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Why every day, and not every month
Diabetes can affect the nerves and the blood supply in your feet, often so gradually that you do not notice it happening. When the nerves are affected, you feel less. When the blood supply is reduced, wounds can take longer to heal. Together, these changes can mean that a small problem develops before it becomes uncomfortable enough to notice.
A blister from a new shoe is a good example. On a foot with normal sensation it stings, you change your shoes, and it settles in a few days. On a foot with reduced sensation it may not register at all, and you carry on walking on it. The daily check is simply a way of catching those things with your eyes when your feet cannot tell you about them.
What to look at
Take your socks off, sit somewhere with decent light, and look at the whole foot rather than only the parts that hurt. Use a hand mirror or your phone camera for the soles if bending is difficult, or ask someone at home to look for you.
- The tops, the soles, the heels and the sides.
- Between every toe, where damp skin and small splits are easy to miss.
- Any change in colour, whether that is redness, a dusky or bluish patch, or an area that has gone pale.
- Cuts, grazes, blisters, or any break in the skin, however small.
- Hard skin, corns and any area that is starting to build up.
- Swelling, especially on one foot and not the other.
- Your nails, for thickening, splitting or a change in colour.
What to feel for
Run your hand over the whole foot. You are checking two things: what your foot feels like to your hand, and what your hand feels like to your foot.
With your hand, feel for warmth. An area that is noticeably warmer than the rest of the foot can sometimes be a sign of inflammation or infection, even if the skin still looks intact. Feel for hard ridges of skin, and for any lumps or areas that feel firmer than they used to.
With your foot, notice numbness, tingling, pins and needles, or a burning feeling, and whether any part feels less sensitive than it did. Changes here are worth mentioning at your next appointment even when nothing looks wrong.
You are not trying to diagnose anything. You are only looking for what is different from yesterday.
When to ring the same week
Many of the changes you notice may be minor, but some are worth a phone call rather than waiting until your next appointment, because they are much easier to deal with when caught early.
- Any new wound, break in the skin or blister that has not started to improve within a couple of days.
- Redness, swelling or warmth spreading around an area.
- Any discharge, wetness or smell.
- A change in the shape of the foot, or a toe that has started to sit differently.
- A colour change that does not settle when you rest with your feet up.
- New numbness, or pain that wakes you at night.
If you are unsure, ring anyway. I would far rather look at something that turns out to be fine than see it three weeks later.
Making it stick
Attach the check to something you already do. Most people find it easiest last thing at night, when socks are coming off anyway. Keep a hand mirror by the bed if you need one. If your eyesight or your reach makes it difficult, ask a partner or a family member to take it on. A thorough check by someone else is more useful than struggling to check your feet properly yourself.
Bring anything you are unsure about to your appointment, including photographs on your phone. A picture from the day something appeared is genuinely useful.
Please do not treat corns or hard skin yourself if you have diabetes. Over-the-counter corn plasters and files can damage the skin underneath, and even a small break in the skin can be a concern if you have reduced sensation or circulation. Bring it to an appointment instead.
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