How often should people with diabetes check their feet?

Many people with diabetes are advised to check their feet every day, especially if they have neuropathy, poor circulation, previous ulcers, kidney disease, or reduced vision.

What are warning signs of a diabetic foot problem?

Warning signs include a cut, blister, ulcer, swelling, redness, warmth, pus, bad smell, black skin, increasing pain, numbness, fever, or a wound that is not healing.

Can a diabetic foot wound be treated at home?

Minor skin issues still need careful monitoring, but infected, deep, spreading, painful, black, or non-healing wounds should be assessed urgently by a clinician.

Diabetic Foot Care: Nerve Damage, Circulation, and Wound Warning Signs

Introduction

The feet are one of the most important — and most vulnerable — areas of the body for people living with diabetes. Over time, diabetes can damage both the nerves and the blood vessels that supply the feet. These two problems often occur together, and together they create conditions in which small injuries can go unnoticed, heal slowly, become infected, and in the worst cases lead to serious complications.

This guide explains why diabetes affects the feet, how to check them daily, what warning signs to act on, when to see a podiatrist or clinician, and when a foot problem requires urgent attention.

It is not a guide to treating wounds at home. If you have a foot wound that is infected, spreading, deep, blackened, painful at rest, or not improving, please seek clinical assessment promptly rather than managing it yourself.

Key Points

Diabetes can damage both nerves (neuropathy) and blood vessels (poor circulation), often in combination
Nerve damage means injuries to the feet may not cause pain and can go unnoticed
Poor circulation means wounds heal more slowly and are more prone to serious infection
Daily foot checks allow early detection of problems before they become serious
Well-fitting footwear and careful skin and nail care reduce injury risk
Podiatry review is an important part of routine diabetes care
Good blood glucose management over time is the most important way to reduce long-term foot risk
Seek urgent clinical review for any infected, spreading, non-healing, blackened, or deeply painful wound

Why Diabetes Affects the Feet

Diabetes does not affect the feet in a single way — it creates two distinct but interrelated problems that compound each other.

Nerve Damage: Diabetic Neuropathy

Diabetic neuropathy is nerve damage caused by prolonged exposure to elevated blood glucose. It affects approximately half of all people with diabetes at some point, and the feet are almost always the first area involved.

The longest nerves in the body — those supplying the feet and lower legs — are the most vulnerable. When these nerves are damaged, several things can happen:

Numbness or reduced sensation — the ability to feel pain, pressure, heat, or texture is reduced or lost. An injury — a blister, a cut from a sharp object inside a shoe, a burn from a hot surface — may not hurt and can go unnoticed.
Tingling or “pins and needles” — often persistent, especially at night.
Burning pain — sometimes severe, particularly at night. This is a sign of active nerve irritation.
Loss of protective sensation — the most dangerous aspect. Without the normal warning of pain, injuries are not noticed and not treated.
Changes to foot shape — long-standing neuropathy can affect the small muscles of the foot, leading to toe deformities, altered weight distribution, and pressure points that break down skin.

The critical point is this: a numb foot is not a safe foot. The absence of pain does not mean no injury has occurred. It means injuries are more likely to be missed.

Poor Circulation: Peripheral Artery Disease and Blood Flow

Peripheral artery disease (PAD) — narrowing of the arteries that supply the legs and feet — is significantly more common and more severe in people with diabetes. Atherosclerosis (fatty build-up in artery walls) progresses faster, affects smaller and more distal vessels, and is harder to treat than in people without diabetes.

When blood flow to the feet is reduced:

Feet may feel cold, particularly compared to the rest of the body or to the other foot
Pulses in the foot or ankle may be weak or absent
Walking may cause leg or foot pain that eases with rest (claudication) — though neuropathy may mask this
Even minor skin damage heals slowly or not at all, because the tissues lack the blood supply and oxygen they need
The risk of wound infection is much higher
At severe stages, rest pain — pain in the foot even without walking, often worse at night — indicates critically reduced blood flow

People with both diabetes and PAD face a compound risk: neuropathy prevents them from feeling pain that might otherwise prompt them to seek care, while PAD prevents adequate healing once an injury occurs.

