By Dr. Rakhi Agarwal, M.S. (General Surgery), FAIS, FICS:Medical Director, Shree Kkasturi Medicare Pvt. Ltd. Published: 26 August 2026; Medically reviewed: 26 August 2026
Almost every diabetic foot I have had to operate on began as something nobody thought was worth mentioning.
A blister from a new chappal. A small cut from cutting a nail too close. A crack in the heel. A patch where a stone had been sitting inside the shoe all day. In every one of those cases, the patient told me the same thing, and told me it as reassurance:
"Madam, dard to bilkul nahi ho raha tha."
I want to explain, as plainly as I can, why that sentence is the most dangerous thing a person with diabetes can say about their foot — and why it is the reason we are having the conversation three weeks later in an operating theatre instead of three days earlier in an OPD.
Pain is a warning system. Diabetes switches it off.
When you step on something sharp, pain makes you lift your foot before real damage is done. That reflex protects you thousands of times a year without you noticing.
Long-standing high blood sugar damages the small nerves in the feet. As those nerves fail, the warning system fails with them. A person can walk an entire day on a stone inside their shoe. They can stand on a hot temple floor in May and feel nothing. They can develop a deep ulcer under the ball of the foot and only discover it when they notice a stain on the sock.
The wound does not hurt. That is not a sign it is minor. It is a sign the alarm is broken.
Three things go wrong at once
This is why a wound that would be trivial on any other foot behaves differently here.
1. The nerves stop warning you. The injury is not felt, so it is not noticed, so nothing is done. The person keeps walking on it, which drives the damage deeper with every step.
2. The blood supply is reduced. Diabetes narrows the arteries that feed the leg and foot. Healing requires blood — oxygen, immune cells, and any antibiotic you swallow all arrive through those same vessels. When flow is poor, the wound heals slowly or not at all, and a tablet taken by mouth may never reach the tissue that needs it.
3. Infection spreads faster. High blood sugar weakens the body's defences and feeds bacteria. An infection that would stay superficial elsewhere can travel along the tendons into deep tissue, and reach bone, within days.
Put together: the wound is not felt, cannot heal, and infects quickly. That combination — not the size of the original injury — is what determines how this ends.
How most of them start
Not one of these sounds like an emergency. Every one of them has ended in an operating theatre.
1. Walking barefoot — in the house, on a terrace, at a temple, to the bathroom at night. A hot floor in summer causes a full-thickness burn on a numb foot with no sensation of heat at all.
2. A new chappal or shoe that rubbed for one day.
3. A strap between the toes cutting into the web space.
4. Cutting toenails too short, or cutting into the corners, leaving a small break in the skin.
5. Treating a corn or callus at home — with a blade, a razor, or a medicated corn cap. Corn caps contain acid that burns healthy skin and cannot be felt doing it.
6. Soaking feet in hot water, using a hot water bottle, or sitting close to a heater. Burns without pain.
7. A salon pedicure with shared instruments, or a cuticle nicked.
8. Cracked heels left to deepen until they split.
9. Fungal infection between the toes — itchy, damp, ignored, and a perfect doorway for bacteria.
10. A thick callus under the ball of the foot that quietly breaks down underneath, so the ulcer forms under intact-looking skin.
When to see a doctor — within 24 hours
For a person with diabetes, these are not "watch and see" findings:
1. Any break in the skin on the foot, however small — a cut, blister, crack, scrape or puncture
2. Redness, warmth, or swelling around any area
3. Any discharge, or a smell
4. A change in colour — a patch turning dark, blue, black or white
5. A new callus or a blackened area under a callus
6. A wound that has not clearly improved in one week
7. An unexplained rise in your sugar readings. This one surprises people: a foot infection frequently announces itself first as sugars that suddenly will not come down. If your readings jump for no reason, look at your feet.
Come the same day — these will not wait
1. Black tissue anywhere on the foot or toes
2. Redness spreading, or red streaks running up the leg
3. Foul-smelling discharge, or pus
4. Fever, chills, or feeling generally unwell alongside any foot wound
5. New pain in a foot that was previously numb. Pain returning to a numb foot is not recovery. It usually means the infection has reached deeper structures.
6. A foot that is hot, red and swollen with no wound at all. This can be an infection — but it can also be Charcot foot, in which the bones of a numb foot fracture and collapse under normal walking. It is frequently mistaken for gout or infection and treated with antibiotics while the foot architecture is destroyed. It needs proper assessment and, usually, immediate immobilisation.
Why the urgency is real: a diabetic foot infection can move from the skin surface to deep tissue and bone in a matter of days. Treated at that stage, the answer is usually cleaning the wound, the right antibiotic, taking weight off the foot, and getting the sugars down. Treated three weeks later, the conversation is about how much has to be removed. The great majority of diabetic amputations begin as a small, painless wound — and a large share of them were preventable.
The daily check — five minutes that prevents most of this
This is the single most effective thing in this article. Do it at a fixed time each day so it becomes a habit, not a decision.
Look at both feet, every day. Tops, soles, heels, and between every toe. If you cannot bend comfortably or cannot see well, place a mirror on the floor, or ask a family member. This is not a small favour to ask — it is the thing most likely to save the foot.
You are looking for: any cut, blister, crack, scrape, redness, swelling, colour change, hard callus, or damp softened skin between the toes.
Wash daily in lukewarm water. Check the temperature with your elbow or a thermometer, never with your foot. Your foot is not a reliable judge of heat any more.
