There are currently over 5 million people living with diabetes in the UK, and foot health remains central to effective management. Diabetes damages both small blood vessels supplying peripheral nerves and larger vessels delivering oxygenated blood to the feet and lower legs. Over time, that damage produces two distinct but related problems: peripheral neuropathy, which reduces sensation in the feet, and peripheral arterial disease, which reduces blood flow. Both make the feet significantly more vulnerable to injury, infection, and slow-healing wounds. Both change the rules around what you can safely wear on your legs.

Compression socks are one of the most frequently recommended garments for managing the circulatory complications of diabetes, including leg swelling, venous insufficiency, and poor venous return. Used correctly and in the right clinical context, they improve circulation in the lower leg, reduce oedema, and support the venous system that diabetes progressively compromises. The problem is that diabetes also introduces contraindications to compression that do not apply in a healthy circulatory system. Using the wrong level of compression, or using any compression when arterial blood flow is already severely compromised, can cause harm that a person with reduced foot sensation may not notice until significant tissue damage has occurred.

This article explains the relationship between diabetes and lower limb circulation, how compression socks help and where they carry risk, which compression levels are appropriate for different levels of diabetic circulatory involvement, how to measure and fit correctly for diabetic feet and lower legs, and what features in a compression sock matter specifically for people with diabetes. By the end, you will understand not just which socks to consider, but which clinical steps to take before putting them on.

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How Diabetes Affects the Legs and Feet

Diabetes affects the legs and feet through two primary mechanisms, both of which are relevant to compression use. The first is peripheral neuropathy, nerve damage caused by prolonged exposure to elevated blood glucose levels. The second is peripheral arterial disease, or PAD, which results from the accelerated atherosclerosis that diabetes drives in the blood vessels supplying the limbs. These two conditions frequently coexist in people with long-standing diabetes, and their combined effect makes the feet simultaneously less able to feel damage and less able to heal from it.

Understanding both conditions is essential for anyone with diabetes considering compression socks, because each one changes the risk profile of compression use in a specific way. Neuropathy affects whether the person can detect a poorly fitting garment. Arterial disease affects whether the arterial blood flow in the leg is sufficient to tolerate external compression at all.

Peripheral Neuropathy and What It Means for Compression

Peripheral neuropathy in diabetes affects the sensory nerves first, reducing or eliminating the ability to feel pain, pressure, heat, and texture in the affected area. For most people, this begins in the toes and progresses proximally up the foot and lower leg over the years. The clinical implication for compression socks is significant: a garment that is the wrong size, incorrectly applied, or has a seam pressing against the skin will cause damage to the underlying tissue without the wearer feeling any discomfort that would normally prompt them to adjust or remove it. A wrinkle in a compression sock against a neuropathic foot can cause a pressure ulcer within hours. A top band that is too tight can create a tourniquet effect that goes entirely unnoticed by the person wearing it.

This is why daily foot inspection is one of the cornerstones of diabetic foot care, and it is doubly important for people with diabetes who wear compression socks. Inspect the entire foot and lower leg each morning before application and each evening after removal, looking for any areas of redness, blistering, skin breakdown, or unusual markings. Redness that corresponds to the position of a seam or the top band of the sock indicates that the garment is causing localised pressure that the nerves are not reporting.

Peripheral Arterial Disease and the Compression Safety Question

Peripheral arterial disease develops when atherosclerosis, the build-up of fatty plaques inside artery walls, narrows the arteries supplying the legs and feet. Diabetes accelerates this process significantly: people with diabetes are two to four times more likely to develop PAD than people without the condition, and PAD in diabetes tends to affect the smaller vessels below the knee more extensively. Reduced arterial blood flow means the tissues of the foot and lower leg receive less oxygen and fewer of the immune cells needed to fight infection and heal wounds.

The connection to compression socks is direct and critical. Compression socks work by applying external pressure to the leg, which narrows the surface and deep veins and increases the velocity of venous blood flow. This is beneficial when arterial blood flow is adequate, because improving venous return does not significantly affect the arterial side of the circulation. When arterial blood flow is already reduced by PAD, however, external compression reduces perfusion pressure at the tissue level and can push already-compromised blood supply below the threshold the tissues need to stay healthy. This is why a clinical assessment that includes an ankle-brachial pressure index test, or ABPI, is essential before a person with diabetes begins wearing therapeutic compression socks.

