Having diabetes increases the risk of developing foot problems. Unfortunately, diabetes and foot problems can go hand in hand. This applies for those with Type 1 and 2 Diabetes Mellitus. People with diabetes need to be careful as they require ongoing assessments and monitoring. As blood glucose (sugar) levels can increase quickly, it is easier for foot infections to take hold and cause further complications.
Other factors such as less blood flow and loss of feeling in the lower limb can also occur and can lead to injuries without a person noticing them. A podiatrist will thoroughly investigate a clients risk assessment status with a classification of either low, moderate or high risk, and will provide full education on how to care for any foot problems in order to prevent injury. At Pod Fit Podiatry all diabetic patients are provided with a management plan and a letter sent to their treating doctor, filled with information about their assessment and treatment.
Foot assessments for Diabetes include
Having a regular foot exam with a podiatrist is one of the best ways to keep on top of foot health.
Diabetic foot assessments are a specialised service offered by podiatrists. The appointment involves taking a full health history and having a thorough assessment performed to check for any risk factors of deterioration. A podiatrist is an important allied health professional involved in both Type 1 and Type 2 Diabetes care management. They are often one of the first therapists that Doctors will refer to when a client is first diagnosed with Diabetes. This ensures that management is optimal starting from the earliest possible point in time.
An initial foot examination includes:
- Nerve sensation checks (ability to feel pressure, touch, temperature)
- Vascular circulation testing (assessing blood flow to the feet and toes through either hands-on palpation or use of a doppler ultrasound in the clinic)
- Assessing areas of high loading, and areas at increased risk of ulceration (3D foot pressure assessments)
- Identifying areas of skin build up
- Identifying any toenail concerns
- Footwear issues and recommendations
- How you walk (your biomechanics)
- Muscle strength and control
- Assessing and treating foot ulcers if they are present
- Hands on treatment for any toenail, skin or musculoskeletal problems
Evaluation of the diabetic foot helps to provide individuals with useful information on how to self manage their condition. It is through education and treatment at a primary care level through a GP and podiatrist, that further intervention is not required or delayed at a tertiary setting in the hospital. Many hospital complications can be managed in a clinic setting when caught early on.
Potential complications of Diabetes:
Over months and years of having diabetes the body can be affected in a number of different ways. Diabetic foot changes can be noticed at any age, and they are largely dependent on overall blood glucose control as well as what other health conditions are present over time.
The main complications that occur include changes to vascular flow, nerve sensation, infection risk, nail and skin changes and pressure areas on the feet.
Listed below are the main complications seen by a podiatrist that will be flagged during an appointment if found.
- Deterioration of vascular blood flow to the legs, foot and toes
- Diabetic Peripheral Neuropathy with less feeling present
- Undetected foot injuries
- Skin changes including callus and corn formation
- Thickened or ingrown toenails
- Foot posture changes
- Gait changes
- Foot ulcers (wounds with slow healing)
A thorough and well explained foot examination will help a client to understand if there are any issues with the feet that require treatment. Treatment may involve regular podiatry care to assist with toenails or corns, a 3,6, or 12 monthly checkup, or may be simple strategies to use at home.
Blood flow and sensation changes with Diabetes
The main concern with foot and leg changes in those with diabetes, is the slow deterioration of blood flow and nerve sensation to the lower legs. The technical term for blood flow changes is peripheral vascular disease, and for nerve changes is peripheral neuropathy.
Some clients may find that blood flow and nerve changes can be quite rapid yet for the vast majority it is a slow change over time that worsens with poor sugar controls and other chronic health conditions. It is so important to have a regular foot examination to monitor these changes over time. Issues may be detected by symptoms that arise, while other times they can occur without notice which is where problems can certainly occur.
Blood Flow Testing
Blood flow testing involves hands-on testing as well as general observations. The podiatrist will check two main pulses in your feet using hands on assessment. If they are unable to find them clearly they will use a doppler ultrasound device in which the client will be able to hear the sound and frequency of your blood flow left to right. This non-invasive assessment is performed in the clinic room.
Other signs of arterial disease can be observed in the appointment also. Observations may include lack of pulses, a quiet or monophasic pulse, and a clear difference between the pulse sound each foot. Other signs of good flow will include pink and warm skin, hair presence on the toes and legs, pink toenails and quick capillary flow to each toe when pressed at the tip. All risk factor observations will be flagged to the client and treating doctor.
The nerve sensation is tested in a few different ways during the diabetic foot examination. Nerve testing involves testing fine touch, vibration, reflexes and screening of nerve symptoms. Nerve symptoms can include numbness, burning, sharp pain and pins and needles in the feet and legs. The Podiatrist will check balance (proprioception) using a tuning fork which will show the degree of protective sensation on each foot. A monofilament will also be used to detect fine touch losses or differences between the feet. Finally, a reflex hammer can be used to assess ankle joint reflexes.
