Diabetic foot: myths that cost health — and why a podiatrist is not a luxury

Why so much confusion around one foot

Myths about diabetic foot come from three sources. First — the absence of pain as a warning sign: if nothing hurts, logic suggests everything is fine. That's the trap, because diabetic neuropathy literally switches off this alarm system. Second — confusing prevention with treatment: a podiatry visit sounds like a pedicure, not medicine, so it seems unnecessary until something actually starts happening. Third — fragmented knowledge: a diabetologist treats diabetes, a GP refers you "to a specialist", an orthopaedist deals with bones — and diabetic foot as a whole often falls through the gap between these specialisms.

Six myths — one by one

Myth 1: "If nothing hurts, everything is fine." This is the most common and most dangerous belief. Diabetic neuropathy doesn't hurt — at least not at first. Peripheral nerve damage can dull sensation gradually and painlessly over months, even years. Someone with advanced neuropathy might walk around with an ingrown nail, a callus pressing on blood vessels, or an early ulcer — and feel absolutely nothing. Lack of pain in diabetic foot is a warning sign, not proof of health.

Myth 2: "A pharmacy ointment and better shoes are enough." Both have their place — but neither replaces a regular foot assessment by a specialist. Moisturising dermocosmetics help maintain skin integrity, and orthopaedic insoles reduce pressure points — these are valuable elements of daily care. The problem arises when they're treated as sufficient on their own. Calluses, corns, hyperkeratosis (thick, hardened skin), incorrectly trimmed nails or fungal infections are changes that need professional, calibrated intervention — not home remedies.

Myth 3: "A podiatrist is just a cosmetic pedicure." This is probably the biggest barrier to seeking help. Medical podology is a distinct specialism. Its scope covers diagnosis and treatment of nail conditions (ingrown, fungal, dystrophic), corns and calluses, hyperkeratosis, warts, foot deformities and ulcer prevention. A podiatrist specialising in diabetic foot can assess tissue vascularisation, recognise early signs of poor circulation, and work alongside a diabetologist or vascular surgeon. This isn't premium nail painting — it's medicine.

Myth 4: "I'll trim my own nails, no need to see a specialist." Nails are a separate chapter in diabetic foot care. Healing is impaired, blood vessels can be weakened, and — as we now know — sensation may be compromised. Even a minor cut while trimming, one that would heal in a day or two on healthy skin, can start a chronic wound in someone with diabetes and accompanying poor circulation. A podiatrist works with sterile instruments, uses techniques suited to tissue with altered properties, and knows when to stop rather than continue. The risk of a "minor cut" is genuinely different here than for someone without diabetes.

Myth 5: "This only affects older people or those with severe diabetes." Foot complications aren't exclusive to people with long-standing, poorly controlled diabetes. Early neuropathic and vascular changes can appear relatively soon after diagnosis — especially when blood sugar was poorly controlled for a long time beforehand. Age matters less than the duration of hyperglycaemia and the quality of control so far. A preventive podiatry visit makes sense right after a diabetes diagnosis — not only once a problem appears.

Myth 6: "My diabetologist will tell me when to worry." A diabetologist manages diabetes as a systemic disease — a demanding, multidimensional task. A detailed foot assessment can end up superficial in that setting, especially during a short appointment. Diabetic foot needs its own specialist — just as teeth need a dentist and eyes need an ophthalmologist, even when your GP "checks that too". A regular podiatrist as part of the diabetes care team is standard in many Western countries — in Poland, this awareness is only slowly taking hold.

What a podiatrist actually does for diabetic foot

Specialist podiatric care for diabetes works on several levels at once. The first is ongoing removal of changes that are potential risk points: corns, calluses and hyperkeratosis aren't just a cosmetic issue. Thick, hardened skin puts local pressure on deeper tissue, which — with impaired circulation — can lead to necrosis. Regular, controlled removal reduces this risk.

The second level is nail care: correct trimming, treating ingrown nails without causing wounds, recognising fungal infections and referring for dermatological treatment when needed, and nail reconstruction when the nail plate is dystrophic. For someone with good sensation, this is routine. For someone with neuropathy — it's an essential intervention.

The third — and often underrated — level is monitoring and early detection of changes. A podiatrist sees the foot regularly, knows its history, and can pick up on subtle signals: a change in skin colour, swelling, localised warmth or coolness, a worrying change in skin texture. These observations, passed on appropriately to the diabetologist, can be an early warning of a developing ulcer.

Daily care — what's on you

Regular podiatry visits are the foundation — but they don't replace daily observation. People with diabetes often build the habit of checking their feet every day (if flexibility makes this difficult — a mirror on the floor or help from a family member works too), checking the inside of shoes before putting them on, and avoiding walking barefoot, especially outside the home.

1. 01

   Daily observation

   Check your feet every day — the soles, the spaces between toes, the heels. Look for redness, abrasions, blisters, skin changes. If something new appears, tell your podiatrist or diabetologist — don't wait.

2. 02

   Skin hydration

   Dry skin cracks and becomes a gateway for infection. Moisturise your feet daily — but not between the toes, since moisture there encourages fungal infections. Your podiatrist can recommend a product suited to your skin condition.

3. 03

   Smart footwear

   Choose soft shoes with a wide toe box and no internal seams at pressure points. Try them on in the afternoon, when feet are slightly swollen. Check the inside by hand before every wear — a stone, a folded insole or a rough surface can cause a wound.

4. 04

   Podiatry visits

   Depending on your foot assessment — quarterly, every six months, or more often. Don't cancel without booking your next appointment. Consistency matters more here than intensity.

Water temperature when washing your feet is a small detail that matters — water that's too hot can burn impaired skin without any warning, given reduced temperature sensitivity. It should be comfortably warm, not hot — check it with your elbow or a thermometer, not your foot.

Diabetic foot and men — different beliefs, same risk

Statistically, men with diabetes see a podiatrist less often and later than women. The reasons are predictable: foot care doesn't fit into the "health visits" men tend to plan. And a podiatry visit sounds more like a beauty salon than medical prevention. Yet men with diabetes are at increased risk of ulcers precisely because they ignore warning signs for longer — or simply don't have any.

Calluses and corns, which more often prompt an early visit in women (thanks to shoes and appearance), tend to build up for years in men without any intervention. The same goes for nails: hard, thickened, yellow nail plates dismissed as "normal ageing" can actually be a fungal infection needing treatment, or early changes linked to poor circulation. A podiatrist is a specialist, not a beautician — and this visit is just as medical as a check-up with a diabetologist.

Before you decide "this isn't for me"

Medical podology for diabetes isn't reserved for people with complications. It's precisely for those who want to avoid them. That's an important shift in thinking — the same shift that separates seeing a dentist "because a tooth hurts" from seeing one "before it hurts". Prevention is cheaper, faster and less invasive than treatment — and this is exceptionally literal when it comes to foot health.

If you have diabetes and have never seen a podiatrist, now is a good moment to change that. If someone close to you has diabetes and says "nothing hurts, why should I go" — now you know what to tell them. Lack of pain in diabetic foot isn't a reason to put off a visit. It's a reason to book one.