Foot complications in diabetes are common but they could post a lifetime disability if no proper foot care is taken. A simple foot ulcer might seem ignorant and non-critical; however, failure of foot ulcers healing can lead to amputation. Of those who have an amputation, about half will experience a subsequent amputation of the other limb. Five-year survival for those who have had limb amputation is poor.
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It is estimated that 15% of people with diabetes will develop a foot ulcer during the lifetime and foot ulceration is a leading cause of hospitalization for people with diabetes (reference). Foot ulcer also accounted for more hospital admissions than any other diabetic complications. As a podiatrist, we are the expert to provide you with the best advice and services in preventing and minimizing your chance of getting a foot ulcer.
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Diabetes can affect the feet in a number of ways, mainly the circulation and nerve supply. (refer here for more detail info)
Blood Supply/Circulation
Poor blood glucose control can cause a reduced blood flow with fewer nutrients/proper nourishment to the feet. This means any injury that breaks the skin or soreness will take longer to heal and therefore, resulting in higher risks of infection.
Signs of poor blood flow include - cold feet, skin of the feet appeared reddish-blue, cuts which are slow to heal, sharp leg cramps after short walking distances or upstairs, pain in the feet - even at rest and often at early morning hours.
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Nerve sensation
Poor blood glucose control can cause nerve damage to feet and reduced sensitivity of the nervous system. This means the diabetic individual may lose some or all feeling in the feet. This increases the risk of accidental damage as they cannot feel any pain. They may not realise they have cuts or blisters that can lead to ulcers that can penetrate to the bone, lead to bone infection (osteomyelitis) and chronic infection in the bones and joints. If an infection is not treated at the earliest signs, this could result in ulceration (an infected open wounds) and eventually amputation (removal of a toe, foot or limb).
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Symptoms of nerve damage include
numbness, coldness, pins, and needles or tingling sensation in the feet, burning sensation or pain in the legs and feet (usually more noticeable in bed at night).
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Other foot complications include
Foot structures - weakened bones causing a shift in the foot, which may change the way the foot distributes pressure; collapsed joints.
Skin conditions - Dryness, cracked heels, blisters, and calluses, a person with diabetes may be more vulnerable to blisters and calluses formation. Also, ulcers or wounds occur more easily as a result of the breakdown of several layers of skin.
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Role of Podiatrist In Diabetes Management
The role of a podiatrist in diabetic foot care ranges from regular prevention and education to identifying and treating problems before they get out of hand. By including a podiatrist in your diabetes care you can reduce the risk of lower limb amputation up to 85%. Podiatrists play an integral role in amputation prevention by performing regular foot screenings and early recognition of potential risk factors.
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At Passion Podiatry, we can assist by
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Conducting a diabetic foot examination every 6-12 months to identify early signs of potential foot complications such as decreased blood flow, nerve sensation, abnormal skin lesions, weakened bones and collapsed joints.
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Providing routine foot care - trimming nails to prevent them from becoming thickened and ingrown; managing skin conditions such as blisters or corns so that they do not become ulcerated and lead to infections.
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Providing advice and education on footwear and devices to relieve pressure and abnormal pain sensitive sites on the feet.
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Ensure any infection, laceration, wounds or signs of a foreign object in the foot are treated promptly.
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Signs And Symptoms To Seek Advice From A Podiatrist
A person with diabetes should seek advice when they notice:
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Colour changes in feet - when paleness or bluishness of the toe occurs, this indicates a decrease in circulation. Abnormal swelling and tenderness occur, this may be the result of poor circulation or infection. Black skin is a sign of dead tissue, and redness with streaks is often a sign of infection.
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Temperature changes, especially extra-warm areas which may indicate an infection has started; extra coolness may mean a decrease of circulation.
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Pins and needles, numbness, tingling, burning is experienced, this may be the result of nerve damage in the foot.
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Hot, inflamed spots - these may turn into blisters, corns or calluses. These maybe a result of friction or pressure.
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Cracks, wounds, and ulcers develop - these may be caused by dry or irritated skin, decrease in circulation, or abnormal pressure.
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Foot Care Tips For Diabetic Patient
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Good control of blood sugar levels and maintain proper health through diet and exercise.
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Quit smoking as it can affect your blood circulation.
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Inspect your feet daily. Check for cuts, blisters, redness, swelling or nail problems. Have a friend or family member help you. You may use a mirror to help you if no one is available to help you.
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Maintain good foot hygiene. Wash your feet daily with warm water and antibacterial soap. Make sure you check the temperature of the water before you place your feet in a tub to avoid burning. Dry your feet thoroughly in between your toes.
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Trim your toenails carefully. Trim your toenails straight across and file the edges with a nail file. Do not cut the nails too short, as this could lead to ingrown toenails. If you need help with toenail cutting, consult our podiatrist today.
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Never treat corns or calluses yourself. No “bathroom surgery” or medicated pads.
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Keep your feet soft and smooth. Apply a thin coat of skin lotion over the tops and bottoms, but not between your toes as that could encourage a fungal infection.
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Maintain proper circulation to your feet. Elevate your feet when at rest, avoid prolonged crossing of the legs and exercise regularly.
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Wear socks and comfortable footwear including custom molded orthotics and/or diabetic shoes that fit well and protect your feet at all times. Consider socks made specifically for patients with diabetes. These socks have extra cushioning, do not have elastic tops, are higher than the ankle and are made from fibers that wick moisture away from the skin. Inspect your shoes thoroughly before placing them on each time to make sure the lining is smooth and there are no objects inside. Never walk barefoot and protect your feet from extreme temperatures. Wear socks at night if your feet get cold.
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Visit a podiatrist on an ongoing basis to ensure proper foot health. Prompt treatment for any foot problem is important and you should visit your physician immediately if you suspect any issues with your feet.
A diabetes diagnosis can be overwhelming. It comes with a lot of lifestyle changes and a lot of concerns. Our feet are literally the furthest organ from our minds, so it is not surprising that many people overlook them. The good news is that those small steps of examining your feet once a day and seeing your podiatrist as required can really help to prevent some of the more serious complications of diabetes. Book an appointment with us today.