Diabetic Foot: Prevention, Symptoms, and Daily Foot Care

Diabetic foot is one of the most serious and underestimated complications of type 2 diabetes. In Italy, approximately 4.8 million people live with diabetes (ISS, 2024), and it is estimated that 15-25% will develop a foot lesion during their lifetime. Each year, about 8,000 major diabetes-related amputations are performed in Italy—one every hour. In most cases, these amputations could be prevented with effective glycemic control and accurate daily foot care.

The peculiarity of diabetic foot lies in an insidious mechanism: neurological and vascular damage caused by chronic hyperglycemia reduces pain sensitivity in the lower extremities. Those who develop peripheral neuropathy may have wounds, blisters, or even severe infections without feeling pain. The late discovery of the lesion is the factor that most often turns a minor problem into a serious complication requiring hospitalization, and in some cases leads to amputation.

How Diabetic Foot Develops: Neuropathy and Angiopathy

Diabetic foot is the result of a combination of two pathological processes that progress in parallel over years of hyperglycemia.

Diabetic peripheral neuropathy affects the sensory, motor, and autonomic nerve fibers of the feet. The reduction in tactile and pain sensitivity is the most dangerous sign: the patient does not perceive trauma, excessive pressure, burns, or foreign bodies in shoes. Motor damage causes changes in plantar support and deformities such as Charcot foot, while autonomic damage reduces sweating, leading to skin dryness and cracking—an entry point for bacteria.

Peripheral angiopathy (obliterative arterial disease of the lower limbs) reduces blood flow to the limbs due to atherosclerosis accelerated by diabetes. Reduced vascularization compromises wound healing and promotes infections. When neuropathy and angiopathy coexist—as in most clinical cases—the risk of ulceration and amputation increases exponentially.

Daily Foot Examination: What to Check Every Day

The Italian Association of Diabetologists (AMD) and the Italian Society of Diabetology (SID) recommend that every person with diabetes examine their feet daily. This check takes less than 2 minutes and can prevent serious consequences. Here's what to look for:

• Wounds, cuts, or abrasions: even very small ones, even in non-painful areas
• Redness and swelling: localized or widespread, especially if asymmetrical between the two feet
• Blisters: from new shoes or excessive pressure—never puncture them yourself
• Calluses and corns: do not cut with blades; rely on a specialized podiatrist
• Changes in skin color: pallor, cyanosis, dark or necrotic areas
• Interdigital mycosis: macerated skin between the toes—treat promptly with antifungals
• Temperature variations: one foot warmer than the other may indicate an ongoing subcutaneous infection

For those who have difficulty seeing the sole of their foot, a floor mirror can be helpful. Alternatively, a family member can perform the check. The important thing is that it happens every day, at the same time—ideally after the evening shower.

Hygiene and Footwear: Rules That Save Feet

Preventing diabetic foot starts with simple habits that must become daily routines:

• Wash your feet every day with lukewarm water (test temperature with your elbow) and mild soap. Do not soak for prolonged periods—it macerates the skin.
• Dry thoroughly between the toes, where moisture promotes mycosis and maceration.
• Hydrate the skin with emollient cream (lanolin or 10% urea), avoiding the interdigital spaces.
• Do not walk barefoot—never, not even at home. Risks are everywhere.
• Cut nails straight across, never into the corners, with blunt-tipped scissors. If in doubt, see a podiatrist.
• Choose closed shoes with a wide toe box, soft upper, and no protruding internal seams. Always inspect the inside before wearing them.
• Prefer seamless socks made of cotton or natural fibers, changed daily.

When to See a Doctor Immediately

Some situations require urgent medical evaluation—within the first 24 hours, not "when convenient":

• Any wound that shows no signs of improvement after 24-48 hours
• Swelling or redness that expands beyond the initial area
• Presence of pus, foul odor, or discharge from the wound
• Fever or general malaise associated with a foot lesion
• Appearance of a necrotic (black) area—this is a vascular emergency requiring access to the emergency room
• Rest pain in the foot or leg (may indicate severe ischemia)

Specialist podiatric examination is recommended at least once a year for all diabetics, regardless of the presence of symptoms. High-risk patients—with diagnosed neuropathy, history of ulcers or amputations—should be followed every 1-3 months.

The Role of Glycemic Control in Prevention

The root of all diabetic foot complications is chronic hyperglycemia. The UKPDS (UK Prospective Diabetes Study, NEJM 1998) demonstrated that every 1% reduction in HbA1c corresponds to a 25-37% reduction in microvascular complications. Control of postprandial glycemic peaks—often neglected in favor of only fasting glucose—is particularly relevant because repeated peaks after meals progressively damage nerve fibers and small vessels.

Frequently Asked Questions

Does diabetic foot always hurt?

No—and this is its most dangerous characteristic. In the presence of peripheral neuropathy, pain may be absent or reduced even with severe lesions. Many patients discover ulcers only when they become visible or produce discharge. This is why daily visual examination is essential regardless of the presence of pain.

Can I use regular bandages on foot wounds if I am diabetic?

With caution. Traditional bandages can traumatize fragile skin upon removal. It is better to use non-adherent dressings specific for fragile skin. In any case, any wound that does not heal within 48-72 hours must be evaluated by a doctor without further delay.

Is podiatrist care reimbursed by the NHS for diabetics?

In many Italian regions, podiatric services for diabetic patients with diagnosed neuropathy or angiopathy are partially or totally covered by the NHS, upon prescription by the diabetologist. Check with your local health authority. AMD/SID guidelines recommend at least annual podiatric checks as a recommended service for all diabetics.

Controlling postprandial glycemic peaks is the most effective preventive measure to protect feet from diabetes. The Glucometer G1 Pro VitaeChek measures blood glucose in 5 seconds with MARD <5% accuracy and sends data to the app to monitor glycemic response after each meal. CE Class IIa Medical Device · ISO 15197:2013 · 2-year warranty.