Your feet and diabetes

It’s important to remember: if you have diabetes, you are always at risk of foot problems, this can include infection and amputation.

Your practitioner will tell you your foot risk at your annual review. This could be low, moderate, or high risk of developing a foot problem. Foot problems can happen to anyone with diabetes, no matter your risk score, so acting quickly is vital.

Breaks in the skin or wounds may heal more slowly or sometimes not at all because of diabetes. These wounds can become infected, and poor circulation and reduced feeling in your feet can make healing harder. Careful foot care and regular podiatry support will help reduce this risk.

Take your prescribed medicines

The medicines you have been prescribed help lower your risk of serious problems this includes medications for blood pressure, cholesterol and diabetes. If you are finding it hard to take them, please contact your diabetes care provider for advice and support.

Smoking and vaping

The nicotine from smoking and vaping affects the blood supply to your feet and increases your risk of foot complications. If you smoke or vape, we strongly advise you to stop. Act now by ringing 0800 169 4219 or visit the Leeds Stop Smoking website

If you have type 1 or type 2 diabetes, Leeds offers programmes and peer support to help you manage your condition every day, from healthy eating to mental wellbeing. Please visit the LCH diabetes service page

You can also get help with mental health or other challenges that make diabetes harder to manage, like money worries or bereavement. Ask your care provider can connect you to the right people.

Annual flu jab

People living with diabetes should get their free NHS flu jab to reduce their risk of getting the flu. This is because people with diabetes are at increased risk of becoming seriously ill from the flu.

Hand hygiene

Hand hygiene is an important part of staying healthy. Washing your hands regularly with soap and warm water helps prevent infections. Make sure to clean all parts of your hands, including between the fingers and around the nails, and dry them thoroughly. Keeping your hands clean is a simple way to protect your health every day.

Check your feet daily

You or your carer should check your feet every day for any blisters, breaks in the skin, pain or any signs of infection such as swelling, heat or redness (or colour change).

• If you discover any breaks in the skin or blisters, cover them with a clean (sterile) dressing.
• If you usually don’t feel pain because of nerve damage (neuropathy) and you suddenly have pain, it could mean you have an infection. Get help straight away.
• Do not burst blisters.

Wash your feet every day

Use warm water (body temperature at about 36°C). Test the temperature with your elbow or ask someone to check it for you. Wash your feet with mild soap, rinse well, and dry carefully especially between your toes.

• Do not soak your feet as this can damage your skin.
• Do not use heat pads directly on your skin.

Skin care

If your skin is dry, apply a moisturising cream every day, but avoid the areas between your toes. Put sun cream on your feet when they’re exposed to the sun.

Socks, stockings and tights

Change them every day. Choose ones without bulky seams and avoid elastic tops.

Avoid walking barefoot

Walking barefoot can lead to injuries from stubbing your toes or stepping on sharp objects.

Toenails, hard skin and corns

Your podiatrist will advise if you need podiatry support to manage your feet. Do not try to remove hard skin or corns yourself. Do not use over-the-counter corn treatments, they can damage your skin and cause wounds.

Check your shoes

Before putting shoes on, check the soles to ensure they are not damaged. Check the inside of each shoe to make sure there are no small stones or other items that could rub your foot. You can either shake your shoe or inspect with your hand. Shoes that don’t fit well can cause pressure and skin damage. We recommend having the width and length of the foot measured.

Prescription shoes

If you have prescription shoes, wear only these. They are made for your feet and usually come with insoles, do not remove them unless your podiatrist or orthotist tells you to. Any repairs or changes should be done by the person who supplied them.

Avoid extreme temperatures

If your feet are cold, wear socks. Never warm your feet by sitting close to a fire. Remove hot water bottles or heating pads from your bed before getting in.

• Leeds Podiatry information
• Leeds’ Diabetes information
• Diabetes Eye Screening: Phone on 0113 867 2500 or email enquiries.lmydesp@nhs.net
• Diabetes UK:
  • Diabetes UK website
  • Helpline: 0345 123 2399
  • For anyone with diabetes, their family or friends, or people worried about their risk. Please note, they cannot access your medical records.

Leeds Diabetes Limb Salvage Service (LDLSS)

If you have an urgent diabetes foot problem, such as a wound or ‘hot foot’, you should be referred to the Leeds Diabetes Limb Salvage Service (LDLSS) at St James’s Hospital (see below for contact details).

The service is a multidisciplinary team that works together during one appointment to:

• assess your foot problem
• diagnose your foot problem
• treat your foot problem

They aim to heal your foot as quickly as possible. Healing can take longer for people with diabetes, particularly when blood supply to the feet is poor. Poorly fitting footwear, poor diabetes control, and infections can also slow healing.

Members of the team

Vascular consultant

A surgeon specialising in blood supply to the feet. They may assess whether the blood flow to your feet and toes can be improved.

Diabetes doctor

A doctor specialising in diabetes who will review your diabetes management and general health.

Specialist podiatrists

Foot specialists who assess and treat foot problems. Treatment may include removing dead skin using a scalpel and redressing wounds.

Specialist orthotists

Specialists in footwear and insoles. They may provide:

• temporary footwear
• off-loading devices to help ulcers heal
• long-term footwear and insoles after healing

Pharmacist

A medicines specialist who will review all your medications during your first visit to ensure they are correct and appropriate.