The ABPI Test: The Assessment That Comes Before the Sock

The ankle-brachial pressure index is a simple, non-invasive vascular assessment that compares the blood pressure measured at the ankle to the blood pressure measured at the brachial artery in the upper arm. The ratio of these two measurements indicates the adequacy of arterial blood flow to the lower limb. An ABPI of 1.0 to 1.3 is considered normal. Values below 0.9 suggest some degree of arterial compromise. Below 0.8, standard therapeutic compression is contraindicated. Below 0.5, compression of any level is contraindicated until the arterial disease has been assessed and managed by a vascular team.

For people with diabetes, ABPI interpretation requires an additional consideration. Diabetes causes calcification of the arterial wall, which makes the vessels less compressible and can produce falsely elevated ABPI readings. An ABPI above 1.3 in a person with diabetes may indicate arterial calcification rather than excellent arterial health. In these cases, a toe-brachial pressure index, which measures pressure in the toe arteries that are less affected by calcification, is a more reliable assessment of true peripheral perfusion. Your GP or diabetes care team can arrange these assessments as part of your annual diabetic foot review.

Who Needs an ABPI Before Using Compression Socks

Not every person with diabetes needs a formal ABPI before wearing mild compression socks for general venous support. The clinical picture determines the level of assessment required. If you have well-controlled diabetes, no symptoms of arterial disease, normal sensation in your feet, and no history of foot ulcers or poor wound healing, mild compression in the 15 to 20 mmHg range for general venous support involves a lower level of risk than it does for someone with established neuropathy and reduced foot pulses.

The following situations require an ABPI assessment before starting compression therapy.

• Any symptoms consistent with PAD, including leg pain on walking that resolves with rest, cold or pale feet, or reduced or absent pulses in the foot

• A history of diabetic foot ulceration or slow-healing wounds on the foot or lower leg

• Long-standing diabetes of more than ten years' duration with poorly controlled blood glucose

• Diagnosed with peripheral neuropathy with significantly reduced or absent sensation in the feet

• Any previous vascular procedure on the leg arteries

If any of these apply, arrange an ABPI assessment through your GP or diabetes care team before using compression socks above 15 mmHg. This is not a bureaucratic step. It is the clinical foundation on which safe compression use for people with diabetes is built.

How Compression Socks Help People with Diabetes

Despite the contraindications discussed above, compression socks provide genuine clinical benefit for many people with diabetes when used appropriately and at the right level. Diabetes impairs venous function through several mechanisms: elevated blood glucose damages the endothelium of the vein wall, reducing its elasticity and contributing to venous insufficiency; diabetic neuropathy reduces the calf muscle contractions that normally drive venous return; and diabetic oedema, which arises from multiple causes including nephropathy, venous insufficiency, and medication side effects, is a common and often underaddressed complication.

Graduated compression socks address these venous consequences directly. By applying external pressure that supports the venous valves and increases the velocity of venous blood return, they reduce the fluid accumulation that produces diabetic leg oedema, ease the heaviness and discomfort of venous insufficiency in a diabetic limb, and support the circulatory function that diabetes progressively compromises. For people with diabetes and confirmed adequate arterial circulation, compression socks are a valuable tool in managing the lower limb complications of the condition.

Reducing Diabetic Oedema

Oedema in the lower legs and feet is common in people with diabetes and arises from several overlapping causes. Venous insufficiency secondary to diabetic vascular damage drives fluid accumulation in the tissue, as does diabetic nephropathy when kidney function is significantly impaired. Certain diabetes medications, most notably the thiazolidinediones pioglitazone and rosiglitazone, cause fluid retention as a side effect. Graduated compression socks at the appropriate level reduce the venous component of diabetic oedema by supporting venous return and reducing the capillary filtration that drives fluid into the surrounding tissue during upright hours.

The clinical benefit of oedema reduction in diabetic feet extends beyond comfort. Oedematous tissue is more susceptible to pressure-related skin breakdown, slower to heal when injured, and provides a better environment for bacterial proliferation. Reducing chronic oedema through consistent compression use, where arterial circulation is adequate to support it, reduces these downstream risks in a population already at elevated risk of foot complications.

