Why the diabetic foot is different

Two mechanisms combine to make foot problems in diabetes disproportionately dangerous.

The first is peripheral neuropathy — nerve damage that reduces or abolishes sensation in the feet. A person with advanced neuropathy can step on a nail, develop a blister from tight shoes, or burn a foot on a hot water bottle and feel nothing. By the time the wound is noticed, it may already be infected.

The second is peripheral arterial disease — the same process that narrows coronary arteries also narrows the arteries of the legs. Reduced blood flow means reduced oxygen delivery, which slows healing dramatically and allows infections to spread that would otherwise be contained.

When both are present — as they often are in long-standing diabetes — even a minor cut or callus can progress to an ulcer, and an untreated ulcer can progress to an infection requiring surgery. The International Diabetes Federation estimates that a leg amputation happens somewhere in the world as a result of diabetes every 20 seconds. Almost all of these are preventable with early, structured foot care.

Annual foot examination — what it covers

Every person with diabetes should have a formal foot examination at least once a year. At Apex, this includes:

• Inspection for calluses, cracks, deformity, nail problems, skin breakdown and early ulcers
• Monofilament test — a nylon filament is pressed against different points on the sole. If you cannot feel it, protective sensation is impaired and your risk classification rises
• Vibration sense testing with a tuning fork
• Ankle reflexes
• Palpation of foot pulses — the dorsalis pedis and posterior tibial arteries
• Footwear assessment — the wrong shoes cause many diabetic foot wounds

Diabetic foot ulcer management

If a wound or ulcer is already present, the management depends on whether it is superficial or deep, whether bone is involved, and whether there is significant infection or vascular compromise.

Grades 0–2 are typically managed at Apex with input from the general surgery team. Grades 3 and above are managed inpatient, with referral to vascular surgery for higher grades. The most important thing is not to wait. A Grade 1 ulcer managed promptly rarely reaches Grade 3.

When to come immediately without waiting for a scheduled appointment

• A new wound or cut on the foot that is not healing after 48 hours
• Redness, warmth or swelling spreading from a wound — signs of infection
• Discharge from a wound, especially if foul-smelling
• Blackening or darkening of a toe or part of the foot
• Foot or lower leg pain at rest, or pain that wakes you at night
• A new blister or nail injury, especially if you could not feel how it happened

For any of these, come to the emergency department at any hour. Do not wait.

Self-care between visits

• Inspect your feet every day — use a mirror for the sole if needed
• Wash feet in lukewarm water (not hot — you may not feel the temperature)
• Dry between the toes — fungal infections start here
• Moisturise the heel and sole; do not moisturise between the toes
• Never walk barefoot, indoors or outdoors
• Wear well-fitting shoes with thick soles and a wide toe box; avoid pointed shoes
• Cut nails straight across, never into the corners
• Do not attempt to cut corns or calluses yourself

For more on overall diabetes management, see the Diabetes Clinic page.

Frequently asked questions

Why do diabetics get foot ulcers?

The combination of nerve damage (which removes pain as a warning signal) and reduced blood flow (which slows healing) means small injuries that a non-diabetic would heal from quickly can deteriorate into ulcers in a person with diabetes.

Can a diabetic foot ulcer be healed without surgery?

Grades 1 and 2 ulcers are often healed with wound care, dressings, offloading (keeping weight off the foot) and antibiotics for infection. Higher grades often require surgical input.

How often should a diabetic have a foot check?

At least once a year if no neuropathy and normal pulses. Every 3–6 months if neuropathy or reduced blood flow is detected. At every visit if there is a history of previous ulcer or amputation.

Is numbness in my feet dangerous if I have diabetes?

Yes, it means protective sensation is impaired. You need to be more careful about footwear and foot inspection, because you will not feel injuries as they happen.

Can I see an orthopaedic surgeon for my diabetic foot?

The orthopaedic team is involved for deeper wound and bone problems. For routine diabetic foot checks, begin with the diabetes OPD.

What is Charcot foot?

Charcot neuroarthropathy is a rare complication of severe neuropathy where repeated minor stresses fracture and dislocate the bones of the foot without the person feeling it, progressively destroying the foot’s architecture. It presents as a hot, swollen, red foot without a wound. It needs urgent specialist assessment.

Is there a 24-hour service for diabetic foot emergencies?

The emergency department at Apex operates 24 hours and handles acute diabetic foot infections that cannot wait. For wound review, call +91 85912 35064 to check emergency OPD availability.

Book a diabetic foot check

Call +91 85912 35064 or book online. Walk-ins are seen in general medicine OPD during consulting hours.