Diabetic foot: small changes deserve early attention

Check both feet every day

This is the single most effective thing a person with diabetes can do to protect their feet — a daily look, taking less than a minute, before an injury has any chance to become serious. It works because it catches problems while numbness would otherwise hide them.

• 01
  Look at the whole foot. Top, sole, heel and between every toe, in good light — use a mirror or ask someone to help if you cannot see the sole easily.
• 02
  Feel for changes. Run a hand over the skin for warm patches, swelling or rough, dry or cracked areas, since reduced sensation means you may not feel these on their own.
• 03
  Check for anything new. A blister, cut, crack, callus, colour change or area that looks different from the day before.
• 04
  Act the same day if you find something. Do not wait to see if a wound heals on its own — contact the diabetic-foot team the same day any break in the skin is found.

Understanding diabetic foot problems

Long-standing high blood glucose can damage two systems that normally protect the feet: the nerves that carry sensation (causing peripheral neuropathy) and the blood vessels that supply oxygen and nutrients to the skin (peripheral artery disease). Diabetes can also blunt the immune response to infection and slow the way skin normally repairs itself. Together, these changes mean an injury that would be trivial for most people — a rubbed heel, a small cut, a blister from a tight shoe — can go unnoticed, heal slowly, and become infected before it is ever felt as painful.

Cardiocare's diabetic-foot and limb-preservation care connects diabetology, wound care, vascular assessment, imaging, infection care and intervention, because a foot problem in diabetes is rarely a single-specialty issue — it usually needs several kinds of expertise working together, and quickly.

What to look and feel for

These are useful clues to discuss with a clinician, and reasons to act the same day — not a checklist for diagnosing yourself.

• ●A blister, cut, crack or wound — however small — that is slow to heal or has not healed within a couple of weeks
• ●Redness, swelling, warmth, discharge, an unusual smell or a colour change around a wound
• ●A foot or toe that becomes unusually cold, pale, dusky or dark
• ●Numbness, tingling, burning or a "pins and needles" feeling, or the opposite — new pain in a foot that previously felt little
• ●A callus, corn or thickened skin that is growing, cracking or has a dark spot underneath
• ●Any change in the shape of the foot, or a foot that looks swollen without an obvious injury

Why numbness makes injury easy to miss

Pain is normally the body's alarm system — it makes you stop, look, and protect an injury before it worsens. Diabetic nerve damage (neuropathy) often reduces or removes that alarm in the feet first, sometimes years before a person notices any change in sensation day to day. This means an object left in a shoe, a stone underfoot, a burn from a hot surface, or days of walking on a small wound can go completely unfelt. By the time swelling, discharge or a smell makes it obvious, the injury may already be infected or deeper than it looks from the surface — which is exactly why the daily look matters more than waiting to feel something wrong.

When a wound will not heal

A cut or ulcer that is not visibly smaller and improving within about two weeks is not "just taking its time" — it is a sign that something is working against healing, and it needs assessment rather than more waiting. Reduced blood flow may mean the wound is not getting the oxygen and nutrients it needs; high blood glucose slows the cellular processes of repair; and pressure from walking on the wound without realising can keep re-injuring it faster than it can heal. Left untreated, a non-healing wound is the single biggest step toward a diabetic foot ulcer, deep infection, and — in the most serious, advanced cases — the loss of a toe, foot or limb. Early, active treatment of a slow-healing wound is what prevents that outcome; this page exists to help that happen earlier.

What causes diabetic foot problems

Three overlapping problems, all driven by long-standing high blood glucose, combine to put the foot at risk.

• ●Peripheral neuropathy — nerve damage that reduces sensation, so injury and pressure go unfelt
• ●Peripheral artery disease — narrowed blood vessels reduce the blood supply the skin needs to heal and fight infection
• ●Reduced infection resistance — high blood glucose can blunt the body's normal immune response, letting a minor infection spread faster than usual

Any break in the skin — a blister, cut, crack between the toes, or pressure sore from footwear — is the trigger event; the three factors above determine how well and how fast the body can respond to it.

Who is more likely to develop diabetic foot problems

• ●Diabetes that has been present for many years
• ●Blood glucose that has been poorly controlled over time
• ●Existing numbness or reduced sensation in the feet
• ●Known peripheral artery disease or poor circulation
• ●High blood pressure, which is very common in Nigeria and often coexists with diabetes
• ●Smoking, which directly narrows blood vessels and slows healing
• ●A previous foot ulcer or amputation
• ●Foot deformity, or footwear that does not fit properly
• ●Reduced vision, which makes daily self-checks harder without help

What happens if diabetic foot problems go untreated

This is written plainly because the stakes are genuinely high — and because early, active care changes this outlook substantially.