Supporting Venous Return in a Diabetic Limb

The calf muscle pump is the primary driver of venous return from the lower leg, and diabetic neuropathy reduces its effectiveness by impairing the nerve signals that coordinate calf muscle contraction. People with significant peripheral neuropathy take smaller, less forceful steps and have reduced calf muscle bulk compared to people without neuropathy, both of which reduce the pumping action that moves blood upward through the leg veins. Compression socks partially compensate for this reduced calf pump activity by providing external graduated pressure that assists venous flow even when the muscle is not contracting effectively. This is one reason why compression is beneficial for people with diabetic neuropathy when arterial circulation has been confirmed as adequate to support it safely.

What are the Compression Levels for People with Diabetes?

Compression socks for diabetes are rated in millimetres of mercury, or mmHg, describing the pressure applied at the ankle. Selecting the correct level for a person with diabetes requires balancing the venous benefit of compression against the arterial risk that external pressure creates when perfusion is already reduced. The principle is straightforward: the higher the compression level, the greater the venous benefit and the greater the arterial risk. The appropriate level for any individual depends on the confirmed ABPI, the severity of venous insufficiency or oedema, and whether neuropathy affects the ability to detect complications.

For people with diabetes and confirmed adequate arterial circulation, the compression level that suits their venous condition is generally appropriate. For people with mild to moderate PAD and borderline ABPI values, lower compression levels may be used under clinical supervision, with careful monitoring and regular skin inspection. For people with severe PAD, compression is contraindicated regardless of the degree of venous insufficiency present.

15 to 20 mmHg: Mild Compression for General Venous Support

Mild compression in the 15 to 20 mmHg range is appropriate for people with diabetes who have confirmed adequate arterial circulation, mild venous insufficiency or leg swelling, and who want circulatory support during prolonged standing or sitting. At this level, the external pressure is sufficient to reduce minor fluid accumulation and support venous return without creating significant additional arterial risk in a limb with normal or near-normal perfusion. This level is also appropriate for people with diabetes who travel frequently, who stand for long periods at work, or who notice moderate end-of-day swelling without significant varicose veins or post-thrombotic disease.

20 to 30 mmHg: Moderate Compression for Confirmed Venous Disease

This level is appropriate for people with diabetes who have confirmed adequate arterial circulation, documented venous insufficiency or significant lower limb oedema, and whose ABPI supports the use of therapeutic compression. Main Squeeze Compression Socks at 20 to 30 mmHg carry MHRA registration as medical-grade compression garments, confirming they meet the clinical standards required for therapeutic use at this level. For people with diabetes and established venous disease who have been assessed and cleared for compression, this level provides meaningful daily symptom control alongside careful, consistent foot monitoring.

30 to 40 mmHg: Firm Compression

Firm compression requires a confirmed ABPI demonstrating adequate arterial perfusion and is typically prescribed and monitored by a clinical team rather than self-managed. For most people with diabetes, the combination of arterial risk and sensory impairment makes this level inappropriate without close specialist involvement. It is reserved for severe post-thrombotic syndrome or advanced venous disease in people with diabetes whose arterial circulation has been comprehensively assessed and confirmed as adequate to tolerate the pressure safely.

Compression Levels for Diabetic Patients at a Glance

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Choosing the Right Style of Compression Sock for Diabetes

The style of compression sock chosen for a person with diabetes must reflect both the location of the venous problem and the specific vulnerabilities that diabetes creates in the foot and lower leg. Style selection for diabetic patients involves additional considerations that do not apply to the general compression-wearing population, including seam construction, toe box fit, and the risk of the garment creating localised pressure points against skin that cannot report discomfort.

Knee-high compression socks are the most practical style for managing lower leg and ankle oedema in people with diabetes, and for most people with diabetic venous insufficiency confined to the calf and foot, they provide adequate coverage. They are easier to apply than thigh-high stockings, more stable during daily activity, and allow easier visual monitoring of the foot and lower leg for the skin changes that require daily inspection in diabetic foot care.