Dry thoroughly, especially between the toes. Trapped moisture breeds fungus, and fungus opens the door.
Moisturise the soles, heels and tops — but never between the toes. Cream left between the toes softens the skin and causes exactly the breakdown you are trying to avoid.
Cut nails straight across, not down into the corners, and file the edges smooth. If your eyesight or reach makes this difficult, have someone else do it — a nail cut wrong is a genuine cause of admission.
Never walk barefoot. Not in the house. Not on the terrace. Not to the bathroom at night. Keep a pair of soft slippers beside the bed.
Check inside your footwear with your hand before wearing it, every time. A small stone, a nail head, a folded insole, a torn lining.
Never use blades, razors, or corn caps on corns and calluses. Have them dealt with properly.
Avoid hot water bottles, heaters near the feet, and hot water soaking — including hot salt water soaks, however often they are recommended.
Footwear
1. Wide at the toes, soft upper, cushioned sole, no internal seams pressing anywhere
2. Closed footwear outdoors. If you have numbness, avoid thin straps that pass between the toes
3. Buy in the evening, when feet are slightly swollen, so the fit is honest
4. Never buy tight expecting it to stretch. It will injure you before it loosens
5. Break in new footwear slowly — an hour a day for the first week, checking the foot after each wear
6. MCR or custom footwear is worth the cost if you have neuropathy, deformity, or a previous ulcer. It redistributes pressure away from the points that break down
7. Clean cotton socks daily, seamless, without tight elastic at the top
Get your feet examined, even when nothing is wrong
Everyone with diabetes should have their feet formally examined at least once a year — more often with neuropathy, poor circulation, foot deformity, or any previous ulcer.
It takes a few minutes. We test sensation with a fine filament pressed against specific points on the sole, feel the pulses in the foot and ankle, look at the skin, nails and pressure areas, and check how your footwear is wearing. It tells us whether your protective sensation is intact — and if it is not, you need to know that before the first wound, not after.
Two other things matter as much as anything local: sugar control, which determines how fast nerves and vessels deteriorate, and stopping smoking or tobacco in any form. Tobacco narrows exactly the arteries the foot depends on. In a diabetic foot, smoking and healing pull in opposite directions.
What treatment involves
Seen early, most of this is unglamorous and effective: cleaning and dressing the wound, removing dead or thickened tissue, an antibiotic chosen on the basis of a wound culture rather than guesswork, and — often the part patients resist most — taking weight off the foot completely while it heals. An ulcer on the sole will not close if you keep walking on it, whatever else we do.
Alongside that: getting blood sugar under control, treating any fungal infection, and assessing whether blood supply is adequate. Where circulation is the limiting factor, arterial assessment and any vascular procedure may require referral to a specialised centre, and we arrange that.
At Shree Kkasturi Medicare, diabetic foot wounds are managed through our general surgical services, with in-patient care, dressings, laboratory support and diabetes management on site. The single thing that changes the outcome is how early you come.
Frequently asked questions
Q. It is a tiny blister and it does not hurt. Can I watch it for a few days? A. No. In diabetes, the absence of pain tells you the nerves are damaged — it tells you nothing about how serious the wound is. Have any break in the skin looked at within 24 hours. If it turns out to be nothing, that is a five-minute OPD visit.
Q. My sugar is well controlled. Do I still need to do all this? A. Yes. Nerve damage that has already occurred does not reverse when sugars improve. Good control slows further damage, which is valuable — but if protective sensation is already reduced, the foot still cannot warn you. Ask at your next visit whether your sensation has been formally tested.
Q. Can I apply a home-made paste, powder or oil to the wound? A. Please do not. Anything applied over a wound hides it, keeps it moist, and delays the day someone qualified looks at it. In a diabetic foot, those days matter more than in almost any other condition. Keep it clean, cover it with a clean dry dressing, and come.
Q. Is soaking in hot salt water helpful? A. No, and it carries two risks. Your foot may not feel water that is hot enough to burn it, and prolonged soaking softens the skin, which makes it break down more easily. This is common advice and it is not safe advice for a diabetic foot.
Q. Can I get a pedicure? A. With caution. Go somewhere that sterilises instruments properly, or carry your own. Tell them you have diabetes. Ask them not to cut cuticles, not to use a blade on calluses, and not to use hot water. If you have numbness or any previous ulcer, it is safer to have foot care done medically.
Q. Will I lose my foot? A. In most cases seen early, no. Amputation is the outcome when infection has reached deep tissue or bone, or when blood supply cannot sustain healing — and both of those take time to develop. The people who lose a foot are very rarely the people who came within a day of noticing a wound. That is the whole reason this article exists.
Q. The wound closed. Am I finished with this? A. A healed ulcer means the risk is managed, not gone. Anyone who has had one diabetic foot ulcer is at markedly higher risk of another, usually at the same pressure point. Continue the daily check indefinitely, keep the protective footwear, and have the foot reviewed regularly.
Shree Kkasturi Medicare Pvt. Ltd. is a 45-bed NABH Entry Level accredited multispecialty hospital in Bhayander West, serving Mira-Bhayander since 2001, with general surgical services, 24×7 casualty, a 24×7 pathology laboratory, ICU and diabetes care. Free ambulance pick-up is available.
Disclaimer: This article provides general health information and is not a substitute for consultation, examination or diagnosis by a qualified doctor. Do not use it to decide that a foot wound can be managed at home. If you have diabetes and any break in the skin of your foot, have it examined.