What diabetic neuropathy is
Persistent high blood sugar damages the small blood vessels that supply nerves, and over years the nerves themselves deteriorate. The longest nerves suffer first, which is why symptoms begin in the feet and move upward in a “stocking” pattern. Patients describe burning, tingling, pins and needles, a sensation of walking on cotton, or pain that flares at night and eases when they get up and walk about. Then, paradoxically, the symptoms fade — and that is the dangerous phase. Numbness is not recovery; it is nerve loss completing itself. The foot that no longer hurts is the foot that will be injured without its owner knowing.
Why numbness leads to amputation
The sequence is depressingly consistent. A thorn in the yard, a stone in a slipper, a burn from a hot floor, or friction from a new shoe creates a small wound. The patient cannot feel it, so they keep walking on it. Weight and pressure prevent healing and open it further. Bacteria enter; poor circulation limits the body’s response and the delivery of antibiotics. Within days an ulcer becomes a deep infection, sometimes reaching bone. By the time swelling, smell or fever forces attention, the choice may be between an operation and a limb.
The overwhelming majority of diabetic amputations begin as minor wounds that were never felt.
That fact is also the good news, because every step of the sequence is interruptible.
Warning signs to act on
See a doctor within days: any new cut, blister, crack or wound that is not clearly healing; a callus with darkening underneath; a corn or a thorn you removed yourself; skin that has changed colour; persistent burning or new numbness; nails that have thickened, discoloured, or grown into the skin.
Go to hospital immediately: spreading redness or swelling up the foot or leg, pus or discharge, a foul smell, black tissue, a wound with fever or shivering, or sudden severe pain in a previously numb foot. In a person with diabetes, a foot infection with fever is an emergency, not an outpatient matter — call 108 if the patient is unwell, drowsy, or vomiting.
How Dr. Ruskin assesses and treats
Every diabetes review at PPK Hospital includes taking off the shoes and socks — a small ritual that catches more problems than any test. Examination covers sensation (touch, vibration and monofilament testing), pulses and circulation in the feet, skin condition, pressure points, calluses, nail health and footwear. Blood tests assess sugar control and infection markers, with the hospital laboratory able to run them the same day.
Treatment addresses three fronts together:
Control the sugar, which slows further nerve damage.
Treat the pain, with medicines specifically effective for nerve pain rather than ordinary painkillers; and
Treat the wound, with cleaning, dressing, offloading pressure, antibiotics where indicated, and prompt surgical input from the hospital’s team when a wound needs it. Admission is available on the same campus when infection is serious.
Daily foot care that prevents ulcers
The routine takes two minutes and prevents most catastrophes.
Look at your feet every day in good light — soles, heels and between the toes; use a mirror, or ask a family member if bending or eyesight is difficult.
Wash daily with lukewarm water — test the temperature with your hand or elbow, never your feet — and dry carefully between the toes.
Moisturise dry, cracked skin, but not between the toes.
Never walk barefoot, indoors or outdoors, and shake out footwear before wearing it.
Cut nails straight across, not into the corners, and do not cut calluses or corns yourself or let anyone shave them at a salon.
Check inside your shoes for stones, grit or torn linings. And when something looks wrong, show it to a doctor while it is still small.
Footwear in this region
Local reality complicates textbook advice. Rubber slippers are near-universal here, and they leave the foot exposed to thorns, stones and hot surfaces while offering no protection against pressure — a poor combination with numbness. Field, estate and construction work adds wet feet, which soften skin and invite infection, and long hours standing, which concentrate pressure. The workable compromise is closed, well-fitted footwear with a soft insole for anyone with reduced sensation, kept exclusively for outdoor use; separate protective slippers indoors; socks that are changed when damp; and shoes bought in the evening, when feet are at their largest. Patients who have already had an ulcer benefit from properly fitted therapeutic footwear — the recurrence rate without it is high.
When to come in
Do not wait for a review appointment if a wound has appeared. Book promptly if you notice burning or numbness for the first time, if a cut or blister is not visibly healing within a few days, if a callus is building at a pressure point, or if your footwear has started rubbing. Come the same day, or go to emergency, if there is spreading redness, pus, smell, black tissue, or fever. Patients across the network can be seen at the Marthandam clinic any day rather than waiting for a monthly camp — foot problems are the one category where waiting for the calendar is the wrong decision.
Frequently asked questions
Dr. Dante Ruskin, senior diabetologist and critical-care specialist at PPK Hospital, Marthandam, treats diabetic neuropathy and diabetic foot problems, with same-day laboratory testing, wound care and surgical backup available at the hospital.
Burning feet that worsen at night is the classic pattern of diabetic peripheral neuropathy — nerve damage from long-standing high blood sugar. It is treatable: sugar control slows progression, and specific medicines reduce the pain. It should be assessed rather than endured.
Within days, not weeks — and immediately if there is spreading redness, swelling, pus, foul smell, black discolouration, or fever. Diabetic foot infections can progress from minor to limb-threatening remarkably quickly, and early treatment is what saves feet.
Established nerve damage generally cannot be reversed, but progression can be slowed substantially with good sugar control, and the pain can be treated effectively with medicines. Caught early, symptoms often improve considerably. This is a strong reason not to postpone review.
Yes — particularly with numb feet. Barefoot walking indoors and in the yard is how thorns, stones, glass and hot surfaces cause injuries that go unfelt and unnoticed until they are infected. Protective footwear indoors and outdoors is one of the simplest amputation-prevention measures available.
Once daily, in good light: look at the soles, between the toes, and the heels — use a mirror or ask a family member if you cannot see properly. Look for cuts, blisters, redness, swelling, cracks, colour changes, or discharge. Feel for warmth. Anything new that is not healing gets shown to a doctor.