Why Foot Wounds in Diabetes Matter

Diabetic foot wounds — including ulcers, infected cuts, and blisters — are among the most serious complications of diabetes. They are not a cosmetic problem or a minor inconvenience.

Ulcers — breaks in the skin that do not heal — can develop from even minor injuries. They are common in areas of pressure or bony prominences (heel, ball of the foot, toe tips).
Infection — bacteria can enter through any break in the skin. In a foot with poor circulation and reduced immune response, infections can progress quickly — from skin and soft tissue to deeper structures including tendons, bone (osteomyelitis), and the bloodstream (sepsis).
Delayed healing — reduced blood flow means the tissues cannot mount a normal healing response. Wounds that would heal within days in a healthy person may take weeks or months, or not heal at all.
Hospitalisation — serious diabetic foot infections are one of the most common reasons for diabetes-related hospitalisation.
Amputation risk — in severe cases where infection is uncontrolled or blood supply is critically compromised, surgical removal of part of the foot or leg may be necessary. The great majority of lower-limb amputations in diabetes are preceded by a foot ulcer. Many can be prevented with early attention.

Understanding this does not mean that every foot problem will lead to amputation — most will not. It means that early action on what appears to be a minor issue is genuinely important.

Who Is at Higher Risk

Not all people with diabetes have the same foot risk. Risk is higher in those with:

Long-standing diabetes — cumulative nerve and vessel damage increases with duration
High blood glucose over time — elevated HbA1c reflects chronic high glucose and greater risk of complications
Known neuropathy — loss of protective sensation is the single biggest risk factor for foot ulcers
Peripheral artery disease — reduced circulation significantly worsens wound healing and infection risk
Chronic kidney disease (CKD) — CKD amplifies cardiovascular and vascular risk, and affects immune function
Smoking — a major driver of atherosclerosis and PAD; smoking worsens circulation throughout the body
Previous foot ulcer or amputation — past ulcers are among the strongest predictors of future ones
Reduced vision — makes it harder to spot early changes during foot inspection
Frailty or reduced mobility — limits a person’s ability to inspect their own feet and respond to problems
Poor-fitting footwear — rubbing, pressure points, and tight shoes cause injuries that may not be felt

If several of these factors apply, more frequent podiatry review and closer monitoring are especially important.

Daily Foot Checks

Daily foot inspection is one of the most important things people with diabetes can do — particularly those with neuropathy, poor circulation, previous ulcers, or other risk factors. It takes only a few minutes once it becomes routine.

What to Check

Check every part of both feet:

Top of each foot — skin colour, swelling, redness, any new bumps or changes
Sole and heel — blisters, calluses, cracks, pressure marks, any discolouration
Between the toes — moisture, cracks, skin breakdown, fungal infection (white, soggy, or scaling skin)
Toenails — overgrown nails, nails cutting into skin, discolouration or thickening (may indicate fungal infection), any bruising under the nail

What to Look For

Cuts, scrapes, or abrasions — however small
Blisters — from friction or heat; do not burst them
Redness or bruising — may indicate a pressure point or injury
Swelling — in one foot or area that is new or worsening
Warmth — a warm patch compared to the surrounding skin or the other foot can indicate infection or inflammation
Cracks — particularly on the heels; can become entry points for bacteria
Calluses or corns — thickened skin over pressure points; can hide deeper problems
Nail problems — ingrown toenails, thickened or yellow nails, nails that have lifted from the nail bed
Any wound that is not healing — if it is not clearly improving within a day or two, seek review

Practical Tips

Use a mirror (or a purpose-made inspection mirror) to see the soles if bending is difficult
Ask a family member or carer to check areas that are hard to see
Do the check at the same time each day — after showering is often easiest
Good lighting matters; do not check in poor light or while tired
If you have poor vision, ask someone else to check your feet regularly

Footwear and Socks

Shoes that fit poorly are a leading cause of diabetic foot injuries. This is particularly important when neuropathy is present — an ill-fitting shoe may cause a blister or pressure sore that is never felt.

