Diabetic foot disease causes more diabetes-related hospital admissions than any other complication and is the leading cause of non-traumatic lower limb amputation in the UK. Approximately 7,000 diabetes-related amputations occur every year in England alone. Yet the vast majority are preventable with correct, consistent daily foot care.
Why Diabetes Threatens the Feet
Two major diabetes complications converge on the feet. Peripheral sensory neuropathy — chronic glucose toxicity damages sensory nerves, causing progressive loss of protective pain sensation in the feet. A cut, blister or pressure ulcer that would normally cause immediate pain goes unnoticed and deteriorates silently for days or weeks before being discovered. Neuropathy also affects autonomic nerves (causing dry, cracked skin by reducing sweating) and motor nerves (causing foot deformity that creates abnormal pressure points). Peripheral arterial disease (PAD) — atherosclerosis in leg arteries reduces blood supply to the feet. Even a minor wound lacks the oxygen and nutrients from blood flow required for healing and infection clearance. When neuropathy and PAD coexist — which is common in longstanding or poorly controlled diabetes — even a tiny wound can progress rapidly to deep infection, osteomyelitis and gangrene.
The Daily Foot Care Routine
Inspect every day: Check all surfaces of both feet daily — including between the toes and the sole (use a mirror or ask for help if flexibility or vision is limited). Look for any cuts, blisters, cracks, redness, swelling, bruising, colour change or temperature asymmetry. Wash daily: Lukewarm water — test with your elbow, not your foot. Dry thoroughly, particularly between the toes (moisture promotes fungal and bacterial infection). Moisturise: Apply emollient cream to the top and sole of the foot — avoid between the toes. Urea-based creams (10–25%) are particularly effective for the dry diabetic skin prone to cracking. Nail care: Cut nails straight across, not too short or rounded at the corners. If nails are thickened, curved, or you have reduced sensation — have them cut by a podiatrist. Footwear: Wear well-fitting shoes at all times, including indoors. Never walk barefoot. Check inside shoes before putting them on — a foreign object or rough seam you cannot feel can cause a catastrophic ulcer.
Red Flags: Seek Help the Same Day
Contact your diabetes team, GP or podiatrist urgently — same day — for any: new break in the skin (however small), blister, ulcer or wound, new redness, swelling or warmth, discharge from any area of the foot, pain that is unexpected given your usual sensation level. The NHS standard for diabetic foot problems is specialist assessment within 24 hours. Fast action is essential — what looks like a small wound on Monday can be a deep infection by Friday in a neuropathic foot with poor circulation. Do not adopt a “wait and see” approach with foot wounds in diabetes.
The Annual NHS Foot Check
Every person with diabetes should receive an annual foot examination as part of their diabetes annual review. This includes monofilament testing (detecting loss of protective sensation), vascular assessment, visual inspection and risk stratification into low, moderate or high risk. Based on this, follow-up frequency is set. Ensure you attend this appointment and that any concerns are flagged.
Frequently Asked Questions About Diabetic Foot Care
Can diabetic neuropathy be improved?
For early neuropathy, tight glycaemic control is the most evidence-based intervention for slowing and partially reversing progression. Some people with Type 2 diabetes who achieve remission experience significant neuropathy improvement. Alpha-lipoic acid (600mg daily) has clinical trial evidence for reducing neuropathy symptoms and may slow progression. For painful neuropathy (burning, shooting, tingling pain), GPs can prescribe gabapentinoids, duloxetine or amitriptyline — all effective treatments.
Why must I never walk barefoot if I have diabetes?
With neuropathy, you cannot rely on pain to detect injury. A nail on the floor, a stone on the beach or a seam inside a shoe can cause a wound that you won’t feel. By the time you notice (often by smell, visible discharge, or someone else pointing it out), significant damage may have occurred. Protective footwear at all times eliminates this risk.
Should I see a podiatrist regularly?
Yes — all people with diabetes should have at minimum their annual NHS foot check. People with moderate or high risk (identified via annual review) are seen by NHS podiatry more frequently for nail care, callus management and monitoring. If you have any foot problem that you’re uncertain about, a podiatry appointment is always appropriate rather than trying to treat yourself.
Does good blood glucose control protect my feet?
Yes — directly. The DCCT (Type 1) and UKPDS (Type 2) landmark trials both showed that tighter glycaemic control substantially reduces the risk of developing neuropathy and PAD — the two conditions that put feet at risk. Every 1% reduction in HbA1c reduces microvascular complication risk by approximately 25–35%. Blood glucose control is the most powerful long-term protective measure for feet.
Browse foot care products and diabetes supplies at Huncoat Pharmacy. Related: Diabetes Care, Foot Health.
At Huncoat Pharmacy: Pharmacy First, Browse diabetic foot care products.