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What can you tell of a man by the shoes he steps out in? If possessed with the analytic prowess of Sherlock Holmes then ‘a little reddish mould adhering to your instep’ might be all it takes to tell that your long-suffering companion Watson has been to the Post Office on Wigmore Street where ‘they have taken up the pavement and thrown up some earth, which lies in such a way that it is difficult to avoid treading in it on entering.’1

As affected as such comments may now sound to our modern ear, there is much to commend the detective's ability to put together a story from careful observation of footwear.

Sometimes the story shouts out loud. The shoes in the picture below belonged to an eccentric but socially-isolated man with neuroischaemic feet who tried to accommodate the swelling from the infected ulceration of his left second and right first toe by de-lacing his shoes and adding bespoke vents with tin snips from the shed.

More often the story is more subtle, made more difficult by the injury amnesia engendered by neuropathy. However, diabetic foot lesions are not miraculous stigmata. There is always a reason to explain their appearance and the answer is often lying at your feet. If visual inspection draws a blank, run your hand carefully along the inside of the shoe worn when the injury occurred. Lost pins, coins, front door keys, and golf balls (honest!) will all be rediscovered. As Holmes explained to Watson, ‘Eliminate all that is impossible, whatever remains is the explanation, however improbable.’

• © British Journal of General Practice, 2008.