16 steps to protect your feet during Hajj (Muslim pilgrimage) @BMJ @APMA @FootinDiabetes #ActAgainstAmputation @KeckMedUSC

We at SALSA@USC are pleased to have participated in this collaborative effort to provide guidance to the nearly quarter million people with diabetes who perform Hajj each year. This manuscript has been published in BMJ Open Diabetes Research and Care.

16 steps to keep the foot healthy before, during and after the Hajj15 17–19

Daily inspection of the feet for lesions such as blisters and bleeding between toes. Using a mirror will help to inspect the bottom of the foot and the heel.
If unable to do it, you may seek the help of a relative or a friend.
Foot examination by a specialist in diabetic foot care is a must before the Hajj.
Socks or stocking should fit well in the shoe; padded hosiery could help in reducing the pressure and offer more protection.
Both the soles and the shoes or sandals should be inspected for any foreign objects before use every time.
Use shoes and/or sandals with proper measurements; they should be comfortable and easy to use.
Always choose leather shoes with good space for the toes. Athletic and/or running shoes are good choices for walking.
Try to change footwear whenever possible.
NEVER walk barefoot.
Avoid soaking your feet in hot water; check the temperature in advance.
A daily wash of the feet is required, and keep your feet dry especially between the toes. You can use moisturizing creams but not between the toes.
When taking a bath, check the temperature in advance. You can use a thermometer or even your elbow. The hot water should not drip onto the toes.
Seek immediate help if you notice any new lesion or swelling of the feet. Redness and pain are also alarming. If so stay off your feet until proper advice is sought.
Education before going to the Hajj on how the feet may be affected.
Ensure optimal glycemic control and do not smoke (smoking is forbidden in Mecca during the Hajj).
Brand-new shoes are not preferred, as new shoes may rub unduly on the feet. Concessions (Rukhus) to patients with diabetes included an arrangement that protects the feet from any injury or prevent unfelt slipping of some footwear.