Footwear

Choose well-fitting shoes with adequate width, depth, and cushioning. There should be roughly a thumb’s width of space at the toe.
Avoid narrow, pointed, or high-heeled shoes that compress the toes or create pressure points.
Check inside shoes before putting them on — small stones, folded socks, or seams can cause pressure injuries without being noticed.
Break in new shoes gradually — even well-fitting shoes need time; wear new shoes for short periods initially.
Avoid walking barefoot, especially on hot surfaces (beaches, pavements in summer), rough ground, or outdoors. Burns and cuts are a significant risk when sensation is reduced.
If you have neuropathy, previous ulcers, or significant foot deformity, your clinician or podiatrist may recommend specialist footwear or custom insoles to redistribute pressure.

Socks

Wear clean, dry socks without tight elastic bands at the top, which can restrict circulation.
Seamless socks reduce friction on the toes.
Avoid walking in only socks on smooth floors — falls risk is increased without proper footwear.

When to Seek Footwear Advice

A podiatrist can assess foot shape, pressure points, gait, and footwear fit — and can recommend appropriate footwear or orthotics for higher-risk feet.

Skin and Nail Care

Skin

Wash feet daily in warm (not hot) water — test the water temperature with your elbow or a thermometer if sensation is reduced; never use very hot water
Dry carefully, particularly between the toes, where moisture accumulates and promotes fungal infection
Moisturise dry skin on the soles and heels to prevent cracking — but avoid applying cream between the toes
Do not soak feet for extended periods, as this can soften skin and increase fragility
Do not use sharp instruments to remove calluses or corns at home; use a podiatrist for this, especially if you have neuropathy or poor circulation

Nails

Trim nails straight across — not curved into the corners, to reduce the risk of ingrown toenails
Use clean, sharp nail scissors or clippers
If nails are thick, curved, or difficult to cut safely — or if you have poor vision, neuropathy, or poor circulation — have them trimmed by a podiatrist rather than attempting to cut them yourself
Do not cut into the skin around the nail

Blood Glucose and Long-Term Prevention

The single most important measure for protecting nerve and blood vessel health over the long term is maintaining blood glucose within the targets agreed with your diabetes team.

Consistently elevated blood glucose — reflected in HbA1c over time — is the driving force behind both diabetic neuropathy and accelerated atherosclerosis. Reducing average glucose levels over years reduces the rate at which nerve damage accumulates and slows the progression of vascular disease.

This does not mean perfection is required — glucose management is genuinely difficult and involves real-life trade-offs. But consistent effort over time makes a meaningful difference to foot and overall diabetes outcomes.

For more on blood glucose monitoring: Blood Glucose Testing and Diabetes Hub.

Smoking, Blood Pressure, CKD, and Circulation

Foot risk in diabetes is not determined by glucose alone. Other factors substantially shape the risk of vascular complications:

Smoking — smoking is the most powerful modifiable driver of PAD. It damages artery walls, accelerates atherosclerosis, and dramatically worsens circulation to the legs and feet. Stopping smoking is one of the most important steps a person with diabetes can take for their foot and vascular health. See Smoking and Tobacco Cessation.
Blood pressure — uncontrolled blood pressure damages blood vessels, accelerates kidney disease, and promotes atherosclerosis. Blood pressure management is part of integrated diabetes and foot care. See High Blood Pressure.
CKD — chronic kidney disease is common in people with diabetes and amplifies both vascular and wound-healing risk. Impaired kidney function also affects immune response and the ability to fight infection. See Chronic Kidney Disease Hub and Managing Chronic Kidney Disease.

Podiatry and Foot Screening

Podiatry — specialist foot care — is an important part of diabetes management, not an optional extra. Most people with diabetes should receive a formal foot assessment at least annually as part of their diabetes review.

What a Foot Assessment Includes

Sensation testing — using a 10g monofilament (a thin nylon probe) pressed against the skin to check protective sensation at key points; vibration testing
Vascular assessment — checking pulses in the foot (dorsalis pedis and posterior tibial), assessing skin colour and temperature, and Doppler assessment if indicated
Skin and nail inspection — calluses, deformities, fungal infection, nail problems
Footwear review — checking that footwear is appropriate
Risk grading — feet are often categorised by risk level (for example: low, moderate, or high risk) to guide review frequency and referral

Why Regular Review Matters

Higher-risk feet (with neuropathy, poor circulation, deformity, or previous ulcers) require more frequent podiatry review — sometimes every few months rather than annually. If you are unsure of your foot risk category, ask your diabetes care team.

