The two minutes at the end of the day that protect your feet

You take your shoes off at the door. The socks come off later, in the dark, on the way into bed. Your feet have carried you around all day and you have not actually looked at them in weeks.

For most people that is fine. If you have diabetes, this is the one habit worth adding that takes almost no time and prevents the thing nobody wants.

Why feet, and not hands or elbows

Two things happen slowly with diabetes, and neither announces itself.

The first is nerve damage. Higher blood sugar over years can dull the nerves in your feet, which are the longest nerves you have. It usually starts at the toes and works upward. What it takes away is pain, and pain is the alarm that normally tells you a shoe is rubbing, a pebble is in there, a blister has formed, the bath is too hot.

The second is circulation. Narrowed blood vessels mean less blood reaching your feet, and blood is what brings healing. A small cut on your hand closes in a few days. The same cut on a foot with poor circulation can stay open for weeks, and an open wound is a way in for infection.

Put those together and you have the situation this check exists to prevent: an ordinary injury you cannot feel, on a part of the body that heals slowly, found late.

When your feet stop reporting pain, looking is how you find out.

The check itself, in about two minutes

Do it in decent light, sitting down, at whatever point in the evening you will actually remember.

• The tops, then the soles. If you cannot bend to see the soles, use a mirror on the floor, or take a photo with your phone and look at that. The phone works well and is easier on your back.
• Between every toe, where dampness and small cracks hide.
• The heels, for dry skin and splits.
• Your nails, for anything ingrown, thickened or discoloured.

You are looking for cuts, blisters, cracks, redness, swelling, an area warmer than the rest, a change in colour, or anything that was not there yesterday. Then dry carefully between your toes, and put moisturiser on the tops and soles but not between the toes, where trapped moisture does more harm than dryness.

While you are down there, run a hand inside the shoes you wore. Grit, a curled insole and a worn seam all cause the injuries you would otherwise have felt coming.

Four things not to do

Each of these is a common way an ordinary foot becomes an urgent problem.

• Do not cut, shave or dig at a corn or callus yourself. Not with a blade, and not with a pumice stone used hard. A chiropodist, podiatrist or foot care nurse can take it down safely.
• Do not use over-the-counter corn removers or medicated corn pads. Most contain salicylic acid, which is meant to burn away skin and cannot tell a callus from the healthy skin around it. On a foot with reduced sensation and slow healing, that is how an ulcer starts.
• Do not test bath or foot bath water with your feet. Use your elbow, or a thermometer. If your feet cannot feel heat properly, a burn is entirely possible. Long soaks are not a good idea either, because they waterlog the skin.
• Do not walk barefoot, indoors included. Many of the injuries people arrive with happened at home, on a doorframe, a stray toy, or a piece of glass nobody saw.

If your eyesight makes it hard to see your feet, if you cannot reach them comfortably, or if you take a blood thinner, ask someone else to do your nails rather than doing them at arm’s length. That is the sensible precaution, not a fussy one.

What warrants a call, and how quickly

Most of what you find will be nothing. Some of it is not, and with feet the timing of the call is what changes the outcome.

Call your care team the same day for:

• Any break in the skin. A cut, a blister, a crack or a scrape on the foot of someone with diabetes is not something to watch for a week.
• Redness, swelling, or an area noticeably warmer than the rest of the foot.
• Any discharge, pus, or a smell.
• A sore that is not clearly healing after a couple of days, or one getting larger or deeper.

Seek urgent care, the same hour, for:

• A sore together with a fever, chills, or feeling unwell in yourself. That combination suggests the infection is no longer only in the foot.
• Redness that is spreading, or a red streak moving up from the wound.
• A foot or toe that has gone pale, blue, black, cold or suddenly very painful. That is a circulation emergency, and the clock matters.

Mention at your next contact, rather than urgently, any new numbness, burning, pins and needles, or pain in your feet at night. Those changes quietly move you into a higher risk group, and knowing about them changes what your team watches for.

The yearly appointment that goes with the nightly look

Your own check finds what has changed. It cannot tell you how much sensation you have lost, because you cannot feel the absence of feeling.

That is what the professional foot examination is for. Diabetes Canada’s guidelines recommend a foot examination by a health care professional at least once a year for everyone with diabetes, and more often for anyone who has lost sensation, has poor circulation, has a foot deformity, or has had an ulcer before. It takes a few minutes, involves a soft filament and a look at your pulses, and it tells you which level of care your feet actually need.

If you have never had one, or cannot remember the last one, that is worth raising.

One small place to start

Attach the check to something you already do every night. Brushing your teeth is the usual choice, because it happens whether or not the day went well.

Tonight, sit down, look at both feet, run a hand inside today’s shoes, and leave the moisturiser somewhere you will see it tomorrow. That is the whole habit.

If you are a 360Care member and you have found something you are unsure about, message your care team in the app and send a photo. We would far rather look at ten things that turn out to be nothing than see one thing three weeks late.