Open-Toe vs. Closed-Toe for Diabetic Feet

Open-toe compression socks are particularly worth considering for people with diabetes, and for two specific reasons. First, they leave the toes visible throughout the day, which makes it easier to monitor toe colour, skin integrity, and the early signs of pressure-related damage without removing the sock entirely. Second, they eliminate the pressure that a closed toe applies across the dorsum of the toes and the tip of each toe, which in a foot with reduced sensation can create injury at a point where the wearer will not feel it. For people with diabetic neuropathy affecting the toes, or a history of toe ulceration, open-toe compression socks reduce this specific risk without sacrificing the circulatory benefit across the ankle and calf.

Closed-toe compression socks remain appropriate for people with diabetes and intact foot sensation, and for those without a history of toe complications. The key consideration is that the toe seam must be flat and positioned so that it does not create a ridge of pressure across the toe tips. A raised or poorly positioned seam in a closed-toe compression sock against a neuropathic foot is a genuine injury risk.

Seamless Construction and Diabetic Skin

Seam construction matters more in diabetic compression socks than in standard ones because the consequences of a seam pressing against neuropathic skin are more serious. A standard wearer feels discomfort from a poorly positioned seam and adjusts or removes the sock. A wearer with significant peripheral neuropathy may wear the same sock for eight hours without any pain signal, and the seam creates a pressure ulcer that then becomes a slow-healing wound in a foot where healing is already compromised. When selecting compression socks for a diabetic foot, prioritise genuinely flat seam construction at the toe and at the top band. Seamless or near-seamless designs in the toe box and ankle zone reduce this risk substantially.

How to Measure for Compression Socks with Diabetes

Measuring for compression socks when you have diabetes follows the same principles as standard compression sock measurement, with one critical addition: foot inspection must precede measurement. Before taking any measurements, examine both feet carefully for any areas of skin breakdown, redness, ulceration, or unusual discolouration. If any of these are present, seek podiatric or medical assessment before applying any compression garment to that foot.

Measure first thing in the morning, before standing for any significant period. For people with diabetic oedema, which can be pronounced and fluctuate with blood glucose control, the morning measurement gives the closest approximation to the resting limb size and produces the most accurate basis for sock sizing. A sock sized to an afternoon measurement in a foot with significant diabetic oedema will be too large by the following morning.

Step-by-Step Measurement Guide for Diabetic Patients

• Inspect both feet thoroughly before measuring for any skin changes or lesions that need assessment

• Measure before rising from bed, or within the first ten minutes of the morning, before extended standing

• Use a flexible fabric tape measure rather than a rigid ruler or a shoe-size estimation

• Measure the ankle circumference at the narrowest point, just above the ankle bone

• Measure the calf at its widest point, typically at the mid-calf

• For thigh-high garments, measure the thigh at its widest point and the floor-to-gluteal-fold length

• Compare measurements against the specific size chart for the product you are purchasing

• If measurements fall between two sizes, consider the smaller size for moderate compression and the larger size if comfort and ease of application are the priority

• If one foot is significantly more oedematous than the other, note this and discuss with your diabetes care team whether bilateral compression at the same level is appropriate

Main Squeeze Compression Socks are available in a wide-calf option for men and women, which is clinically relevant for people with diabetes whose lower leg oedema takes the calf circumference above the standard sizing range. A sock that is too narrow at the calf creates a constriction band at the top of the garment, which is the opposite of the graduated gradient it is supposed to deliver, and in a leg with neuropathy, the resulting pressure may go entirely unfelt.

How to Apply Compression Socks Safely with Diabetes

Application technique matters more for people with diabetes than for almost any other compression-wearing population, because errors in application, such as wrinkles in the compression zone, a twisted sock, or the heel cup sitting in the wrong position, create localised pressure against skin that cannot signal discomfort. Every stage of the application process needs deliberate attention rather than speed.

Turn the sock inside out from the top down to the heel. Position the foot section carefully over the foot, ensuring the heel cup sits directly over the heel and the toe section, whether open or closed, aligns correctly with the toe structure. With an open-toe design, check that no toe is being pushed into an uncomfortable angle by the edge of the fabric. Roll the sock upward in small increments, smoothing the fabric completely flat against the skin at each stage before moving further up the calf. After full application, run a hand over the entire sock surface from ankle to top band to check for any wrinkles, twists, or areas where the fabric has bunched.