Diabetes nurse specialist

Provides support with diabetes management and may review:

• medication
• insulin therapy
• monitoring equipment

Good blood glucose control can improve ulcer healing.

Clinical support workers

Support your clinic appointment and carry out assessments such as:

• blood pressure measurement
• weight checks
• other necessary assessments

Research team

Representatives from our research team may discuss ongoing research studies and clinical trials.

Participation is entirely voluntary and will not affect your ongoing treatment. If you have questions about research projects, please ask a member of the team.

Clinic information

Clinic days

• Monday
• Tuesday
• Thursday
• Friday

Time: 8:30am to 1:00pm

Location

Manny Cussins Diabetes Centre
Ground Floor, Beckett Wing
St James’s Hospital
Leeds LS9 7LS

Appointments

The clinic operates in the mornings only and afternoon appointments are not available.

As this is a busy clinic caring for people with complex needs, delays can sometimes occur. We recommend bringing:

• something to eat
• something to occupy your time while waiting

People are seen in appointment order.

Your first appointment may take longer because you may need to see several members of the multidisciplinary team and undergo additional tests.

What to bring to every appointment

Please bring:

• A list of your current medications, including any antibiotics
• your blood glucose meter or a record of your blood glucose readings
• your usual footwear
• any specialist footwear provided to you
• A snack in case of delays
• something to occupy you while waiting

Transport

If transport is required, this should be arranged by the person attending or their carer.

To request transport:

• call 0300 330 2000
• contact the service before 2pm
• Call at least three days before your appointment

You will be asked questions to determine eligibility and, if appropriate, transport will be arranged.

About Diabetic Foot Ulcers

Diabetes is a lifelong condition that can cause foot problems due to damage to nerves and blood vessels.

This can lead to:

• Neuropathy (reduced sensation or numbness)
• Ischaemia (reduced blood flow)

These changes often develop gradually and may not be noticed.

A diabetic foot ulcer occurs when the skin breaks down and the tissue beneath becomes exposed. Approximately 1 in 10 people with diabetes will develop a foot ulcer at some point.

In some people, even minor injuries can be slow to heal. Foot ulcers can become infected and infections may become serious very quickly. If you think an ulcer is infected, seek medical help immediately.

Treatment may include:

• Antibiotics
• Up to six weeks of antibiotic treatment for deep infections
• Surgery, where necessary

Foot ulcers are sometimes hidden beneath hard skin and dead tissue. A podiatrist may need to remove this tissue to assess the wound and promote healing. This may cause a small amount of bleeding and is usually not a cause for concern.

Do not attempt to remove hard skin or dead tissue yourself.

Looking after your diabetic foot ulcer

Follow your treatment plan

Follow the treatment plan discussed at your appointment. If anything is unclear, please ask a member of the team.

Dressings

Your podiatrist will discuss who will carry out dressing changes.

• Dressings are usually changed every 2 to 3 days.
• Do not change your dressing unless you have been shown how to do so and have suitable supplies.
• Keep dressings dry.
• Do not soak your foot in water.

Wet dressings can slow healing and increase the risk of infection.

Avoid pressure on the affected foot

A wound cannot heal properly if it is constantly under pressure.

• Rest as much as possible.
• Elevate your foot where appropriate.
• Wear any prescribed footwear, casts, or off-loading devices at all times, including indoors.

These devices will only help if they are worn consistently.

Check your feet daily

Check both feet every day for:

• new wounds
• areas of concern
• signs of infection

Moisturise dry skin on your feet, but avoid:

• broken skin
• the spaces between your toes

Lifestyle advice

Stop Smoking

Smoking affects circulation and increases the risk of amputation, especially when combined with diabetes.

Leeds Stop Smoking Services can provide free advice and support:

• Telephone: 0800 169 4219
• Leeds Stop Smoking website

Alternatively, visit the NHS website for local stop smoking support services.

Eat healthily

A healthy, balanced diet helps wound healing by providing the nutrients needed to repair tissue.

Reduce foods high in fat and sugar and aim for a balanced intake from the following food groups:

Bread, breakfast cereals and potatoes

Provide energy for healing. Fortified cereals and breads also provide:

• iron
• zinc
• B vitamins

Milk and dairy foods

Provide:

• vitamin A
• zinc
• protein

These can be particularly important if appetite is poor.

Fruit and vegetables

Provide:

• vitamin C
• vitamin A

Green leafy vegetables and dried fruits also provide iron.

Meat, fish, eggs and alternatives (nuts and pulses)

Provide:

• protein
• iron
• zinc
• vitamins A and D

Danger signs

Seek advice if you notice any of the following:

• New pain or throbbing
• Your foot feels hotter than usual
• New redness, inflammation or swelling
• Fluid or discharge from the wound
• A new smell from the foot
• Flu-like symptoms

If you experience any of these symptoms, follow the emergency action plan below.

Emergency action plan

If your foot is hot, red, swollen, or develops breaks in the skin, contact:

Diabetes Foot SOS (Urgent Advice)

• Phone: (0113) 206 0741
• Monday to Friday, 8am to 3pm (Not available on bank holidays)
• Outside these hours, contact your GP, NHS 111, or attend A&E if urgently required.