He was the kind of man who kept a notebook. Rajaram Iyengar, sixty-three, retired BEML engineer, R T Nagar, Bangalore. Eleven years of diabetes, HbA1c of 6.9 — the number that makes doctors nod with quiet approval. He walked every morning on the Veterinary college campus at 5 AM sharp, past the sleeping dogs and the serious aunties in salwar suits doing power-walking like it was a competitive sport. Four kilometres. Same route. Same discipline. Same chappals, too — bought in 2019, “still good.” He was meticulous. He was doing everything right.
Three months ago, he sat in my clinic, and I looked at his foot for a long moment without speaking. This is the story nobody forwards on WhatsApp.

India has, by recent estimates, over 100 million diabetics, a number so large it has stopped alarming anyone, which is itself an emergency. And what is the single most universal piece of advice everyone of them receives from their physician, their neighbour, their sister-in-law who lost weight and now dispenses medical opinions freely? Walk. Walk more. Ten thousand steps. Lalbagh. Cubbon Park. The building terrace will do. Just walk.

The advice is correct. That is what makes it dangerous.

What nobody explains — not in the rushed consultation, not in the WhatsApp forward, not anywhere — is that diabetes does not only raise blood sugar. It erases sensation. Peripheral neuropathy, it is called, and it dismantles the foot’s ability to report injury with the slow efficiency of a government office closing down. The nerves that carry pain — gone. Heat — dulled. Pressure — unregistered. The foot stops speaking. The patient, unaware, keeps walking.

Rajaram walked four kilometres with a blister he didn’t even know existed. A small rough edge inside his chappal, something a normal foot would notice in minutes, went completely unnoticed. He came home, had his filter coffee, watched the news, and carried on as usual. Four days later, his wife spotted the wound. By then, infection had set in, and once it enters, it doesn’t leave easily. This is not a rare story. This is common in any clinic in India.
The ancient Ayurvedic physicians called it the loss of sparsha jnana — the intelligence of touch, the body’s own reporting system travelling upward through the sira, the channels, to the seat of awareness. Pada raksha, the daily protection of the feet, was not a cosmetic ritual. It was medicine. Abhyanga — warm oil massaged into the feet and lower legs each evening was understood to maintain circulation, nourish the snayu, and preserve exactly the sensory intelligence that diabetes destroys. Our grandmothers pressed oil into their feet every night before bed without knowing the physiology behind it. They were, it turns out, practising preventive diabetology. We replaced this with rubber chappals and forgot the wisdom entirely.

Now add the second catastrophe, the one even informed patients rarely know about. Peripheral Artery Disease narrows the arteries feeding the legs and feet. If neuropathy is the security guard falling asleep, this is the water supply being cut. A wound needs oxygen and white blood cells, all delivered by blood, to heal. In a foot with compromised circulation, the wound receives none of this adequately. It sits there, worsening, attracting infection like a Bangalore pothole attracts complaints — reliably, comprehensively, with no resolution in sight. High blood sugar makes it worse still. Glucose is bacteria’s favourite food. A warm, well-stocked buffet with no closing time. What started as a chappal seam on a Tuesday morning becomes, six weeks later, a surgical conversation in a hospital room that no one in that family had prepared for.

Walking is not the enemy. Let that be absolutely clear. The enemy is the half-sentence prescription. “Go walk in Lalbagh” without the paragraph that must follow it — what to wear, what to check, what to never do barefoot, what to look for when you return. That missing paragraph is where Rajaram’s toes went.

So here is that paragraph. Before every walk, examine both feet in good light—between the toes, under the heel, across the entire sole —areas most people have not examined carefully since childhood. Wear proper enclosed shoes. Not the 2019 chappals. Real footwear, clean socks, seamless. Walk on flat known surfaces. After every walk, inspect again. Five minutes of warm oil on the feet before sleep — your grandmother’s ritual, now validated. Total daily commitment: six minutes. Those six minutes are the distance between a walk and an amputation.
There is a family in R T Nagar, the wife checks her husband’s feet every night under a table lamp. He grumbles. She ignores him. Thirty- six years of diabetes. All ten toes present, accounted for, fully operational. He does not know what she is protecting him from. She does. She read it once, in a clinic waiting room, on a sheet a doctor had thought to leave on the table. That sheet is the thing most consultations run out of time to reach.

The most dangerous diabetic foot is not the one that is injured. It is the one that has gone silent. Pain is not the problem; its absence is. By the time a diabetic foot begins to hurt, the disease is often already advanced. This is the small, uncomfortable truth most patients are never told. So the disciplined patient keeps walking, doing everything right, unaware that the body has quietly stopped reporting. Your chappals may look perfectly fine. Your feet can no longer confirm it. Which is why this cannot be left to chance. Tonight, before the television goes off, sit under a lamp and look carefully and deliberately. In diabetes, the eye must replace what the nerve has forgotten.

Note: Rajaram Iyengar is a fictional name. The original patient’s identity and personal details have been changed to protect privacy and confidentiality.