Diabetes is one of the leading causes of lower-limb amputation worldwide, and most amputations start with a small foot ulcer that could have been prevented. Nurses are often the first to spot a problem. This guide gives patients a daily checklist and gives nurses a practical approach to foot assessment and education.
Contents
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Why diabetes damages the feet
- Neuropathy: high blood glucose damages nerves, so people may not feel cuts, blisters or burns.
- Poor circulation: narrowed blood vessels slow healing.
- Infection risk: high glucose weakens the immune response.
- Foot deformities: such as bunions, hammer toes and Charcot foot change pressure points.
The daily foot care checklist (for patients)
- Look at both feet every day, including between the toes and the soles. Use a mirror or ask a family member if you can’t see well.
- Wash feet daily in warm (not hot) water. Test the temperature with your elbow, not your foot.
- Dry carefully, especially between the toes.
- Moisturise dry skin, but not between the toes.
- Never walk barefoot, even at home or on the beach.
- Check inside shoes for stones or rough seams before putting them on.
- Wear well-fitting shoes and clean socks without tight elastic.
- Cut toenails straight across and file sharp edges. If you can’t see or reach, ask a podiatrist.
- Don’t use corn plasters, blades or chemical treatments on corns or calluses.
- Keep blood glucose, blood pressure and cholesterol in target, and stop smoking.
Warning signs: get help the same day
- A new cut, blister, ulcer or crack that isn’t healing
- Redness, swelling or warmth in part of the foot
- Pus, a bad smell or discharge
- A change in colour, such as a dusky or black toe
- New pain, or loss of feeling
- Fever or feeling unwell with a foot wound
A hot, red, swollen foot without obvious injury can be acute Charcot foot and needs urgent specialist assessment.
Nursing assessment of the diabetic foot
History
- Duration and control of diabetes (recent HbA1c)
- Previous ulcers or amputations
- Smoking, kidney disease, vision problems
- Footwear and self-care ability
Examination
- Skin: colour, dryness, calluses, fissures, ulcers, infection
- Nails: thickened, ingrown or fungal nails
- Deformities: bunions, claw toes, Charcot changes
- Sensation: test with a 10 g monofilament at standard sites
- Circulation: palpate dorsalis pedis and posterior tibial pulses; note capillary refill and temperature
Risk classification
Many guidelines classify patients as low, moderate or high risk based on neuropathy, poor circulation, deformity and previous ulceration. High-risk patients need regular review by a foot protection team or podiatrist.
Caring for a diabetic foot ulcer
- Refer promptly to the multidisciplinary foot team or wound clinic.
- Offload pressure from the ulcer (special footwear or casts as prescribed).
- Clean and dress the wound as per local wound care guidelines.
- Look for infection and escalate for antibiotics and imaging if needed.
- Optimise glucose control and nutrition.
- Document size, depth, appearance and photographs (with consent) at each review.
Teaching tips for nurses
- Ask the patient to show you how they check their feet.
- Use simple language and pictures.
- Involve family members when vision or mobility is limited.
- Address cultural practices such as walking barefoot at home or in places of worship, and suggest clean indoor footwear.
Related guides
- Normal lab values for nurses (including HbA1c)
- NANDA nursing diagnosis list with examples
- Medical-surgical nursing practice questions