The Post-Application Check

For people with diabetes, a post-application skin check is a sensible daily habit rather than an occasional precaution. Approximately thirty minutes after applying the compression sock, remove it briefly and inspect the skin of the foot and lower leg for any areas of redness, indentation, or pressure marking that correspond to the seam or top band position. If any are present, the sock is either the wrong size, has been applied incorrectly, or has a seam construction that is not appropriate for a diabetic foot. Reapply the sock only after identifying and addressing the cause of the pressure marking. This thirty-minute check is particularly important in the first two weeks of wearing a new pair of compression socks.

Donning Aids for Diabetic Patients

Donning aids are valuable for any compression sock wearer who finds application difficult, but they are particularly relevant for people with diabetes who have reduced manual dexterity from peripheral neuropathy in the hands, or whose visual impairment from diabetic retinopathy makes careful foot inspection and sock alignment difficult. A frame-style donning aid allows the sock to be pre-loaded and the foot guided in without requiring a tight grip or significant visual monitoring of foot positioning. Rubber gloves with a textured grip surface improve control during the rolling stage for wearers with reduced hand sensation. Apply compression socks before standing up from bed wherever possible, when the foot is at its least swollen and the application is easiest to perform carefully.

Daily Foot Care Alongside Compression Use in Diabetes

For a person with diabetes using compression socks, daily foot care is not separate from compression management. It is integral to it. Compression socks change the pressure environment around the foot for eight to twelve hours each day, and for a foot with reduced sensation and potentially compromised healing, that sustained contact with the garment requires active monitoring rather than passive tolerance.

Each evening after removing compression socks, wash the feet in lukewarm water, checking the temperature with your hand rather than the foot to avoid scalding skin that cannot detect heat adequately. Dry thoroughly between the toes, where moisture accumulates under compression and can cause maceration of the skin that provides a route for infection. Apply an unperfumed moisturiser to the entire foot and lower leg, avoiding the skin between the toes. Inspect the whole foot carefully, including the sole and heel, for any new lesions, blisters, calluses, or areas of redness that correspond to the seam positions or top band of the compression sock.

When to Seek Urgent Podiatric or Medical Review

People with diabetes using compression socks should seek same-day assessment from their diabetes care team, podiatrist, or GP if they notice any of the following.

• New redness, swelling, warmth, or skin breakdown on the foot or lower leg that was not present before starting compression

• A wound or blister that does not improve within two to three days, or that shows signs of infection, including increasing redness, warmth, swelling, or discharge

• Skin discolouration in the toes, including blueness, whiteness, or darkening, during or after compression wear

• A pressure mark or indentation at the top of the sock that does not resolve within thirty minutes of garment removal

• Any pain in the foot or lower leg during compression wear, even if sensation is generally reduced, as pain in a neuropathic foot that is capable of reporting it is always significant

What to Look for in a Compression Sock for Diabetes

The features that define a good compression sock for a person with diabetes overlap with general compression quality standards but extend further into construction details that directly affect safety in a neuropathic, potentially arterially compromised foot.

The starting point is the same as for any therapeutic compression use: the garment must carry independent verification that it delivers a genuine graduated compression gradient from ankle to knee. Products that claim a compression rating without confirmed graduated pressure measurement should not be used for therapeutic purposes in diabetic foot management, where the consequences of under-delivery or inappropriate pressure are more serious than in a standard venous compression context.

MHRA Registration for Medical-Grade Compression

MHRA registration confirms that a compression garment meets the clinical standards required to make medical-grade claims in the UK. For a person with diabetes managing venous insufficiency or oedema as part of a complex lower limb picture, this registration means the ankle pressure is verified, the graduated gradient from ankle to knee has been independently measured, and the garment is produced to consistent standards. Main Squeeze Compression Socks carry MHRA registration as medical-grade compression products, which is the appropriate standard for therapeutic use in a condition with direct clinical implications rather than general leg support.

Flat Seam Construction at the Toe

The toe seam is the most clinically critical construction detail in a compression sock for diabetic patients. A raised seam across the toe tips applies sustained pressure to skin that may have no capacity to register it as pain. Over a full day of wear, this creates the conditions for a pressure ulcer at a site where wound healing is already impaired. Look specifically for compression socks with flat-knit toe seams that sit flush with the surrounding fabric rather than creating a ridge, or for seamless toe designs where the construction eliminates a toe seam. For people with significant peripheral neuropathy or a history of toe ulceration, open-toe designs are the safest option, as they remove the toe seam risk entirely.

