Diabetic Foot Care: A Daily Routine to Prevent Ulcers, Infection and Bone Infection

It often starts with something small. A new pair of chappals rubs the side of the little toe at a wedding. A grain of gravel sits inside a shoe all day during a temple visit. A corn gets trimmed at home with a blade. In someone with long-standing diabetes and numb feet, that tiny break in the skin may go unnoticed for days, and by the time anyone looks, it has become an open sore, then an infected one. In some people the infection reaches the bone underneath.

The good news is that most diabetic foot ulcers are preventable, and prevention costs almost nothing: a few minutes a day, the right footwear and regular checks. In this guide, our doctors explain why diabetes puts the feet at risk, the daily foot care routine that protects them, what to do about nails, corns and calluses, which tests your doctor should do every year, and the warning signs that need same-day medical care.

Why does diabetes put your feet at risk?

Three problems tend to come together in a diabetic foot, and each one makes the others worse.

• Loss of feeling. Years of high blood sugar damage the long nerves to the feet. This is diabetic neuropathy, which can cause burning and tingling at first and later numbness. A numb foot does not warn you about a stone in the shoe, a blister or hot water.
• Poor circulation. Diabetes, smoking, high blood pressure and high cholesterol narrow the arteries in the legs. Less blood means less oxygen and fewer infection-fighting cells reach a wound, so it heals slowly.
• Lower resistance to infection. High sugar levels weaken the body’s defences. A small crack can let germs in, and infection can spread from skin to deeper tissue and, in some cases, into bone. Bone infection is called osteomyelitis, and it can take months of treatment to clear.

Nerve damage also changes the shape of the foot over time. Toes may curl, the arch may flatten, and pressure builds under the ball of the foot, where thick calluses form. Under a callus, the skin can quietly break down. In a small number of people, the bones and joints of a numb foot weaken and collapse, a condition called Charcot foot, which shows up as a warm, swollen foot that may not even hurt.

The daily diabetic foot check: a five-minute routine

Pick a fixed time, such as after your evening bath or before bed, so the habit sticks. Sit down in good light.

1. Look at the whole foot. Check the top, the sole, the heel, the sides and the skin between every toe. Use a hand mirror for the soles, or ask your spouse or children to look if your eyesight is weak or bending is difficult.
2. Look for change. Cuts, blisters, cracks in the heel, red or dark patches, swelling, new calluses, soggy white skin between the toes, ingrown nails, or any spot of blood or fluid on your socks.
3. Feel for warmth. Run the back of your hand over both feet. One foot or one area that feels clearly warmer than the other is worth showing a doctor.
4. Act early. Clean a small cut gently with clean water, cover it with a sterile dressing, keep pressure off it and check it again the next day. If it is not clearly better within a day or two, or shows any warning sign listed below, see a doctor.

Washing, drying and moisturising the right way

Washing

Wash your feet every day with lukewarm water and mild soap. Test the water with your elbow or a bath thermometer first, never with your feet, because numb feet cannot judge heat and burns are a common way ulcers begin. Do not soak your feet for long periods; long soaks soften the skin and make it crack later. Avoid hot water bags, heating pads and sitting with your feet close to a heater.

Drying between the toes

Pat your feet dry with a soft towel and take extra care between the toes. Moist skin there turns white and soggy, fungal infection settles in, and the skin splits. Those small splits are a common entry point for bacteria. If you notice itching, peeling or white skin between the toes, get it treated rather than ignoring it.

Moisturising, but not between the toes

Diabetes often makes the skin dry, and dry heels crack easily, especially in Bengaluru’s dry months. Apply a plain moisturising cream or coconut oil to the tops, soles and heels once a day. Do not apply it between the toes, where extra moisture encourages infection. Wipe off any excess cream before putting on socks.

Nail cutting, corns and calluses: what is safe at home

Nails. Trim toenails after a bath, when they are soft. Cut straight across, not deep into the corners, and gently file sharp edges. Do not dig into the corners or tear nails off. If your nails are thick, discoloured or ingrown, or if you cannot see or reach your feet well, ask a doctor or a trained foot care professional to trim them.

