Diabetes Foot Care: Ulcer Prevention and Daily Inspection Checklist

Why Diabetic Foot Care Can Save Your Legs

Every year, over 82,000 people in the U.S. lose a foot or leg to diabetes-related amputation. Most of these aren’t caused by sudden accidents. They start with a tiny cut, a blister, or a red spot that goes unnoticed. For someone with diabetes, even a small injury can turn into a life-altering ulcer - and worse, an amputation. The good news? Almost all of these cases are preventable. The key isn’t fancy surgery or expensive gadgets. It’s a simple, daily habit: checking your feet.

Who’s at Risk? Know Your Foot Risk Level

Not everyone with diabetes has the same foot risk. The International Working Group on the Diabetic Foot (IWGDF) breaks it down into four clear levels:

• Risk 0: No nerve damage, no past foot problems. You’re low risk, but not immune.
• Risk 1: Nerve damage (neuropathy) but no foot deformities. You need to be more careful.
• Risk 2: Nerve damage plus foot changes like bunions, hammertoes, or flat arches. Your feet are under more pressure.
• Risk 3: You’ve had a foot ulcer or amputation before. This is high risk - every day matters.

If you’re Risk 2 or 3, you need to see a foot specialist every 1 to 3 months. Risk 1? Every 6 months. Risk 0? Once a year is enough - but don’t skip it. Many people think if they don’t feel pain, they’re fine. That’s exactly how ulcers sneak up.

The Daily Foot Inspection Checklist: Do This Every Single Day

There’s no magic tool. No app replaces your eyes. The most effective way to catch trouble early is a consistent, step-by-step inspection. Follow this routine every day, preferably between 10 a.m. and 2 p.m. when your body temperature is most stable.

1. Wash your feet. Use lukewarm water - between 90°F and 95°F. Test it with your elbow or a thermometer. Hot water can burn you without you realizing it.
2. Dry thoroughly. Pay special attention to the spaces between your toes. Moisture there breeds fungus and cracks.
3. Look at every inch. Use a hand mirror or ask someone to help. You need to see the bottom of your feet, the sides, and between your toes. Don’t guess. Look closely.
4. Check for these warning signs: Blisters larger than a pea, cuts deeper than a scratch, redness bigger than a coin, swelling that makes your shoe feel tight, or skin that’s warmer than the other foot.
5. Moisturize. Use lotion on dry skin - but never between your toes. That’s a recipe for infection.
6. Trim nails straight across. Cut them so they’re just short of the tip of your toe. Don’t round the corners. Don’t dig into the sides. Ingrown nails are a major cause of ulcers.
7. Don’t ignore changes. If something looks off - even if it doesn’t hurt - write it down. Take a photo. Call your doctor the same day.

Studies show that 68% of ulcers start from injuries you never noticed. Why? Because nerve damage steals your sense of pain. You can step on a nail, walk on it for days, and feel nothing. That’s why inspection isn’t optional. It’s your first line of defense.

Footwear: The Silent Killer

Shoes are one of the biggest reasons people end up with ulcers. The IWGDF says 87% of forefoot ulcers and 79% of midfoot ulcers come from shoes that don’t fit right. Here’s what you need to know:

• No barefoot walking. Not even in your house. Walking barefoot increases your ulcer risk by more than 11 times. That’s not a suggestion. That’s a fact.
• Shoe fit matters. There should be at least half an inch (12.7 mm) between your longest toe and the end of the shoe. Your toes should be able to spread out naturally - no pinching.
• Heel counter support. The back of your shoe should be stiff enough to hold your heel in place. Too soft, and your foot slides forward, putting pressure on the ball of your foot.
• Therapeutic shoes aren’t optional for high-risk patients. If you’re Risk 2 or 3, custom shoes with pressure-reducing soles are medically necessary. They’re not luxury items. They’re medical equipment.
• Avoid sandals and flip-flops. Even in summer. A study found people who wear sandals have a 4.3 times higher chance of developing ulcers. They offer no support, no protection.

Don’t wait until your feet hurt to change your shoes. By then, it’s too late. Get fitted by a podiatrist or certified pedorthist. Many insurance plans, including Medicaid, cover them now.

What Doesn’t Work - And What Could Hurt You

There’s a lot of misinformation out there. Don’t fall for these traps:

• Antibiotics won’t prevent ulcers. If you don’t have an infection, taking antibiotics won’t stop an ulcer. It’ll just make future infections harder to treat.
• Foot exercises aren’t always safe. Some people think stretching your ankles helps. But without gait analysis, unsupervised exercises can actually increase pressure on weak spots. Stick to walking - and only if your doctor says it’s safe.
• Nerve surgery doesn’t prevent ulcers. A recent review of 9 studies found nerve decompression procedures offer zero benefit for ulcer prevention. Skip it.
• Don’t use heating pads or hot water bottles. You might not feel the heat, but your skin burns anyway.

Also, avoid cutting calluses yourself. Don’t use razors, corn removers, or chemical solutions. These can easily turn into open wounds. Let a professional handle it.

Barriers to Care - And How to Beat Them

Even if you know what to do, life gets in the way. Here’s what stops people:

• Vision problems. If you can’t see your feet clearly, use a mirror or ask a family member to help. Many clinics offer free foot-checking training.
• Cost. Therapeutic shoes and sensors can be expensive. But Medicaid now covers annual foot exams in 47 states. Ask your provider about coverage. Some nonprofits offer free or low-cost footwear.
• Neuropathy severity. The worse your nerve damage, the harder it is to stay consistent. Set phone reminders. Put your mirror next to your toothbrush. Make it part of your morning routine.
• Summer slip-ups. When it’s hot, people switch to sandals. Don’t. Keep your protective shoes on. Use breathable socks instead.

One study found that patients who had a family member help with foot checks were 52% more likely to stick with the routine. You don’t have to do this alone.

New Tools - Helpful, But Not Required

There are new gadgets: smart socks that detect temperature changes, insoles that warn of pressure hotspots, apps that analyze photos of your feet. They’re promising. Some can predict ulcers days before they form.

But here’s the truth: none of them replace daily inspection. A $300 smart mat won’t help if you don’t look at your feet. The CDC found that even the best apps require fast internet - something 22 million Americans don’t have.

Use tech if it works for you. But don’t wait for it. Start today with a mirror, a towel, and a checklist.

What Happens If You Don’t?

Let’s be clear: skipping foot care doesn’t just mean discomfort. It means hospital visits. Long-term antibiotics. Surgery. Amputation. And death. One in five people with a diabetic foot ulcer die within five years - not from diabetes, but from complications of infection and immobility.

The CDC’s goal is to cut amputations by 25% by 2030. That’s possible - but only if people start checking their feet every day. It’s not about being perfect. It’s about being consistent. One day off can cost you your foot.

Start Today. No Excuses.

You don’t need to be an expert. You don’t need to buy anything. You just need to look. Every single day. Before you get dressed. After you shower. When you sit down to watch TV.

Put the mirror where you can’t ignore it. Set a reminder on your phone. Tell someone to check in with you. This isn’t about fear. It’s about control. You can’t control your diabetes completely - but you can control whether a tiny cut becomes a lost limb.