If you live with diabetes, looking after your feet is essential. Diabetes can affect the nerves, circulation, skin, joints and bones of the feet long before pain or obvious symptoms appear. Regular diabetic foot checks with a podiatrist are one of the most effective ways to detect problems early and prevent serious complications.
At our clinics across Sydney CBD, Darlinghurst and Randwick, many patients are surprised to learn they have reduced sensation or circulation despite feeling completely fine. The encouraging news is that most diabetic foot complications can be prevented with timely assessment and appropriate care.
This guide explains what happens during a diabetic foot check, how often reviews are recommended under Australian guidelines, and the key steps you can take to protect your feet.
Why Diabetes Affects the Feet
Diabetes can impact the feet in three main ways:
- Peripheral Neuropathy (Nerve Damage)
High blood glucose can damage nerves, causing loss of protective sensation. You may not feel:
- Cuts or blisters
- Pressure points
- Burns or temperature extremes
- Foreign objects in shoes
- Developing ulcers
Without pain as a warning signal, injuries may go unnoticed.
- Peripheral Artery Disease (Poor Circulation)
Reduced blood flow can lead to:
- Slower healing
- Higher infection risk
- Skin and tissue breakdown
- Increased risk of amputation in severe cases
- Immune System Changes
Diabetes can impair the body’s ability to fight infection, allowing minor wounds to worsen more quickly.
What Happens During a Diabetic Foot Check?
A diabetic foot assessment is a structured medical examination designed to identify risk factors before complications develop.
Medical History Review
Your podiatrist will ask about:
- Duration of diabetes
- Blood sugar control (HbA1c if known)
- Previous ulcers or infections
- Foot pain or numbness
- Kidney disease
- Smoking history
- Mobility and activity levels
- Footwear habits
Previous ulceration or amputation significantly increases future risk.
Circulation Assessment
Blood flow to the feet is evaluated through:
- Palpation of foot pulses
- Capillary refill time
- Skin temperature and colour
- Possible Doppler ultrasound assessment
Signs of reduced circulation may include cool skin, hair loss on toes, shiny skin and delayed healing.
Nerve Testing (Loss of Protective Sensation)
This is a key part of the assessment.
Common tests include:
- Monofilament testing (light pressure detection)
- Vibration perception using a tuning fork
- Pinprick sensation
- Temperature discrimination
Reduced sensation means pressure or injury may not be felt.
Skin Inspection
The skin is examined for:
- Dryness or cracking
- Callus (hard skin)
- Blisters
- Fungal infections
- Ulceration
- Colour changes
- Signs of pressure or friction
Small skin breaks can become entry points for infection.
Nail Assessment
Toenails are checked for:
- Ingrown nails
- Thickened or fungal nails
- Trauma
- Signs of infection
Nail problems are a common source of wounds.
Foot Structure and Deformity
Structural features that increase pressure are assessed, including:
- Bunions
- Hammertoes or claw toes
- Prominent bones
- Flat or high arches
- Previous fractures or Charcot changes
- Limited joint mobility
These changes can create high-risk pressure areas inside shoes.
Footwear Assessment
Shoes are evaluated for safety and suitability:
- Fit (length, width, depth)
- Cushioning and support
- Wear patterns
- Internal seams or pressure points
- Suitability for daily activities
Ill-fitting footwear is a major contributor to foot injury.
Risk Classification: Why It Matters
After the assessment, patients are classified using the International Working Group on the Diabetic Foot (IWGDF) risk system used in Australian guidelines.
Your classification determines how often monitoring and care are needed.
How Often Should You Have Diabetic Foot Checks?
According to Australian Diabetic Foot Disease prevention guidelines:
Very Low Risk- IWGDF Risk 0
- No neuropathy and no peripheral artery disease
- Recommended review: Once per year
- Screening ensures early changes are detected
Low Risk- IWGDF Risk 1
- Loss of protective sensation OR peripheral artery disease present
- Recommended review: Every 6–12 months
Moderate Risk- IWGDF Risk 2
- Loss of sensation PLUS additional factors such as:
- Foot deformity
- Callus
- Poor circulation
- Limited joint mobility
- Recommended review: Every 3–6 months
- Medical-grade footwear or orthotics may be recommended
High Risk- IWGDF Risk 3
- History of foot ulcer, amputation, or severe deformity
- Recommended review: Every 1–3 months
- Ongoing professional care and monitoring are required
Further Guidelines Recommend for Prevention
Regular podiatry care should be combined with daily self-care.
- Never Walk Barefoot
Even indoors, walking barefoot or in thin slippers increases injury risk.
Always wear protective, well-fitting footwear.
- Daily Foot Inspection
Check both feet every day for:
Redness, blisters, cracks, swelling, cuts, nail problems, colour changes
Also inspect inside your shoes before putting them on.
- Hygiene and Skin Care
Wash feet daily
Dry thoroughly, especially between toes
Use moisturiser for dry skin (not between toes)
Trim nails straight across
Avoid chemical corn or callus removers
- Footwear Matters More Than You Think
Moderate- to high-risk patients may need medical-grade footwear to reduce pressure.
Custom orthotics or toe devices may be prescribed for deformities or callus.
Specialised pressure-relieving footwear is recommended for those with previous ulcers.
- Treat Problems Early
Pre-ulcerative signs must not be ignored, including:
Thick callus, ingrown toenails, fungal infections, pressure spots, redness over bony areas
Prompt podiatry treatment can prevent progression to ulcers.
The Real Goal: Preventing Ulcers and Amputation
Diabetic foot ulcers are serious but largely preventable. Once established, they can take months to heal and may recur.
Regular foot checks help to:
- Identify risk factors early
- Reduce excessive pressure
- Manage minor issues before they escalate
- Provide personalised advice
- Maintain mobility and independence
Why Local, Ongoing Care Matters
Consistency allows subtle changes to be detected over time. Seeing the same podiatry team regularly ensures continuity of care and quicker intervention if problems arise.
Our clinics provide comprehensive diabetic foot assessments for patients living and working in inner Sydney, with convenient access for those in the city and eastern suburbs.
What Makes a Thorough Diabetic Foot Assessment Different?
A comprehensive diabetic foot check is:
✔ Medical, not cosmetic
✔ Preventative rather than reactive
✔ Evidence-based using international guidelines
✔ Focused on long-term health outcomes
✔ Tailored to your individual risk level
If an appointment only involves nail cutting without assessment, important risk factors may be missed.
Frequently Asked Questions
“My feet feel fine, do I still need checks?”
Yes. Reduced sensation means problems can develop without discomfort.
“I only have pre-diabetes. Does this apply to me?”
Early changes to nerves and circulation can still occur, so screening is worthwhile.
“Can I manage my foot care myself?”
Daily self-care is important, but professional assessments detect issues you may not notice.
“Is podiatry covered by Medicare?”
Some patients qualify under a GP Chronic Condition Management Pla. Private health insurance may also provide rebates.
The Bottom Line
Diabetic foot complications are largely preventable with appropriate monitoring and care. Regular assessments help identify problems early and guide the level of protection your feet need.
Your feet support you every day, protecting them is a vital part of managing diabetes.
When Should You Book Your Next Check?
If you have diabetes and cannot recall your last professional foot assessment, it is a good time to arrange one.
If you live or work in Sydney, our clinics are available to provide thorough, evidence-based diabetic foot care to help you stay active and confident on your feet for the long term. Book and appointment HERE
BOOK YOUR LOCAL PODIATRIST TODAY!
The human foot is a masterpiece of engineering and a work of art.