Diabetic foot is one of the most frequent and serious complications of diabetes mellitus. According to the International Diabetes Federation (IDF), it is estimated that between 15% and 25% of people living with diabetes will develop some form of foot lesion during their lifetime. In many cases, these lesions can progress to severe infections, gangrene, and — in the most critical scenarios — amputations that permanently compromise the patient’s quality of life.

Understanding what diabetic foot is, why it occurs, and — above all — how to prevent it forms part of the comprehensive management of diabetes. Prevention is not a supplement; it is the most effective treatment strategy available today. If you already have diabetes and have not yet undergone a foot assessment, we invite you to request a consultation with Dr Christian Leyva.

 

What is diabetic foot?

The term “diabetic foot” encompasses a group of anatomical and functional alterations affecting the feet of people with diabetes, generated primarily by two pathophysiological mechanisms: peripheral neuropathy and peripheral arterial disease.

Diabetic neuropathy causes progressive loss of sensation in the feet. The patient stops perceiving pain, temperature, and pressure, meaning that minor wounds — a rub from footwear, a stone inside a shoe, an accidental burn — go unnoticed and progress without treatment for days or weeks. The American Diabetes Association (ADA) details how peripheral neuropathy is the contributing factor in more than 80% of diabetes-related amputations.

Vascular insufficiency reduces blood flow to the lower limbs, compromising the body’s ability to heal wounds and fight infections. Both factors, when combined, create ideal conditions for an apparently minor lesion to develop into a chronic ulcer that is difficult to resolve.

 

Risk factors you should know

Not all people with diabetes carry the same level of risk. The following factors significantly increase the likelihood of developing diabetic foot:

• Poor long-term glycaemic control. Chronic hyperglycaemia is the primary driver of neuropathy and vascular damage.
• Prolonged duration of diabetes, particularly more than 10 years of progression.
• A history of ulcers, which is the strongest predictor of recurrence.
• Foot deformities such as claw toes or cavus foot, which create abnormal pressure points.
• Inappropriate footwear, one of the most frequently underestimated modifiable factors.
• Smoking and other conditions that worsen peripheral vascular disease.
• Uncontrolled arterial hypertension and dyslipidaemia.
• Visual impairment that makes daily foot inspection difficult.

Identifying which risk category each patient falls into allows the specialist to determine the frequency of reviews and specific preventive measures.

 

How to prevent diabetic foot

The prevention of diabetic foot rests on three fundamental pillars: metabolic control, local foot care, and regular medical supervision.

1. Optimal glycaemic control

The first and most important preventive step is maintaining blood glucose within the therapeutic targets established by your doctor. Elevated glycated haemoglobin (HbA1c) levels accelerate neurological and vascular damage. According to the guidelines, each percentage point reduction in HbA1c translates into a significant decrease in the risk of microvascular complications, including neuropathy.

2. Daily foot inspection

This is a simple but high-impact practice. It is recommended to examine both feet every day — ideally in good lighting and, if vision is limited, with the help of a mirror or a family member — looking for:

• • Blisters, wounds, or cuts, however small
  • Changes in skin colour (redness, pallor, or bruised areas)
  • Areas of callosity or hyperkeratosis
  • Thickened, ingrown, or fungally infected toenails
  • Changes in local temperature (areas that are warmer or cooler than normal)

Any finding, however minor it may seem, should be discussed with a health professional without delay.

3. Foot hygiene and moisturisation

It is recommended to wash the feet daily with warm water — never hot, as neuropathy prevents burns from being detected — and mild soap. Drying should be thorough, with particular attention to the spaces between the toes, as moisture encourages the proliferation of fungi and bacteria.

Dry, cracked skin provides an entry point for infections. The use of emollient moisturising creams on the top and sole of the foot — avoiding the spaces between the toes — maintains the integrity of the skin.

4. Correct toenail care

Toenails should be cut in a straight line, without rounding the corners, to prevent ingrown nails. In patients with severe neuropathy, deformities, or pathological nails, this procedure should be carried out by a professional.

5. Appropriate footwear and orthopaedic insoles

Footwear is a determining factor. A shoe with the following characteristics is recommended: a wide, rounded toe, a thick non-slip sole, breathable material, adjustable fastening (with laces or Velcro), and no internal seams that cause rubbing. Walking barefoot should never be done, even indoors.

In patients with documented deformities or areas of high pressure, the use of custom insoles or bespoke therapeutic footwear has been shown to significantly reduce the incidence of plantar ulcers.

6. Do not self-medicate or treat lesions without medical supervision

Cutting calluses, applying chemical corn plasters, or attempting to treat wounds at home are practices that can considerably worsen a lesion. At the first sign of any change in the skin of the foot, medical advice should be sought immediately.

 

The importance of regular medical review

Systematic foot examination forms part of the routine follow-up of the diabetic patient. During the medical consultation, sensitivity is assessed using the Semmes-Weinstein monofilament, alongside osteotendinous reflexes, peripheral pulses, ankle systolic pressure, and other variables that allow risk stratification and preventive action before any lesion appears.

Diabetic foot is not an inevitable consequence of living with diabetes. It is, to a large extent, a preventable complication when consistent care habits are established and an active relationship is maintained with the treating medical team. Patient education, responsible self-care, and specialist follow-up are the pillars on which effective prevention is built.

Early detection of warning signs and timely intervention make the difference between a lesion that heals without consequences and a complication that can irreversibly change a patient’s life.

 

Do you have diabetes and want to protect the health of your feet?

At Dr Christian Leyva’s practice, a specialist in diabetes, a comprehensive assessment of diabetic foot risk is carried out, including physical examination, analysis of metabolic control, and personalised guidance on care and prevention.

The best intervention is always the one that takes place before the problem arises.

Book your appointment with Dr Christian Leyva and take the first step towards complete control of your diabetes.