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Diabetes

Foot care amongst diabetics is incredibly important. As many as 1 out of 10 diabetes sufferers are affected by foot ulcers at  some point during their life time with diabetes.

 

Over time diabetics may suffer from a condition called diabetic neuropathy. This condition usually presents as peripheral neuropathy affecting the sensory nerves in the lower limbs. If this occurs and your nervous system becomes  even slightly damaged, the extremities (feet/hands) of the body can become numb.  As a result of peripheral neuropathy you may not be able to detect problems that have developed on your feet.  In some cases these problems can become limb and/or life threatening.  

 

People with diabetes are also at an increased risk of peripheral vascular disease.   This causes a reduced blood supply to the lower limb which can lead to impaired healing.  

 

Detection and monitoring of diabetic neuropathy and vascular status are an essential routine part of managing diabetes.  As part of a diabetic review, our trained podiatrists will examine your feet to detect risk factors for ulceration.  If any concerns arise that we are unable to manage, we are able to efficiently  communicate with appropiate health services eg. your GP or district nurse.

A diabetes review will include:

  • Testing of foot sensation using a 10g monofilament and tuning fork

  • Palpation of foot pulses or if needed a doppler assessment

  • Inspection of any foot deformity and footwear

  • Classification of foot risk

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Definitions of the diabetic at risk foot:

Low Risk

  • no risk factors present except callus alone

Moderate Risk

  • deformity

  • neuropathy

  • non-critical lower limb ischaemia (reduced blood flow)

High Risk

  • previous ulceration

  • previous amputation

  • on renal placement therapy

  • neuropathy and non-critical lower limb ischemia together

  • neuropathy in combination with callus and/or deformity

  • non-critical lower limb ischaemia in combination with callus and/or deformity

Ulcerated Foot

  • Clinical Emergency

Affects of Diabetes to the lower limbs

 

Vascular - Blood Supply

People with diabetes can develop foot problems due to damage to blood vessels to the leg and feet.  This means that injuries can take longer to heal as less blood gets to the skin, muscles and soft tissues.  A severe disruption of the blood supply to the lower limb is known as Ischaemia.  This occurs when an obstruction occurs in the arteries.

Symptoms include:

  • Cramping in the calves

  • Smooth shiny skin

  • Loss of hair on the legs and feet

  • Thickened toenails

  • Pale cold feet

  • Skin colour changes of the feet

  • Wounds

  • Foot pain upon elevation, eg when going to bed

Neurological - Motor and Sensory Nerves

Long term or poorly controlled diabetes can cause damage to the nerves (neuropathy).  Neuropathy is usually divided into 2 categories - Peripheral and Autonomic neuropathy

Symptoms include:

  • Tingling or buzzing in the feet (parasthesia)

  • Pins and needles (dyethesia) which can become an intense or burning sensation.  It can be intermittant or constant depending on the amount of nerve damage and the nerves affected.

  • Muscle pain different from above, more spread out and feels like cramp.

  • Loss of temperature perception - the feet become more sensitive to cold but less sensitive to heat.

  • Exaggerated sensitivity to the skin (hyperesthesia).  Wearing socks or tights can become very uncomfortable and minor trauma can be very painful.

What to check for

  • Swelling

  • Redness or any changes in skin colour

  • Cuts or blisters

  • Pain or discomfort

  • Discharge coming from a wound

  • Place a mirror on the floor so you can check the bottom of your feet

Foot care

  • Wash feet daily in warm soapy water - not hot especially of you have impaired sensation

  • Dont soak your feet for too long.

  • Dry your feet gently, in particular between your toes.

  • Rub a foot moisturiser on the top and bottom of your feet.

  • Do not rub moisturiser in between your toes - it will make the skin too moist.

Prevention methods

  • Do not walk barefoot.

  • Wear only good fitting shoes.

  • Wear in new shoes slowly.

  • Cut toe nails straight across - not into the corners.

  • Do not use heating pads, hot water bottles on the feet.