Non-Binding Top Band

The top band of a compression sock must provide enough grip to prevent the sock from rolling down without creating a constriction that restricts blood flow or leaves a visible pressure mark on the skin. For people with diabetes and peripheral neuropathy, a top band that is too tight may go entirely unnoticed during wear and produce a ring of tissue damage above the compression zone. A well-designed top band for diabetic patients is firm enough to stay in place through a full day of activity but does not leave a visible indentation in the skin after removal. This is an easy self-test: remove the sock after a day of wear and check whether the skin at the top band shows a groove or ring of redness. If it does, the top band is too tight for that limb circumference, and either a different size or a design with a softer, non-binding band is needed.

Breathable, Moisture-Managing Materials

Diabetes impairs sweat gland function in affected areas, which reduces the body's ability to regulate moisture and temperature in the feet and lower legs. This, combined with the sustained contact of a compression garment, creates conditions in which moisture accumulates beneath the sock and increases the risk of skin maceration and fungal infection. Compression socks with moisture-wicking fabrics that draw sweat away from the skin surface and allow it to evaporate through the garment reduce this risk. Merino wool blends provide natural moisture management and temperature regulation and are particularly well tolerated by people with sensitive or compromised skin. Avoid synthetic fabrics that trap heat and moisture against the skin for extended wear periods, particularly during warmer months or in active roles.

A Clear and Safe Starting Point

Diabetes and foot health are inseparable, and compression socks are a meaningful part of managing lower limb complications for many people with the condition. The route to using them safely is not complicated. It requires the right clinical checks first, the right garment features for a diabetic foot, and the right daily habits to catch problems before they become serious.

If you have diabetes and are considering compression socks for leg swelling or venous insufficiency, start with an ABPI assessment arranged through your GP or diabetes care team. Once your arterial circulation has been confirmed as adequate, measure your ankle and calf circumference before rising in the morning, inspect your feet before and after each application, and choose a garment with flat toe seams, a non-binding top band, and moisture-wicking material.

Main Squeeze Compression Socks are available in 15 to 20 mmHg and 20 to 30 mmHg with MHRA medical-grade registration, a wide-calf option for men and women, flat seam construction at the toe, and breathable fabrics designed for all-day wear. Use the measurement guide above to find your size, confirm your arterial health with your care team first, and apply your socks before you stand up each morning. That sequence, done consistently, is how compression works safely for people with diabetes.

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Frequently Asked Questions

Can everyone with diabetes use compression socks?

No. People with diabetes and peripheral arterial disease must have their arterial circulation assessed before using therapeutic compression socks above 15 mmHg. An ankle-brachial pressure index test is the standard assessment, and compression is contraindicated where ABPI results indicate significantly reduced arterial perfusion. People with diabetes and intact arterial circulation, confirmed by ABPI, can generally use graduated compression socks at the level appropriate to their venous condition with standard precautions and daily foot monitoring.

Is 20 to 30 mmHg safe for people with diabetes?

It can be, but only when arterial circulation has been assessed and confirmed as adequate. For people with diabetes and a normal ABPI, 20 to 30 mmHg compression for confirmed venous insufficiency is appropriate with daily foot monitoring. For people with diabetes and borderline or reduced ABPI values, lower compression levels under clinical supervision are more appropriate. Do not apply 20 to 30 mmHg compression to a diabetic foot without a prior vascular assessment if there are any symptoms of arterial disease or a history of foot complications.

How often should I inspect my feet when wearing compression socks?

Daily inspection, both before applying and after removing compression socks, is the minimum standard for people with diabetes. For those with significant peripheral neuropathy who have begun wearing compression socks for the first time, a brief mid-day check by removing the sock and inspecting the foot and lower leg for thirty minutes is worth adding in the first two to three weeks until you are confident the garment is fitting without causing pressure-related issues.

Should people with diabetes wear compression socks to bed?

No. Overnight compression is not appropriate for most people with diabetes managing venous oedema. The horizontal position during sleep assists venous return passively, and overnight compression in a diabetic foot increases the risk of localised pressure injury during hours when the foot is not being monitored. Remove compression socks before bed and perform the evening foot inspection described earlier in this article as part of that routine.

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