Podiatry is also the appropriate service for:

Safe nail care in high-risk feet
Management of calluses and corns
Assessment and provision of appropriate footwear and insoles
Wound review and dressing in complex cases

Diabetic Foot Ulcers

A diabetic foot ulcer is a break in the skin — ranging from a shallow surface wound to a deep crater exposing tendons or bone — that occurs in the context of neuropathy, poor circulation, or both.

Why They Occur

Ulcers often develop at sites of repeated pressure or friction: the ball of the foot, the heel, over bony prominences, or between or under the toes. When neuropathy is present, the usual warning signal of pain is absent — the first sign may be a visible wound, a wet patch on a sock, or a smell.

Why They May Not Hurt

This is perhaps the most counterintuitive aspect of diabetic foot ulcers. A wound that would be painful and immediately noticed in someone without neuropathy may produce no sensation at all in someone with significant nerve damage. This is why daily inspection is the only reliable early-detection strategy.

Why Early Assessment Matters

Ulcers that are identified early — before deep tissue, tendon, or bone is involved, before infection takes hold — have much better outcomes than those that are identified late. Do not wait for an ulcer to become painful or dramatically worse before seeking review. Any wound that is not clearly improving should be seen by a clinician or podiatrist promptly.

How Ulcers Are Managed

Management of diabetic foot ulcers is a specialist area — it is not a process that should be attempted at home beyond basic cleanliness and dressings under clinical guidance. Clinical management includes:

Offloading — reducing pressure on the wound, often using specialist footwear, removable cast walkers, or total contact casts; this is one of the most important elements of healing
Wound assessment and dressing — by a podiatrist, wound care nurse, or vascular team
Infection treatment — antibiotics (often intravenous for serious infections) and surgical debridement if needed
Vascular assessment — if circulation is a limiting factor, vascular referral is needed before effective healing can occur
Multidisciplinary team care — for complex ulcers, a team including a podiatrist, vascular surgeon, orthopaedic surgeon, diabetes physician, and wound care nurse may be involved

Infection Warning Signs

Infection in a diabetic foot can progress rapidly — what appears to be localised inflammation can spread to deeper tissues within hours or days. Recognising infection warning signs early allows for prompt treatment.

Seek clinical review promptly (same day) for any of the following:

Increasing redness around a wound, blister, or ulcer
Warmth — a hot patch on the foot or lower leg
Swelling that is new or worsening
Pus or discharge from any wound
A bad or unusual smell from the wound or foot
Spreading redness — a red streaking that extends outward from a wound, travelling up the leg, is an urgent sign (may indicate lymphangitis — infection tracking along lymph channels)
Fever or feeling generally unwell alongside a foot wound
Increasing pain — or the development of pain in a foot that previously had reduced sensation
A wound that is not improving within 1–2 days of basic care, or that appears to be getting worse

If infection is suspected alongside fever, confusion, or rapid general deterioration, seek emergency care — this may represent sepsis. See Sepsis and Cellulitis for more on serious skin and systemic infection.

PAD and Limb-Threatening Symptoms

Some presentations indicate critically reduced blood flow to the foot or limb. These are vascular emergencies that require immediate assessment.

Call emergency services immediately (000 in Australia, 999 in the UK, 911 in the US) for:

Sudden severe leg or foot pain — especially if new, severe, and different from any previous symptoms
A foot or lower leg that has become cold, pale, blue, or mottled
Black toes or areas of dark discolouration (may indicate tissue death or critical ischaemia)
Sudden loss of sensation or inability to feel in the foot or leg
Sudden weakness — inability to move the toes or foot normally

These signs may indicate acute limb ischaemia — a sudden severe reduction in blood supply to the limb — which is a time-critical emergency. Without urgent treatment, permanent damage or limb loss can occur within hours. See Peripheral Artery Disease for more detail.