The combination of not being able to feel the feet if they are numb, with having less blood flow, increases the risk of having foot ulcers and wounds with slow healing. To avoid ulcers and other complications, it is best to see a podiatrist as they recommend for a regular diabetic foot examination. It is also helpful to regularly monitor the feet for any changes in colour, temperature, pain and toenail/skin health. This ensures less likelihood of painful symptoms, hospital visits over time, recurrence of ulcers, and potential amputations from happening (in more severe cases).
I’ve got Diabetes. what should I do?
It is strongly recommended to see a podiatrist for a checkup for any person diagnosed with diabetes. Podiatrists will conduct a full circulation and nerve assessment and point out areas that require treatment. This can include treatment that is provided immediately at the appointment, as well as the offering of simple self management strategies that can be performed at home. If a client is not coping independently then ongoing treatment will be recommended. This is helpful for for regular nail and skin maintenance, or musculoskeletal pains or aches that benefit from in clinic treatment. For some clients an ongoing three, six or twelve monthly review will be booked.
Having a regular examination has been shown to reduce the ill effects of deterioration over time, particularly when it comes to circulation or sensation changes and foot ulcer formation. Foot ulcers can form when there is a loss of feeling in the feet, and a person becomes injured without knowing that they are. Over time they can continue to walk on the injury or wear shoes that are rubbing onto it without having an awareness that it is there. This is why regular monitoring is the best prevention, along with having an ongoing diabetic foot exam performed with a podiatrist. Diabetes care can save your limbs and your life!
When urgent care is needed
Certain foot injures will require urgent medical care for diabetic patients. It is best to look out for any clinical sign that may indicate infection or injury and monitor closely. If symptoms are deteriorating or you are not quite sure, it is best to have an expert assess any concerns.
Clinical practice guidelines for immediate care:
- Ingrown toenails
- Redness (see emergency if redness is tracking up your leg)
Diabetic foot disorders can be managed quickly when receiving adequate medical care. If you notice any of the urgent clinical signs we urge you to seek care immediately from a podiatrist. If you are experiencing a fever alongside any listed symptoms then it may be required to see a GP or visit hospital emergency care.
Facts About Diabetes In Australia – what do the systematic reviews say:
- Diabetes is a serious and complex medical condition which is estimated to affect 1.7 million Australians and is continually rising.
- It is the fastest-growing chronic disease in Australia.
- With diabetes, foot nerve damage is affected in 13% of cases, and circulation damage in 14% of cases.
- Diabetes is the leading cause of lower limb amputation
Frequently Asked Questions
What happens during a diabetic foot exam?
Your podiatrist will assess your blood flow, nerve sensation, walking and overall foot health. The podiatrist will provide hands on treatment to nails and skin if required in the appointment. Information will be provided to you and your Doctor from this appointment.
Is there anything else I need to know about a diabetic foot exam?
It is important to be aware of your general health status – please bring a list of any medications you are on, as well as any other health conditions.
Why do I need a diabetic foot exam?
Diabetic foot exams provide you with valuable information on how to best look after your feet. Many diabetic foot wounds, ulcers and amputations are largely avoidable when the feet are regularly checked.
How can diabetes affect my feet?
Diabetes affects blood flow, sensation, and slows healing in the lower legs. It can cause injuries without being noticed and can lead to disablement over time. Much of this is largely preventable with regular podiatry assessments.
What causes a diabetic foot?
Diabetes can be due to genetics, overall health, body weight, the effect of other health conditions and lifestyle factors. The diabetic foot as such is an issue that occurs either over time or with poor blood glucose control.
Why is a foot exam important?
Foot exams help to keep the feet in healthy and working order. Any issues can be picked up quickly and improved upon.
When should I see my health care provider about foot problems?
A podiatrist should be seen within the first month of being diagnosed with diabetes. Your podiatrist will advise on the frequency of appointments moving ahead.
How is it diagnosed?
Diabetes is diagnosed through a series of blood tests from your Doctor.
How to give yourself a foot exam?
Each day it’s important to wash and dry between the toes. You can have a good look into the spaces between the toes, the toenails, the general appearance of your feet, and any new lumps and bumps. If you have any concerns see your podiatrist immediately.
What can I do to keep my feet healthy?
Maintaining the best general health is a fantastic way to ensure your feet and the rest of your body are going well. The better that your blood sugar levels are managed over time, the better and healthier your feet will be too. Having a visit to a podiatrist on an as recommended basis helps to keep feet in optimal health too.
Take action and be in control of your Diabetes today!