Foot ulcers. An unnoticed or unhealed wound can deepen into an open sore (ulcer) that exposes deeper tissue and is vulnerable to infection.

Spreading infection. Infection can spread from skin into deeper soft tissue and, in serious cases, into bone (osteomyelitis), which is harder to treat and often needs a longer course of care.

Tissue death (gangrene). Where blood supply is severely reduced, tissue can die outright, appearing dark or black — a serious complication needing urgent specialist care.

Amputation. In advanced, untreated cases, removing a toe, part of the foot, or more may become necessary to stop spreading infection or dead tissue from threatening life. This is the outcome that early daily checks, prompt wound care and good glucose control are specifically aimed at preventing.

How Cardiocare investigates diabetic foot problems

The exact pathway depends on symptoms, examination and overall health. It typically draws on some or all of the following:

• 01
  Skin, nerve and circulation examination. The foot is examined for wounds, deformity, and sensation is tested with simple bedside tools to check for neuropathy.
• 02
  Blood glucose and infection review. Blood tests check glucose control and look for signs of infection where a wound is present.
• 03
  Vascular assessment. Pulses are checked and, where indicated, ultrasound or other imaging maps blood flow to the leg and foot.
• 04
  Wound and, where needed, bone imaging. A wound is measured and assessed for depth; imaging can check whether infection has reached the bone.
• 05
  Multidisciplinary limb-preservation planning. Diabetology, wound care, vascular and, where needed, surgical teams plan care together rather than in sequence.

How diabetic foot problems are treated

Treatment addresses the wound itself, the blood supply, infection, and the pressure that caused or is worsening the injury — usually together, not one after another.

Wound care

Regular cleaning and dressing by a trained wound-care team, removal of dead or unhealthy tissue when needed (debridement), and protecting the wound from further pressure or friction.

Offloading pressure

Special footwear, padding or a walking device redistributes weight away from the wound so it can heal instead of being re-injured with every step.

Restoring blood flow

Where peripheral artery disease is limiting healing, procedures through Cardiocare's cath lab — such as angioplasty to reopen a narrowed vessel — can restore enough blood supply for a wound to heal.

Medicines, by class

Alongside wound and vascular care, medicine treats infection and supports overall diabetes control:

• ●Antibiotics — treat infection in the wound or, when needed, deeper tissue or bone
• ●Glucose-lowering medicines — tighter blood glucose control directly supports wound healing
• ●Pain and circulation-supporting medicines — used where relevant to symptoms and vascular findings

Surgery

Where infection or dead tissue cannot be controlled by the measures above, surgery to remove affected tissue is used specifically to preserve as much of the limb as possible; amputation is a last resort, not a first response.

Living with diabetes: protecting your feet every day

• ✓Look at and feel both feet every day, including between the toes and the sole
• ✓Wash and dry feet daily, especially between the toes, and moisturise dry skin — but not between the toes
• ✓Wear well-fitting, enclosed footwear, and never walk barefoot, indoors or outdoors
• ✓Check inside shoes for stones, seams or anything that could rub before putting them on
• ✓Trim toenails straight across, and see the diabetic-foot team for calluses or ingrown nails rather than treating them yourself
• ✓Do not cut into a wound, apply unverified chemicals or "hot compress" remedies, or delay because a wound "doesn't hurt"
• ✓Keep blood glucose, blood pressure and cholesterol well controlled, and attend every scheduled foot check
• ✓Contact the diabetic-foot team the same day for any new wound, however small it looks

Preparing for your appointment

What to bring

• ✓A list of all medicines you take, including herbal and over-the-counter preparations
• ✓Recent blood glucose readings or a glucose log if you keep one
• ✓Your HMO card or payment details
• ✓A valid means of identification

What we will ask

When you first noticed the problem, whether it has changed, your recent blood glucose control, and whether you have had foot problems, ulcers or reduced sensation before.

Questions worth asking us

• ●How serious is this wound, and what happens if it does not heal?
• ●Is my circulation or nerve function affected, and by how much?
• ●What footwear or offloading do I need while this heals?
• ●How often should my feet be checked from now on?