Seek same-day urgent review for:

Rest pain — pain in the foot when lying down or at rest, especially at night
A wound in a person known to have PAD, CKD, or previous foot ulcers that is not clearly improving

After Hospital Discharge or Foot Procedure

If you have been admitted to hospital for a diabetic foot problem, foot surgery, or vascular procedure, the period after discharge requires particular attention.

Before Leaving Hospital

Before discharge, make sure you have clear information about:

Wound care instructions — what to do, what not to do, and what products to use
Dressing changes — who changes dressings, how often, and where
Offloading devices — if a boot, cast, or specialist shoe was provided, instructions for its correct use
Medicines — antibiotics, pain relief, blood thinners, and any changes to diabetes medicines; who to contact with questions
Follow-up appointments — with your podiatrist, vascular surgeon, diabetes team, or GP; confirm the dates and who is responsible for booking

After Discharge

Attend all follow-up appointments; do not cancel them because the wound appears to be healing
Contact your team promptly if the wound changes, infection signs develop, pain increases, or you are concerned
Do not bear weight on a healing foot ulcer without specific instructions to do so
See Hospital Discharge and Recovery for a general checklist covering medicines, wound care, warning signs, and follow-up after any hospital admission

Falls and Mobility

Foot problems in diabetes can affect balance and mobility in several ways:

Peripheral neuropathy affects the small sensory signals from the feet that normally help with balance. Even mild neuropathy can increase fall risk.
Foot pain or wounds alter the way a person walks, change weight distribution, and can cause instability.
Offloading devices (casts, boots) change gait and may make falls more likely.
Deconditioning after hospital admission or a period of reduced activity further weakens muscle strength and balance.

If you have a foot problem and are concerned about your balance or walking safety, discuss this with your physiotherapist or podiatrist. Appropriate walking aids and footwear adjustments can reduce fall risk.

See Falls Prevention and Frailty: What It Means and How to Reduce Risk.

When to Seek Urgent Help

The following situations require same-day urgent clinical assessment (not a routine appointment):

Any open wound, ulcer, or blister that is not clearly improving
A wound that is spreading, deepening, or worsening
Any sign of infection — redness, warmth, swelling, pus, bad smell, fever, or feeling unwell
Red streaking extending from a wound up the leg
A wound in someone with known PAD, CKD, or a previous ulcer
Increasing pain in a foot that was previously numb or painless
A wound or foot problem after hospital discharge that is worsening

Call emergency services immediately for:

Sudden severe foot or leg pain
A cold, pale, blue, or mottled foot
Black toes or areas of clear skin death
Sudden inability to move the toes or foot
Severe pain at rest in the foot or leg
Rapid general deterioration alongside a foot wound (possible sepsis)

If you are uncertain whether a wound is serious, contact your GP, diabetes care team, or a nurse helpline. Diabetic foot problems that present early are far more treatable than those that present late.

FAQ

Why does diabetes affect the feet? Diabetes can damage nerves and blood vessels over time. Nerve damage (neuropathy) reduces sensation, meaning injuries to the feet may not be felt. Vascular damage impairs circulation, slowing wound healing and increasing infection risk. Together, these create a compound risk for foot ulcers, infection, and serious complications.

How often should I check my feet? Most people with diabetes are advised to check their feet every day — including between the toes and on the sole. This is especially important for those with neuropathy, poor circulation, previous ulcers, kidney disease, or reduced vision. A mirror can help inspect the soles; a carer or family member can assist if needed.

What are warning signs I should not ignore? Seek clinical review promptly for a cut, blister, ulcer, swelling, redness, warmth, pus, bad smell, spreading redness, increasing pain, or any wound that is not healing. Call emergency services for sudden severe pain, a cold or blue foot, or black toes.

Can I treat a diabetic foot wound at home? Minor skin issues need careful monitoring. But infected, deep, spreading, non-healing, painful at rest, or blackened wounds should be assessed urgently by a clinician — not managed at home. Diabetic foot infections can progress rapidly and require professional assessment.

How are diabetic foot problems prevented? Daily foot checks, well-fitting footwear, careful skin and nail care, regular podiatry review, good blood glucose management over time, smoking cessation, and prompt clinical attention for any wound or change are all important. The goal is to detect problems early, before they become serious.