Corns and calluses. These are the skin’s response to pressure, usually from tight or ill-fitting footwear or a change in foot shape. In diabetes:

• Never cut them yourself with a blade, scissors or nail cutter, and do not let a roadside “corn specialist” do it.
• Do not use medicated corn plasters or corn caps. Many contain acids that can burn healthy skin, and a numb foot will not feel the burn.
• Find the cause. A callus means something is pressing. Fixing the footwear, and sometimes using cushioned insoles, matters more than removing the hard skin.
• Let a professional treat thick calluses, especially any with a dark or bloody spot underneath, which can be a sign of an ulcer forming below.

Footwear: never barefoot, not even at home or in the temple

Walking barefoot is one of the commonest ways a diabetic foot gets hurt. At home, a dropped pin, a toy or a hot kitchen floor can cause a wound you do not feel. Use soft, closed-back indoor footwear. Temple floors, hot stone courtyards in the afternoon sun, and festival walks are a real risk. If you must remove footwear, keep visits short, wear clean socks where allowed, walk on shaded or matted paths, and check your soles as soon as you are back.

When choosing footwear:

• Check inside before wearing. Run your hand inside each shoe every time to feel for stones, nails, torn lining or rough seams. Shake them out.
• Choose a good fit. A wide, deep toe box, soft upper, cushioned sole, and a strap or laces that hold the foot so it does not slide. Avoid pointed toes, high heels and thin rubber slippers held only by a toe post.
• Buy in the evening, when feet are slightly larger, and break new shoes in slowly, checking your feet after each short wear.
• Wear socks that are clean, soft and without thick seams or tight elastic. Change them daily, or more often if your feet sweat.
• Ask about special footwear if you already have deformity, a previous ulcer or high-pressure calluses. Customised insoles or diabetic footwear spread pressure more evenly.

Good footwear also helps other foot problems that are common in people with diabetes, such as plantar fasciitis and Achilles tendinopathy. If your heel hurts, our guide to heel pain causes explains how to tell them apart.

Blood sugar, smoking and the rest of your health

Daily foot care protects the skin, but what happens inside the body decides how well that skin heals. Keeping blood sugar within the target your doctor sets slows nerve damage and helps the immune system fight infection. Your HbA1c gives the average over about three months; our guide on HbA1c and fasting sugar explains what the numbers mean. Take your diabetes medicines and insulin as prescribed and do not stop or change them without your doctor.

Smoking, beedis and chewing tobacco narrow the blood vessels and slow healing. Stopping is one of the most effective things you can do for your feet. Blood pressure, cholesterol and weight all affect circulation too, and they often travel together in metabolic syndrome. A balanced, mostly home-cooked anti-inflammatory diet, steady weight management, good sleep and correcting low vitamin D and B12 (metformin can lower B12 over time, which can add to nerve symptoms) all support healing.

Daily walking helps sugar control and circulation. Walk in proper shoes, on even ground, and check your feet afterwards. If your calves cramp and force you to stop after a short distance, mention it to your doctor; it can be a sign of narrowed leg arteries, though leg aching on walking can also come from the spine, as explained in neurogenic claudication.

One more point for people with diabetes who also live with back, knee or shoulder pain: repeated steroid injections and tablets can push blood sugar up for days. Read why steroid-free care matters in diabetes and what repeated steroids can do before agreeing to one. Diabetes is also linked with joint problems such as frozen shoulder.

Regular foot examinations: the monofilament test and more

Everyone with diabetes should have a full foot examination by a doctor at least once a year, and more often if they already have numbness, poor pulses, deformity or a past ulcer. The examination usually includes:

• Monofilament test. A thin nylon thread is pressed against several points on the sole until it just bends. If you cannot feel it at certain spots, protective sensation is reduced and your foot is at higher risk.
• Vibration and reflex tests with a tuning fork and reflex hammer to check nerve function further.
• Pulses and circulation. Feeling the foot pulses, and sometimes comparing blood pressure at the ankle and arm, to look for narrowed arteries.
• Skin, nails, shape and footwear. Looking for calluses, deformity, fungal infection and shoes that do not fit.

