bridge Rd, Suite 110, St. Louis, MO 63044.

Protecting the feet and protecting against falls are the same project. See balance and fall-risk assessment.

Exercising without making it worse comes down to the feet and the falls rather than the nerve.

Sources

• McDermott K et al. Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes care, 2023. PubMed 36548709
• Lim JZ et al. Prevention and treatment of diabetic foot ulcers. Journal of the Royal Society of Medicine, 2017. PubMed 28116957
• Wang X et al. Diabetic foot ulcers: Classification, risk factors and management. World journal of diabetes, 2022. PubMed 36578871
• Rehman ZU et al. Diabetic Foot Ulcers: Contemporary Assessment And Management. JPMA. The Journal of the Pakistan Medical Association, 2023. PubMed 37469062