Foot Care for People with Diabetes

Diabetes mellitus affects over 460 million people globally, and one of its most serious complications is diabetic foot disease, which can lead to ulcers, infections, and amputations. In Australia, where diabetes prevalence exceeds 1.3 million cases, diabetic foot complications account for more hospital admissions than any other diabetes-related issue. The cornerstone of preventing these outcomes is meticulous daily foot care, combined with professional monitoring and lifestyle adjustments. People with diabetes must treat their feet as a priority organ system because peripheral neuropathy, poor circulation, and impaired wound healing dramatically increase vulnerability to injury. This essay outlines evidence-based practices that individuals with diabetes should adopt to protect their feet, drawing from guidelines by Diabetes Australia, the International Working Group on the Diabetic Foot (IWGDF), and podiatric best practices.

The first and most critical step is **daily foot inspection**. Neuropathy—nerve damage that reduces sensation—means that cuts, blisters, or pressure points can go unnoticed and escalate into ulcers. Every day, preferably at the same time (such as after bathing), individuals should visually examine both feet, including between the toes and the soles. Use a mirror or ask a family member for hard-to-see areas. Look for redness, swelling, cracks, calluses, ingrown toenails, or any breaks in the skin. Even minor changes warrant attention; for example, a small blister can ulcerate within days if undetected. Podiatrists recommend keeping a foot care diary to track changes and share with healthcare providers during check-ups.

• Proper washing and moisturizing** form the hygiene foundation. Feet should be washed daily in lukewarm water—never hot, as neuropathy impairs temperature sensation and increases burn risk. Use a mild, pH-balanced soap and avoid soaking for more than 5 minutes to prevent skin maceration. Pat dry gently, especially between the toes, to reduce fungal infection risk. After drying, apply a urea-based moisturizer (10–25% concentration) to the tops and bottoms of the feet, but **not between the toes**, as excess moisture there promotes tinea pedis or bacterial growth. Products like Flexitol or Eulactol are commonly recommended in Australia. For those with dry, fissured heels, nightly application followed by cotton socks can enhance absorption and protect bedding.
• Nail and callus management** requires caution. Toenails should be cut straight across—not rounded—to prevent ingrown nails, using clean, sharp clippers. File edges 200-grit or higher to smooth edges. People with thick, dystrophic nails or poor vision should avoid self-cutting and attend a podiatrist every 6–8 weeks. Calluses, while protective, can hide ulcers underneath; never use corn pads, medicated plasters, or razor blades. Instead, use a pumice stone gently after bathing or schedule professional debridement. The IWGDF classifies callus as a pre-ulcerative lesion, emphasizing its removal under controlled conditions.
• Footwear selection** is non-negotiable. Ill-fitting shoes cause 80% of diabetic foot ulcers. Shoes must have a wide toe box, soft leather uppers, cushioned insoles, and a rocker sole to reduce forefoot pressure. Lace-up or Velcro styles ensure adjustability for swelling. Always wear seamless socks—preferably cotton or bamboo blends—without tight elastic bands. Check inside shoes daily for foreign objects (e.g., pebbles) or worn linings. Custom orthotics or depth shoes are subsidized under Australia’s National Diabetes Services Scheme (NDSS) for high-risk patients. Never walk barefoot, even indoors; use slippers with non-slip soles.
• Temperature and trauma avoidance** prevents burns and injuries. Use a bath thermometer to confirm water is below 37°C. Avoid hot water bottles, electric blankets, or heating pads directly on feet. In winter, wear insulated socks instead. Cross legs only briefly to avoid pressure neuropathy. When sitting, elevate feet periodically to improve circulation, but avoid tight garters or knee-high stockings that constrict blood flow.
• Circulation and neuropathy management** involve lifestyle measures. Smoking cessation is critical—nicotine causes vasoconstriction, reducing oxygen delivery by up to 30%. Exercise, such as 30 minutes of walking daily (in proper shoes), enhances peripheral blood flow. For those with limited mobility, seated ankle pumps or calf raises stimulate circulation. Glycemic control (HbA1c

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.