Diabetes and your feet: changes you should not ignore

September 23, 2026Mediwell Support General Practitioners Fourways mediwell

A small blister or sore can be easy to overlook, particularly if it does not hurt. When you have diabetes, changes in sensation and circulation can make that approach risky. Looking at your feet every day and acting on new changes helps you get care before a problem becomes more difficult to treat.

You do not need to decide whether a mark is serious by yourself. The key is knowing which changes to report promptly, which symptoms need emergency care and how to protect your feet between professional checks.

Why pain is an unreliable warning

Diabetes can damage the nerves that carry sensation from the feet. This is called peripheral neuropathy. It may cause tingling, burning or numbness, and sometimes develops without obvious symptoms. An injury can therefore be present even when walking feels comfortable.

Reduced blood flow can also make a wound harder to heal. A shoe rubbing one area, a small object inside a shoe or unnoticed broken skin may lead to a sore that becomes infected. These risks do not mean every person with diabetes will develop an ulcer, but they explain why a painless change should still be taken seriously.

Build a short daily foot check into your routine

Choose a time that is easy to remember, such as when you remove your shoes. Look at the tops, soles, heels and spaces between the toes. A mirror can help you see the sole; if your eyesight or mobility makes checking difficult, ask someone you trust to help.

Look for anything different from your usual skin and nails:

A blister, cut, crack, open sore or blood on a sock
Swelling, a new colour change or an area that feels warmer than the other foot
Fluid, an unusual smell or a dressing that has become wet with discharge
New pain, burning, tingling, numbness or a change in the shape of the foot
A troublesome nail, hard skin or pressure mark where footwear rubs

A daily check is a chance to notice a change, not to perform a diagnosis. Make a note of when you first saw it and contact your healthcare team if you are unsure what it means.

New wounds and a hot swollen foot need prompt care

Contact your GP, diabetes clinic or a podiatrist the same day if you discover a new wound, blister, discharge, unexplained redness or swelling. Do not wait for your next routine diabetes appointment, for the wound to become painful or for a fever to develop.

A foot that becomes unusually hot, swollen or changes colour needs urgent assessment even if the skin is intact and there is little pain. Clinicians need to consider infection, circulation problems and conditions such as Charcot arthropathy, in which the bones and joints of the foot can become damaged. You cannot reliably distinguish these at home.

While arranging urgent assessment, avoid walking on or putting weight on a newly hot, swollen foot. Ask the healthcare team how to move safely; do not delay getting help.

Explain that you have diabetes when asking for help. In South African practice, an initial assessment may be through your GP, clinic or diabetes service, with referral to hospital or a specialist foot-care team when needed. SEMDSA recommends hospital assessment for suspected Charcot foot. If prompt assessment is unavailable, or the foot is deteriorating, go to a hospital emergency department. Do not assume that a routine booking request has been clinically assessed.

When to get emergency help immediately

A foot wound with fever, shaking chills or feeling seriously unwell can indicate a dangerous infection. Blackened tissue, a suddenly cold or markedly pale foot, or rapidly deteriorating symptoms also need emergency assessment. Do not wait for a standard clinic appointment.

If there is confusion, collapse or severe breathing difficulty, call emergency services. In South Africa, use 112 from a cellphone or 10177 for an ambulance. Even if you are unsure of the cause, describe the symptoms and mention the diabetes and foot problem.

What to do while arranging assessment

Cover a new break in the skin with a clean, preferably sterile, dressing. Avoid putting unnecessary pressure on the affected foot and get advice about safe movement. Do not burst a blister, cut away hard skin, probe a wound or use a chemical corn-removal product.

Do not apply heat or soak the foot. A photograph may help you describe when a visible change began, but a picture cannot assess circulation, sensation or the depth of a wound. Sending a photograph is not a reason to delay an in-person assessment when urgent signs are present.

Protect healthy skin and plan regular checks

Wash your feet in warm rather than hot water and dry them carefully, including between the toes. Moisturise dry intact skin, keeping cream out of the toe spaces. Wear well-fitting footwear and socks, and inspect the inside of your shoes before putting them on. Avoid walking barefoot, including at home.

Ask for professional help with nail or hard-skin care if you cannot safely reach or see your feet, or have been told you are at increased risk. Keep following your diabetes care plan and ask for support if medicines, glucose monitoring or stopping smoking are difficult.

Professional foot assessments check more than visible skin. South African primary healthcare guidance includes a baseline and annual foot examination for adults with type 2 diabetes, and a foot check at each visit for people with neuropathy. SEMDSA also recommends more frequent review for higher-risk feet. Sensation, blood flow, footwear and previous problems help set the plan. New symptoms should never wait for an annual appointment.

Discuss foot health at Mediwell

Mediwell offers GP care and diabetes management in Fourways. A GP can assess concerns and advise on further care or referral when needed. Bring your medicine list and tell the clinician about any previous ulcer, reduced sensation or circulation problem. Urgent warning signs require prompt care wherever it is available.

This article provides general health information and does not diagnose symptoms or replace an assessment by a qualified healthcare professional.