A great deal of circulation care happens at home, and most of it is done by someone who was never trained for it. This is the practical version: what to look at, what to do, what to leave alone, and when to stop reading and pick up the phone.
Call 911
A foot or leg that becomes suddenly cold, pale, mottled, numb or severely painful over minutes to hours. Sudden breathlessness, chest pain worse on breathing in, or coughing blood. Confusion or collapse alongside a red, hot, swollen leg.
Same-day call
Any new break in the skin on a foot with poor sensation or poor circulation. A wound that is spreading, smells different, or has new discharge. Redness and warmth spreading up the leg. Fever or chills. One leg newly swollen, painful or warm. A dark or black area on a toe or heel. New pain in the forefoot at night that eases when the leg hangs down.
The daily foot check
This is the highest-value two minutes in the day, and it is worth doing at the same time each day so it does not get forgotten — after the evening wash is a natural slot.
- Both feet, in good light. Tops, soles, heels, and between every toe. A hand mirror or a phone camera reaches what your eyes cannot.
- Look for redness, blisters, cuts, cracks, calluses, a dark patch, a wet or soggy area between the toes, anything new.
- Feel for warmth, coolness, hard areas, and compare one foot against the other.
- Check the shoes too, inside, with your hand — a stone, a fold, a nail head, a torn lining.
- Photograph anything you are unsure about, with a coin or ruler beside it for scale. Same spot, same angle, each day. That series of photos is the most useful thing you can bring to an appointment.
What helps day to day
Washing and drying. Warm water — test it with your elbow or a thermometer, never with the person’s own foot if sensation is reduced. Dry thoroughly, especially between the toes. Moisturize the tops and soles but never between the toes, where damp skin breaks down.
Compression garments. Put them on first thing, before the legs have had time to swell, and take them off at night unless you have been told otherwise. If they are a struggle, say so — donning aids, rubber gloves, and different garment styles all exist, and a garment that gets worn beats a stronger one that does not. Never use one that leaves deep marks, causes pain or makes the toes cold. Fit and application.
Elevation. Above heart level to be useful, supporting the whole leg rather than just the ankle, for periods through the day rather than one long stretch. The exception matters: if elevating makes foot pain worse, stop and report it, because that points to an arterial problem. Doing it properly.
Movement. Even in a chair — ankle circles, pointing and flexing the feet, pressing the balls of the feet down and lifting the heels. The calf muscle is the pump. A few minutes every hour does more than one long session.
Shoes. Worn indoors as well as out, fitted in the afternoon when feet are largest, with room across the toes. New shoes broken in for an hour a day at first, with a foot check after each wear.
Five things not to do
No heat. No heating pads, hot water bottles, electric blankets on the feet, hot soaks or foot spas. Burns on feet that cannot feel temperature are common and become serious wounds. Warm socks instead.
No home surgery. No cutting corns or calluses, no medicated corn plasters, no digging at nails. These cause a large share of the wounds that follow.
No soaking. It softens and macerates skin rather than helping it.
No compression without an arterial check, ever, in someone who has not had one.
No waiting to see if it settles. With reduced circulation or sensation, the usual rule of giving it a few days does not apply.
At appointments
- Bring the photo series, the current medicine list including anything bought over the counter, and a written note of what has changed since last time.
- Ask what specifically should prompt a call before the next appointment, and write the answer down.
- Ask who to call out of hours, and put that number somewhere both of you can find it.
- Ask about referrals that are easy to miss: a lymphedema therapist, a supervised exercise program for PAD, podiatry for nail and callus care, and a wound clinic if there is an open wound.
- Let the person answer for themselves where they can. It is their body and their appointment, and being talked over in front of a clinician is a common and demoralizing experience.
About you
Caregiving for someone with wounds, mobility limits or daily dressing changes is genuinely demanding, and the people doing it tend to notice their own exhaustion last. Two things are worth knowing: respite and home health support exist and are under-requested, and asking about them is a practical step rather than an admission of anything. If you are managing this alone, raise it at the next appointment — a social work referral is a normal thing to ask for.
Common questions
How do I know if a wound is getting worse?
Compare photographs rather than memory — the change is usually too gradual to notice otherwise. Getting larger, deeper, more painful, developing a new smell or discharge, or redness spreading outward all mean call the same day. A wound that is not measurably smaller after four weeks of proper treatment also needs review, even if it looks stable.
Can I trim their toenails?
If the person has normal sensation, good circulation and straightforward nails, careful trimming straight across is fine. If they have diabetes, reduced sensation, poor circulation, thickened or ingrown nails, or you cannot see clearly what you are doing, this belongs with a podiatrist. The cost of a professional visit is trivial next to the cost of the wound.
They refuse to wear the compression stockings. What can I do?
Find out which reason it is, because they have different fixes. Too hard to get on — donning aids, rubber gloves, or a wrap-style garment with fasteners instead. Too hot or uncomfortable — a different fabric or a lower class that actually gets worn. Painful, or the toes go cold — stop and report it, because that needs checking rather than persuading. Blaming the person rarely works and the garment is usually the problem.
Is it safe to let them walk if walking hurts?
For diagnosed, stable claudication, walking to moderate discomfort, resting, then continuing is the treatment and should be encouraged. It is not the right advice for an open wound, pain in the foot at rest, a leg that has changed suddenly, or anyone who has not been assessed. If in doubt, ask before starting rather than after. The distinction.
What should I keep at home?
A hand mirror, a plain unscented moisturizer, non-adherent dressings and tape if wounds are an ongoing issue, a bath thermometer, a notebook for changes and weights, and the out-of-hours number written down. Not antiseptics, not medicated corn removers, and not a heating pad.
Where to go next
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes and Foot Problems.
- Centers for Disease Control and Prevention. Diabetes and Your Feet.
- Centers for Disease Control and Prevention. About Cellulitis.
- National Institute on Aging. Caregiving.
Written by Tom Biernacki, DPM, FACFAS. Published 21 September 2026. General education, not medical advice.