Bermuda has a problem that most people living here have never seen quantified.
In a study comparing 30 affluent countries with high rates of diabetes, Bermuda was found to have the highest lower limb amputation rate among women, at 46 per 100,000, and the second highest among men, at 43 per 100,000.
The average across those countries was 15 per 100,000.
Roughly three times the rate. On an island of this size.
Diabetes is described as the main cause of lower limb amputation here, and around 13 per cent of the adult population has diabetes, more than twice the OECD average.
Here is the part that should change how you read those numbers. International estimates suggest that an amputation reduction of over 50 per cent could be achieved through better education.
Not new technology. Not new surgery. Education, and the daily habits that follow from it.
This article is that education.
Why Reduced Sensation Changes Everything
If you have numbness, tingling or reduced feeling in your feet, the protective system you have relied on your entire life is no longer working properly.
Pain is not an inconvenience. It is a warning system, and it normally works automatically. A stone in your shoe becomes unbearable within a few steps. A blister forces you to stop. A cut announces itself immediately.
When that system is impaired, injuries happen silently. A wound can develop, progress and become infected without producing a single symptom you notice.
And the sequence that leads to amputation almost always starts small. A blister. A crack in dry skin. A cut from a shell on the beach. A pressure point from a shoe. None of which hurt.
Which means the thing protecting your feet is no longer sensation. It is your eyes, every single day.
The Daily Check
This takes two minutes and it is the single most valuable habit available to you.
Every day, at the same time, so it becomes automatic rather than something you remember occasionally.
Look at all surfaces: the tops, the soles, the heels, the sides, and between every toe.
If you cannot see your soles easily, use a mirror on the floor, or ask someone to look for you. This is not something to skip because it is awkward.
What you are looking for:
Redness, particularly redness that does not fade.
Blisters, cuts, cracks or grazes, however small.
Changes in skin colour.
Swelling.
Areas that feel warmer than the surrounding skin when you touch them with the back of your hand.
Hard skin, corns or calluses.
Changes to your nails.
Any discharge, or any area that looks wet when it should be dry.
And anything that looks different from yesterday.
What to Do When You Find Something
This is where the amputation statistic is actually determined.
Do not wait to see whether it resolves. In a foot with reduced sensation, a small problem has no pain to tell you whether it is getting worse. Waiting is how small becomes serious.
Contact a healthcare professional promptly for any wound, blister, crack, burn or ulcer, however minor it looks.
Seek urgent medical attention for redness spreading, warmth, swelling, discharge, a foul smell, any black or darkened tissue, or if you feel generally unwell alongside a foot problem.
Do not attempt to treat corns or calluses yourself with blades, files or over the counter corn removers. Those cause a meaningful number of the wounds that start this process.
And do not use heat. No hot water bottles, heating pads or soaking in water you have not tested with your elbow or a thermometer. If you cannot feel temperature, you cannot detect a burn.
Daily Protection
Never go barefoot. Not indoors, not on the patio, not crossing the beach, not on a boat deck. This is the rule most commonly broken in Bermuda, understandably, and it is the most important one.
Check inside your shoes with your hand before putting them on. Every time. Sand, grit, a small stone, a fold in the lining. Your foot will not tell you.
Wear shoes that fit properly, with a roomy toe box and no internal seams pressing anywhere. Buy later in the day when feet are slightly larger, and have both feet measured.
Break new shoes in gradually, wearing them an hour at a time and checking your feet afterwards.
Moisturise daily, but not between the toes, where trapped moisture encourages the skin to break down.
Keep your feet dry, which takes attention in this climate. Change damp socks promptly. Dry carefully between the toes after swimming or showering.
And have your nails cut carefully, straight across, not down the sides. If you cannot see or reach them comfortably, or if they are thickened, that is a job for a professional rather than a risk worth taking.
The Bermuda Specifics
Some local realities worth naming.
The beaches. Sand gets hot enough to burn, shells and glass are present, and the walk from the car park is exactly the kind of brief barefoot moment people make an exception for. Wear water shoes.
The sea. Coral, rocks and sea urchins all cause wounds you may not feel. Protective footwear in the water matters.
Boats. Hot decks, hardware underfoot, and wet surfaces.
The heat and humidity year round, which means damp feet are a constant consideration rather than a summer one.
And the sun. Feet get sunburned, and sunburn on skin that cannot feel it can be severe before you notice.
The Professional Side
Ask your doctor how often your feet should be checked professionally. People with diabetes should be having regular foot examinations, and the frequency depends on your individual risk.
Ask whether you have been assessed for both nerve function and circulation, because those are two different things and both matter.
And if you have had a previous foot ulcer, your risk of another is substantially higher, and that warrants a more intensive approach rather than the standard one.
Free screening is available periodically on the island, and it is worth taking advantage of.
Where We Fit
To be clear about scope. We do not manage diabetes and we do not treat wounds. Those belong with your doctor and the diabetes service.
What we contribute is the other half of the picture.
Balance and fall prevention, because reduced sensation in the feet degrades the information your balance system depends on.
Strength, which compensates for the feedback you are no longer receiving reliably.
Walking and gait, which change when feet stop reporting accurately.
Safe exercise progression, adapted around reduced sensation, foot risk and any other health considerations.
And education, including everything above.
Seek Medical Attention Promptly For
Any wound, blister, burn, crack or ulcer on a foot with reduced sensation.
Redness, warmth, swelling or discharge.
Any darkened or black tissue, which needs urgent assessment.
A foot that suddenly becomes swollen, red and warm, which needs same day attention.
Feeling generally unwell alongside a foot problem.
Any new numbness, or numbness that is rapidly worsening.
And emergency care for sudden numbness or weakness on one side of the body, especially with facial drooping, arm weakness or difficulty speaking.
Let Us Help You Protect Them
The amputation figures on this island are not inevitable. International evidence suggests more than half of these outcomes could be prevented with better education and earlier action.
InTouch Therapy offers a free discovery visit at no cost and no obligation. You will get a thorough assessment of your balance, strength, walking and fall risk, practical guidance on protecting your feet in a Bermudian climate, and a programme built for someone working with reduced sensation.
We work alongside your doctor and diabetes team, not instead of them.
