Diabetes Foot Care: Ulcer Prevention and Daily Inspection Checklist

Every year, over 82,000 people in the U.S. lose a foot or leg because of diabetes. Most of these amputations don’t have to happen. They start with a small cut, blister, or sore that goes unnoticed-because the person with diabetes can’t feel it. Diabetic foot ulcers are not rare. About 1 in 4 people with diabetes will develop one in their lifetime. The good news? Almost all of them can be prevented-with daily attention, the right tools, and a simple checklist.

Why Your Feet Are at Risk

Diabetes doesn’t just affect blood sugar. Over time, high glucose damages nerves, especially in the feet. This is called peripheral neuropathy. You lose the ability to feel heat, pain, or pressure. A stone in your shoe, a tight sock seam, or a hot shower can burn your skin without you knowing. At the same time, diabetes narrows blood vessels, slowing healing. A tiny cut that would vanish in days for someone without diabetes can turn into an open wound-and then an infection-in weeks.

The International Working Group on the Diabetic Foot (IWGDF) classifies risk into four levels:

• Risk 0: No nerve damage, no past ulcers. Low risk, but still need yearly checks.
• Risk 1: Nerve damage but no foot deformity. Check feet every 6 months.
• Risk 2: Nerve damage with foot deformity (like bunions or hammertoes). Check monthly.
• Risk 3: History of foot ulcer or amputation. Check weekly or even daily. This is your critical zone.

If you’re Risk 2 or 3, you’re not just at risk-you’re in the danger zone. And if you’ve had one ulcer before, your chance of getting another is over 70% within five years.

The Daily Foot Inspection Checklist

This isn’t optional. It’s non-negotiable. Do this every single day, same time, same place. Consistency saves limbs.

1. Wash your feet in lukewarm water-between 90°F and 95°F. Test the water with your elbow or a thermometer. Never use your feet to test temperature. Hot water burns unnoticed.
2. Dry thoroughly, especially between your toes. Moisture breeds fungus and cracks. Use a soft towel. Don’t rub hard.
3. Inspect every surface using a mirror or ask someone to help. Look at the soles, heels, between toes, and under toenails. Don’t guess. Look closely. A blister as small as a pea, a cut deeper than a millimeter, or a red spot bigger than a dime matters.
4. Look for these warning signs:
   • Blisters ≥3mm
   • Cuts or scrapes ≥1mm deep
   • Redness larger than 1cm
   • Swelling that makes your foot feel tighter than usual
   • Warmth-use the back of your hand. If one foot feels noticeably warmer than the other, it could mean infection.
   • Discoloration-black, blue, or purple spots
   • Odor-any unusual smell, even slight, can signal infection
5. Moisturize dry skin with unscented lotion. But never put lotion between your toes. That’s where fungus grows.
6. Trim nails straight across. Cut them so they’re 1-2mm above the skin fold. Don’t round the corners. Don’t dig under the nail. If you can’t see well or have thick nails, get a podiatrist to do it.
7. Check your shoes before putting them on. Shake them out. Look for pebbles, torn linings, or sharp seams. A small wrinkle inside your shoe can cause a pressure sore that turns into an ulcer.

Studies show that 68% of ulcers start from injuries you didn’t notice because inspections were skipped or rushed. Do this checklist in natural light between 10 a.m. and 2 p.m. Body temperature changes during the day can mask early signs of inflammation. Doing it at the same time every day makes it a habit.

Footwear Is Your First Line of Defense

Shoes aren’t just about comfort. They’re medical equipment.

87% of forefoot ulcers and 79% of midfoot ulcers in people with neuropathy are caused by shoes that don’t fit right. That’s not a typo. It’s almost all of them.

Here’s what your shoes must have:

• At least 0.5 inches (12.7mm) of space between your longest toe and the end of the shoe
• Width that lets your toes spread naturally-no squeezing
• A rigid heel counter that doesn’t collapse when you press it
• No seams or stitching inside that rub against your skin

Therapeutic shoes aren’t just for people with ulcers. If you have Risk 2 or 3, you need them-even if you think you’re fine. Insurance often covers them. Ask your doctor for a prescription.

