On this page
- If this is happening right now
- Why a numb foot becomes an amputation
- The two-minute check, step by step
- What you are looking for
- Never barefoot — house, yard, temple
- Footwear that survives this district
- The wounds that need care the same day
- What not to do at home
- Making the habit survive a busy household
- Related
- Frequently asked questions
If this is happening right now
If there is a wound on the foot together with fever or shivering, redness spreading up the foot or the leg, swelling with a foul smell, black skin, or if the person is drowsy, vomiting or breathing fast — stop reading and call 108. The ambulance network knows the nearest equipped centre and the crew can begin care on the way. In a person with diabetes, a foot infection can enter the bloodstream within a day or two, and that is how a scratch picked up in a paddy field ends in intensive care. PPK Hospital, Marthandam runs a 24/7 emergency and intensive care with ventilator support for precisely this situation. Everything below this line is written for the other days — the ordinary ones, when nothing is wrong yet.
Why a numb foot becomes an amputation
In Indian studies, most non-traumatic amputations — limbs lost to something other than an accident — begin as a diabetic foot ulcer. The sequence rarely varies. Years of high blood sugar, sugar as everyone here says it, damage the long nerves running down to the feet, and the foot stops reporting. A thorn picked up crossing the yard, grit inside a slipper, a strap rubbing on the walk to the bus stop, a floor left hot by the afternoon — any of them opens the skin, and the person keeps walking on it, because there is no pain to make them stop. Weight holds the wound open, bacteria get in, and reduced circulation slows both the healing and the antibiotics that eventually arrive. The nerve damage behind all this is explained on the diabetic foot and neuropathy page. What matters here is that every single step in that sequence is interruptible, and the interruption costs two minutes a day.
The two-minute check, step by step
Attach it to something you already do — after the evening bath, before the night tablet — because a routine tied to another routine survives, and a good intention does not. Sit down in good light, not in a dim corner, and take both feet in turn.
The soles. Lay a mirror flat on the floor and hold the foot over it, or ask a family member to look. This is the half of the foot no one ever sees and where most ulcers begin.
Between the toes. Separate each pair, including the little toe, and look for cracks, sogginess and white peeling skin — the monsoon and wet fieldwork make this the wettest, most fragile skin on the body.
The heels and edges. Deep cracks are a doorway, not a cosmetic problem.
The pressure points. The ball of the foot, the base of the big toe, the tips of the toes, and any spot where a callus has built up.
The nails and the shoes. Check the nail folds for redness, then put a hand inside both slippers for a stone, grit, a torn lining or a raised nail.
What you are looking for
Anything new. A break in the skin, however small; a blister; a heel crack; a callus with a dark spot underneath, which is usually blood beneath the hard skin and an ulcer beginning; redness, especially spreading redness; one patch that feels warmer than the rest; one foot swollen when the other is not; a change in colour, whether pale, dusky or black; wet white skin between the toes; a nail thickened, discoloured or growing into the flesh; any discharge or smell. And the finding people most often talk themselves out of: a wound that is exactly the same size today as it was three days ago. Healing looks like shrinking. A wound holding still is a wound that has been stopped by something — pressure, infection or poor circulation — and it needs a doctor rather than another week of patience.
Never barefoot — house, yard, temple
The rule has no exceptions, and the exceptions are what bring people to us. Most injuries in this district are picked up at home and in the yard: a thorn carried in on the floor, a splinter, a stone, a doorstep, a floor that holds the afternoon heat long after the sun has gone. Keep one clean pair of slippers used only indoors, put them on before the first step out of bed, and keep a second pair for outside. Temple visits need a plan rather than an exemption: go with someone, keep the walk from footwear to sanctum as short as possible, wear clean socks kept only for that purpose where it is permitted, and check both soles carefully afterwards, in light, the same evening. The same applies to wet estate paths, rubber plantations, and any walk taken barefoot out of habit rather than choice.
