The appointment where you find out you have type 2 diabetes is a crowded one. Blood sugar numbers, maybe a new prescription, a conversation about food, a referral to a diabetes education program. Feet tend to get one line near the end, usually a reminder to keep an eye on them. You go home with plenty to absorb and no clear sense of what that line was asking you to do.

The honest answer is a small one. Your feet move out of the category of things you deal with when they hurt and into the category of things you check on a schedule. Setting that up while nothing is wrong takes one appointment and a handful of decisions. Retrofitting it after a problem appears is harder.

Why feet come up in a diabetes diagnosis

Two systems protect a foot. Nerves report trouble, and small blood vessels repair it. Sustained high blood glucose can gradually affect both, and gradually is the operative word. Nothing changes the week you are diagnosed, and for many people with steady glucose control nothing changes for years.

What puts feet in their own category is the reporting system. A blister on your palm announces itself. The same blister under a forefoot, inside a sock, inside a shoe, on a foot that has quietly lost a little sensation, can go most of a week unnoticed. The risk that foot care manages is not pain. It is the delay between when something starts and when you find out about it.

Our fuller guide to how diabetes affects the feet and which changes matter works through the mechanism and the warning signs in detail. This article covers something narrower: the order to do things in, starting from a new diagnosis.

Book one assessment while your feet still feel fine

A first foot assessment on a newly diagnosed patient usually turns up nothing. Normal sensation, good pulses, unremarkable skin. Patients sometimes read that as a wasted visit. It is the opposite. A normal result that has been written down becomes the reference point every later result is read against.

Consider what happens without one. At year four, a sensation test comes back slightly reduced. Reduced compared with what? Some people have always tested lower on one side. Others have genuinely changed since their diagnosis, which is a far more useful fact and the kind that changes how closely they should be followed. Only a recorded baseline tells those two situations apart.

A chiropody foot assessment done for this purpose is mostly measurement: sensation checked with a monofilament and a tuning fork, pulses at the ankle and the top of the foot, skin and nail condition, pressure areas and foot shape, and a look at the shoes you actually wear. If you have never seen a chiropodist, what happens at a first visit is worth reading beforehand, and what a diabetic foot assessment covers in practice goes through the testing in more depth.

What the first year usually looks like

None of this is intensive. Spread over twelve months it comes to one assessment, one habit, and one follow-up interval.

The first few weeks. Book the baseline assessment. Decide who is handling your toenails and any hard skin from now on. In the meantime, keep anything sharp or acid based away from your own feet.

The next few months. Build the habit of looking at the soles of both feet and between the toes. Daily is the standard advice. The valuable part is not really the frequency, it is that you come to know what your feet normally look like, so a change registers as a change. Replace shoes that have gone flat or thin through the sole.

The rest of the year. Your assessment findings set the follow-up interval. Feet with normal sensation and good circulation need very little. Reduced sensation, a toe or arch shape that concentrates pressure, or a smoking history moves you to a shorter cycle. Separately, Diabetes Canada guidance has your primary care team examining your feet at least once a year, and that annual check carries on regardless of what foot care you arrange yourself.

Decisions that are easier to make now

Four questions come up constantly in the first year. All four are simpler to settle before anything hurts.

• Who cuts your nails. If you can see your feet clearly, reach them comfortably, and your sensation tested normal, careful self care is reasonable. If any one of those three is not true, hand the job over. The threshold does not shift much from year to year, so it is worth deciding deliberately rather than by default.

• What you do about hard skin. Corn plasters, acid removers and hard filing are the products most likely to cause trouble on a foot that cannot fully feel what is being done to it. Calluses and corns when you have diabetes sets out which of the drugstore options to leave on the shelf and why.

• How your activity ramps up. Plenty of people are told to walk more at diagnosis. It is good advice that lands on feet unused to the mileage. Walking more with diabetes covers sock and shoe choices and the hot spots that tend to show up in the first few weeks.

• How it gets paid for. Chiropody is not covered by OHIP. Most extended health plans include it, usually with an annual maximum, and the amounts differ a lot between plans. Coverage for diabetic foot care in Ontario explains what to look for on your benefits statement before the first visit.

When not to wait for the next appointment

A scheduled interval assumes nothing is happening in between, and some things override it. Call instead of waiting if you notice a break in the skin that has not started healing within a few days, new redness, warmth or swelling in one foot and not the other, drainage or a new odour, a colour change that does not settle when you move your leg, or new numbness, tingling or burning. The warning signs guide carries the complete list and what each sign tends to indicate. Burning and electric pain have their own management, covered in what helps diabetic nerve pain.

This is not an argument for inspecting your feet anxiously. It is closer to the opposite trade. A baseline on file and one steady habit are what let you stop thinking about your feet between appointments.

Frequently Asked Questions

My feet feel completely normal. Is an assessment still worth booking?

Yes, and normal feet are the best time for it. The assessment produces the measurements that later readings get compared against, and that comparison decides how closely you need to be followed. A visit that finds nothing has still produced the most useful result it can.

How soon after the diagnosis should the first foot check happen?

No deadline is attached to it. Most people reasonably get it done in the first few months, once the more urgent parts of a new diagnosis have settled. Move it earlier if you already have numbness, a nail or skin problem you have been putting off, or a foot shape that rubs inside your shoes.

Is this something my family doctor already does?

Partly. Primary care owns the annual foot screen and will usually do it at a diabetes review. A chiropodist works at a finer resolution: more detailed sensation and circulation testing, treatment of nails, calluses and corns on the day, footwear and pressure assessment, and a shorter follow-up cycle when the findings call for one. The two are not alternatives to each other.

Does good blood sugar control make foot checks unnecessary?

Control is the largest single factor in whether nerve and vessel changes develop at all, so it genuinely lowers your risk. It does not remove the value of a baseline. Control across decades is rarely uniform, and some people arrive at diagnosis having had elevated glucose for years without knowing it.

I was told prediabetes rather than diabetes. Does any of this apply?

Some of it. Nerve changes are occasionally found in people with prediabetes, so unexplained numbness or burning is worth assessing rather than filing away. The structured follow-up cycle above is aimed at diagnosed diabetes. With prediabetes and no symptoms, a single baseline and a frank conversation about your risk factors is usually proportionate.

Donwood Foot Clinic provides diabetic foot care and baseline assessments at our North York clinic. Book an appointment online.