Based on these findings, your doctor can tell you whether your foot is low, moderate or high risk, and how often it should be checked. Blood tests such as HbA1c, kidney function and lipids, and an X-ray if bone damage is suspected, complete the picture. When a wound is not healing or bone infection is suspected, an MRI may be needed, similar to how it is used in spinal infection.

Diabetic foot care checklist: daily, weekly and yearly

How Dr Heal can help

Preventing foot problems in diabetes needs teamwork between you, your diabetes doctor and others. At Dr Heal, we look at the whole person, not just the foot:

1. Careful examination. A detailed history, foot and nerve examination, and a clear answer to whether burning or numbness comes from diabetic neuropathy, a nerve in the spine, or both. Our doctors are available 24 hours at both branches; you can meet them on our doctors page.
2. Tests under one roof. Blood sugar, HbA1c, vitamin and other blood tests in our in-house laboratory, and X-rays through in-house radiology, as described on our facilities page.
3. Nutrition and lifestyle support. Through functional medicine and clinical nutrition, we help with diet, weight, sleep and vitamin deficiencies that affect sugar control and healing.
4. Steroid-free care for related pain. Many people with diabetes also have knee, back or shoulder pain. When an injection is needed, we use our own regenerative medicine from Dr Heal Pharma, which contains no steroids, so it does not send sugar readings soaring. See our joint pain treatment and full list of treatments.
5. Coordination with the right specialist. If you need wound care, vascular assessment or surgery for an infected foot or bone, we help you reach the right specialist without delay, and continue supporting your sugar control and rehabilitation alongside.

Simple habits that make a big difference

• Keep a mirror and a torch near your bed for the nightly foot check.
• Keep indoor footwear by the bed so you never step barefoot at night on the way to the bathroom.
• Carry spare socks on long trips and change them if they get damp.
• Do not self-treat with home remedies such as turmeric pastes on open wounds, hot fomentation or herbal burns. Clean water and a sterile dressing are safer until a doctor sees it.
• Do not rely on painkillers to get through foot pain. Pain, or its absence, is a signal to check the cause. Read why painkillers are not the answer.
• Take ankle twists seriously. A numb foot may hide a significant injury; see our guide on when an ankle sprain needs more than rest.

Frequently asked questions

How often should a person with diabetes check their feet?

Every day, at home, including the soles and between the toes. A doctor should do a full foot examination at least once a year, and more often if you have numbness, poor circulation, deformity or a past ulcer.

Why should I not put cream between my toes?

The skin between the toes stays moist naturally. Extra cream keeps it damp, which encourages fungal infection and skin splitting, and those splits let bacteria in. Moisturise the rest of the foot and keep the toe spaces dry.

Can I use corn plasters if I have diabetes?

It is best not to. Many corn plasters contain acids that can burn the surrounding skin, and with reduced feeling you may not notice the damage until a wound forms. Let a doctor or trained foot care professional treat corns and calluses.

What is the monofilament test?

It is a quick, painless check in which a doctor presses a thin nylon thread on different points of your sole. If you cannot feel it, your protective sensation is reduced, and your feet need extra care and more frequent checks.

How do I know if a foot wound has become infected or reached the bone?

Warning signs include spreading redness, swelling, warmth, pus or a bad smell, fever, rising sugar readings, or a wound that will not heal. A deep wound where bone can be felt or seen, or one that keeps coming back, raises concern for bone infection. Only a doctor can confirm it with examination, blood tests and imaging, so seek care the same day.

Where can I get a diabetic foot check in Bengaluru?

Dr Heal Pain Cure Hospital offers foot and nerve examinations, sugar and HbA1c testing and X-rays under one roof at its HSR Layout and Banashankari branches. Both are open 24 hours, and patients come from all over Karnataka.

This article is for general information and is not a substitute for a medical consultation. Please see a doctor for advice about your own symptoms.