Footwear that survives this district
Textbook advice meets local reality here, and the compromise has to be liveable. For a foot with reduced sensation, closed and well-fitted footwear with a soft insole beats a thin rubber slipper, which leaves the skin exposed to thorns and hot ground while protecting nothing from pressure. Buy shoes in the evening, when feet are at their largest, and break new ones in for an hour a day with a foot check afterwards — new footwear causes more ulcers than old footwear does. Change socks whenever they are damp; wet fieldwork and monsoon walking soften skin until it tears. Avoid straps that cut between the toes on a numb foot. Anyone who has already healed one ulcer should ask specifically about properly fitted therapeutic footwear at their next review, because a foot that has ulcerated once will do it again far more readily than a foot that never has.
The wounds that need care the same day
Show a doctor within a day, not at the next convenient time, if a cut, blister, crack or ulcer has not visibly begun healing in a few days; if redness is spreading from it; if the foot is swelling; if there is discharge, pus or a foul smell; if any tissue has turned black; or if a foot that was numb has suddenly become painful. Fever alongside a foot wound is the one that cannot wait at all — it may mean the infection has reached the blood, which is an emergency, and 108 is the right response. New numbness or new burning also deserves an appointment rather than a wait, since it changes how carefully the foot has to be protected from then on.
What not to do at home
Do not cut corns or calluses, and do not let anyone shave them with a blade at a salon — that is how a hard patch becomes an open wound. Do not use a hot water bottle or test bath water with your feet; use a hand or an elbow, because numb skin cannot judge heat and burns arrive without warning. Do not bandage tightly. Do not apply anything to an open wound that a doctor has not advised, and do not buy antibiotics over the counter for a foot wound — they blur the picture without treating the depth of it. And do not start a daily aspirin on your own to “improve circulation”: routine aspirin for people without established heart disease was pulled back in 2019 and tightened further in 2022, and aspirin, statins or circulation medicines are prescribed only after assessment.
Making the habit survive a busy household
Two minutes is not the difficulty; remembering on the hundredth day is. Tie the check to a fixed daily event, keep the mirror where the check happens rather than in a cupboard, and give a second person in the house the job of looking at the soles once a week — elderly patients, people with stiff hips or poor eyesight, and anyone living alone need that second pair of eyes. Take shoes and socks off at every diabetes review, without being asked, so the feet are examined properly; and keep working on the sugar itself, since control is what slows further nerve damage in the first place. The daily look and the long-term numbers protect the same foot from opposite ends.
Related
Frequently asked questions
Put a mirror flat on the floor and rest each foot over it — that shows the sole without bending. If eyesight is poor, ask a family member to look, or take a photograph of each sole with a phone and enlarge it. Choose one person in the house whose job this is, so it actually happens every day rather than whenever someone remembers.
No — with diabetes it often means the opposite. Pain is the alarm that makes an ordinary person stop walking on an injury; when nerve damage has switched that alarm off, the wound keeps taking weight and keeps opening. A painless ulcer in a numb foot deserves more urgency than a painful cut in a foot that feels normally, not less.
Yes. Most injuries we see were picked up at home or in the yard — a thorn brought in on the floor, a splinter of glass, a stone, a floor hot from the afternoon sun, a stubbed toe against a doorstep. Keep one clean pair used only indoors and one for outdoors, and put them on before the first step out of bed in the morning.
Anything that has not visibly begun healing within a few days needs a doctor, and the same day is right if there is spreading redness, swelling, discharge, a foul smell, black skin, or sudden pain in a foot that was numb. A fever alongside a foot wound is an emergency, because the infection may already be in the blood — call 108.
Not on their own. The guidance on routine daily aspirin for people without established heart disease was reversed in 2019 and tightened again in 2022, because bleeding risk can outweigh the benefit. Aspirin, statins and medicines for circulation may be prescribed after assessment — that is a decision made with a doctor who knows the patient's history, never one copied from a relative's strip.