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-related complications. Most of these amputations are preventable. The key? Consistent, correct foot care. If you have diabetes, your feet are at risk-not because of something dramatic, but because of small, unnoticed problems that grow worse over time. A tiny blister, a cut you didn’t feel, a shoe that rubs just right-these can turn into ulcers. And once an ulcer forms, the path to infection, hospitalization, and even amputation becomes much more likely.

Why Diabetic Foot Ulcers Happen

Diabetes doesn’t just raise blood sugar. It damages nerves and blood vessels, especially in the feet. Nerve damage, called neuropathy, means you might not feel pain, heat, or pressure. So you can step on a sharp object, develop a blister, or rub your foot raw inside your shoe-and never know it until it’s too late. At the same time, poor circulation slows healing. Even a small wound can fester for weeks without showing signs of improvement.

The International Working Group on the Diabetic Foot (IWGDF) says that 15-25% of people with diabetes will develop a foot ulcer in their lifetime. And once you’ve had one, your chance of getting another jumps dramatically. The good news? Most ulcers start with something small. And if you catch them early, you can stop them before they become serious.

The Daily Foot Inspection Checklist

This isn’t optional. It’s non-negotiable. Every single day. Here’s what you need to do, step by step.

1. Wash your feet daily in lukewarm water-between 90°F and 95°F. Test the temperature with your elbow or a thermometer. Hot water can burn you without you realizing it.
2. Dry thoroughly, especially between your toes. Moisture trapped there invites fungal infections and skin breakdown.
3. Inspect every surface of both feet. Use a mirror or ask someone to help. Look at the soles, between toes, heels, and tops. Don’t skip anything. Many ulcers start under the ball of the foot or near the big toe.
4. Look for these warning signs:
   • Blisters larger than 3mm
   • Cuts or scrapes deeper than 1mm
   • Redness spreading more than 1cm
   • Swelling that makes your foot feel tighter than usual
   • Warmth in one spot-more than 99°F compared to the other foot
   • Ingrown toenails or thick, yellow nails (signs of fungus)
5. Apply moisturizer to dry skin, but never between your toes. Dry skin cracks. Cracks let bacteria in.
6. Trim toenails straight across, leaving about 1-2mm of nail beyond the tip of your toe. Don’t cut into the corners. Curved nails lead to ingrown toenails, which are a common cause of ulcers.
7. Check your shoes before putting them on. Shake them out. Look for pebbles, torn linings, or rough seams. A single foreign object can cause a pressure ulcer in minutes.

The CDC says 68% of foot ulcers start from injuries that were never noticed-because inspections weren’t done consistently. Do this at the same time every day. Natural daylight between 10 a.m. and 2 p.m. is best. Your body temperature changes throughout the day, and checking in consistent lighting helps you spot real changes, not just normal variations.

Footwear: Your First Line of Defense

Shoes aren’t just about comfort-they’re medical equipment if you have diabetes. The wrong pair can cause more damage than walking barefoot.

The IWGDF says that 87% of forefoot ulcers in people with nerve damage come from shoes that press too hard. That’s not an accident. It’s a design flaw. Here’s what to look for:

• Space at the toe: At least 0.5 inches (12.7mm) between your longest toe and the end of the shoe. Your toes need room to move.
• Width: Your foot should fit without squeezing. Allow for 15mm of toe splay-your toes should naturally spread out.
• Heel support: The back of the shoe (heel counter) should be firm, not floppy. A weak heel lets your foot slide, causing friction.
• No barefoot walking: Even indoors. The CDC found that walking barefoot for just 5 minutes a day increases your ulcer risk by more than 11 times.

Therapeutic shoes aren’t just for people with amputations or severe deformities. If you have neuropathy-even mild-you should be wearing shoes designed to reduce pressure. Many insurance plans, including Medicare, cover them. Ask your doctor for a prescription.

What Not to Do

Some common practices can actually hurt you.

• Don’t use heating pads or hot water bottles on your feet. You can’t feel the heat, and burns happen fast.
• Don’t cut calluses yourself. Use a pumice stone gently after bathing. Let a podiatrist remove thick skin.
• Don’t use over-the-counter corn removers. These contain acid that can burn your skin.
• Don’t ignore a red spot. If you see redness that doesn’t fade after 24 hours, call your provider. Don’t wait for pain.
• Don’t assume you’re low-risk. Even if you feel fine, nerve damage can be silent. The IWGDF classifies risk levels: Risk 0 (no neuropathy), Risk 1 (neuropathy without deformity), Risk 2 (neuropathy with deformity), and Risk 3 (history of ulcer or amputation). Your risk level determines how often you need professional checks.

When to See a Professional

You should have a comprehensive foot exam at least once a year. But if you’re at higher risk, you need more frequent visits.

• Risk 0: Annual screening for nerve damage (10g monofilament test) and circulation (ankle-brachial index).
• Risk 1: Every 6 months.
• Risk 2 or 3: Every 1-3 months. That’s not optional. That’s life-saving.

If you notice any of these, call your doctor immediately:

• A wound that hasn’t started healing in 2 days
• Drainage, pus, or foul smell
• Red streaks spreading up your leg
• Fever or chills
• Swelling that won’t go down

Antibiotics won’t fix an uninfected ulcer. The IDSA says using them preventatively increases antibiotic resistance without helping healing. Treatment isn’t about pills-it’s about offloading pressure, cleaning the wound, and managing blood sugar.

Real Barriers-And How to Overcome Them

Let’s be honest: Doing this every day is hard. Studies show only 42% of people with diabetes do a full daily inspection. Why?

• Vision problems: If you can’t see well, use a mirror or ask a family member to help. Smartphone apps like FootCheck AI can take photos and flag abnormalities-though they need good internet.
• Neuropathy: The worse your nerve damage, the less likely you are to check. That’s why reminders matter. Set a daily alarm. Put your mirror next to your toothbrush.
• Cost: Therapeutic shoes and smart socks can be expensive. But many Medicare and Medicaid plans cover them. Ask your provider. Some clinics offer loaner shoes.
• Summer heat: People switch to sandals. Big mistake. Sandals expose feet and increase pressure on the ball of the foot. Look for diabetic sandals with cushioned soles and closed heels.

Integrated care works. Programs that connect your primary doctor, podiatrist, diabetes educator, and orthotist reduce ulcers by over 35%. If your care team isn’t talking to each other, ask them to. You’re not just a patient-you’re the center of your own care team.

The Bigger Picture

The CDC wants to cut diabetes-related amputations by 25% by 2030. That’s possible. But it won’t happen with fancy gadgets or new drugs. It’ll happen because people check their feet every day. Because they wear the right shoes. Because they don’t ignore a red spot.

This isn’t about being perfect. It’s about being consistent. One missed day won’t cause an ulcer. But a pattern of missed days? That’s how it starts.

You don’t need to be a medical expert. You just need to be committed. Your feet carry you through your life. Protect them like you would your eyes or your heart. Because in diabetes, your feet are just as vital.