Diabetic & At-Risk Feet
About the condition
Diabetes, peripheral vascular disease, rheumatoid disease and long-term steroid therapy all place the foot at heightened risk of ulceration, infection and, in the worst cases, amputation. The good news is that most of this risk is preventable with structured screening and prompt attention to warning signs.
The 'at-risk foot' is any foot with reduced protective sensation, impaired circulation, altered shape or a previous ulcer. A single annual screen is the baseline; more frequent review is offered where risk factors are stacked.
Our role is to identify problems early, coordinate with GPs, diabetologists and vascular surgeons where needed, and give patients a clear plan they can follow at home.
What patients notice
- •Numbness, tingling or burning in the feet
- •Cramping in the calves when walking (intermittent claudication)
- •Cold, pale or discoloured feet
- •Cuts, blisters or callus that are slow to heal
- •Any break in the skin that appears without a remembered injury
- •Changes in foot shape or new areas of pressure
Why timely assessment matters
- •Neuropathic ulceration under pressure areas
- •Ischaemic wounds that fail to heal without vascular intervention
- •Deep soft-tissue and bone infection (osteomyelitis)
- •Charcot neuroarthropathy — silent collapse of the mid-foot
- •Hospital admission and, in advanced cases, amputation
How we treat it
Structured screening
Vascular assessment (pulses and Doppler), neurological testing (monofilament and vibration), skin and nail review, and footwear inspection.
Personalised risk plan
A clear, written summary of your risk stratification and a self-care routine tailored to it.
Preventative skin and nail care
Regular reduction of callus and safe management of nails to avoid the pressure lesions that precede ulceration.
Custom footwear and offloading
Bespoke insoles and, where needed, prescription footwear to redistribute load away from high-risk areas.
Rapid-access wound care
Prompt appointments for any new lesion, with same-day coordination to vascular, diabetes or microbiology teams when required.
Patient and family education
Practical guidance on daily foot checks, footwear, nail care and when to seek urgent help.
And why
'Bathroom surgery' on corns, callus or nails
Why: A small at-home injury in an insensate or ischaemic foot can become a limb-threatening infection within days.
Hot water bottles, radiators or foot-spas at high temperature
Why: Reduced sensation means burns can occur without you feeling them.
Walking barefoot, even indoors
Why: Small unseen injuries — a splinter, a dropped pin — are the commonest starting point for a diabetic foot infection.
Ignoring 'that little sore that will heal on its own'
Why: In an at-risk foot, any new wound should be reviewed within days, not weeks. Early treatment is dramatically more successful.
Cheap, unstructured footwear
Why: Rough seams, poor fit and inadequate cushioning create the pressure points where ulcers begin.
This page provides general information about the condition and is not a substitute for personalised clinical advice. Diagnosis and treatment planning should always follow an in-person consultation.
Discuss diabetic & at-risk feet with a consultant.
Book a consultation at Spire Parkway or an online review with Mr Stuart Metcalfe.