Never walk barefoot-not even in your house. The CDC found that walking barefoot indoors for just 5 minutes a day increases ulcer risk by more than 11 times. Socks should be seamless, moisture-wicking, and clean. No elastic tops that cut into your skin.

And no flip-flops or sandals. They don’t protect your feet. A 2022 pressure-mapping study showed sandals increase ulcer risk by 4.3 times. Even in summer heat, wear closed shoes with breathable material.

What Not to Do

There are myths that hurt. Avoid these:

• Don’t use corn removers or chemical peels. They burn skin. You won’t feel it. You’ll end up with an ulcer.
• Don’t soak your feet for long. Soaking dries out skin and makes cracks worse. Wash, don’t soak.
• Don’t try to cut calluses yourself. Use a pumice stone gently after washing. Let a podiatrist handle thick calluses.
• Don’t ignore redness or warmth. If you see it, call your doctor the same day. Waiting 2 days can mean the difference between healing and amputation.
• Don’t use heating pads or hot water bottles. You can’t feel how hot they are. Burns happen fast.

And forget the idea that exercise is always safe. The 2023 IWGDF guidelines say foot-ankle exercises can help-but only if you have good sensation and no open wounds. Unsupervised exercise without gait analysis increases ulcer risk by 22%. Talk to your doctor before starting any new routine.

When to See a Professional

You don’t have to wait for an emergency. Build a team:

• Annual check-up: Everyone with diabetes needs a full foot exam once a year. This includes a monofilament test (to check sensation) and an ankle-brachial index (ABI) test (to check blood flow).
• Every 3-6 months: If you’re Risk 1 or higher, you need to see a podiatrist this often.
• Immediately: If you see any redness, swelling, warmth, drainage, or a break in the skin-even if it’s tiny-call your doctor. Don’t wait. Don’t try to treat it yourself.

Many people delay because they think it’s “just a small thing.” But the CDC found that 92% of plantar ulcers start under the ball of the foot-the metatarsal heads. That’s where pressure builds. That’s where ulcers hide.

Technology Can Help-But It’s Not a Replacement

New tools like smart socks and temperature-sensing mats can detect heat changes that predict ulcers 4-7 days before they form. These work well in trials. But they cost $150-$300 upfront, plus monthly fees. For many people, especially on Medicaid, they’re out of reach.

Smartphone apps that use your camera to scan your feet for early signs of ulcers are emerging. One study showed 89.7% accuracy. But they need fast internet. In rural areas, that’s not always possible.

Technology can help. But nothing replaces your eyes, your hands, and your daily habit of checking your feet.

What’s Working: Integrated Care

The best outcomes come from teams-not solo efforts. The 2023 IWGDF guidelines call this “integrated foot care.” That means your primary care doctor, podiatrist, diabetes educator, and orthotist all talk to each other. Referrals happen within 14 days. No waiting months.

Programs that use this model cut ulcers by 36% and amputations by 42% in Medicare patients. But only 39% of U.S. doctors are doing full foot exams regularly. Time, lack of training, and missing tools are the barriers.

If your doctor doesn’t check your feet properly, ask for a referral. You have the right to a full foot exam every year. In 47 states, Medicaid now requires it-but enforcement is weak. Be your own advocate.

Final Thought: It’s About Consistency, Not Perfection

You don’t need to be perfect. You just need to be consistent. Miss one day? Do it the next. Forget to check your shoes? Do it tomorrow. The goal isn’t flawless execution-it’s making foot care part of your routine, like brushing your teeth.

Every day you inspect your feet, you’re not just preventing a sore. You’re preventing a hospital visit. You’re preventing a surgery. You’re preventing the loss of a limb.

It’s not about fear. It’s about power. You have control. You can stop this before it starts.

Next Steps: Make It Stick

Set a daily alarm. Put your mirror by your bathroom sink. Keep your shoes by the door. Tie foot care to something you already do-like brushing your teeth or checking your blood sugar.

Keep a simple log: Date, no issues, or issue found. Show it to your doctor. It helps them see patterns.

This isn’t just about your feet. It’s about your independence. Your ability to walk, to travel, to live without pain. One small habit-daily inspection-can keep you mobile for decades.

You’ve got this.