Diabetes is a condition that develops when the pancreas either fails to produce enough insulin to control the amount of glucose in the blood, or fails to use the insulin properly.
There are approximately 4 million people living their lives with diabetes and around 10% will have a foot ulcer in their life time. Many people with diabetes are not actively seeking the necessary or recommended treatment and care for their feet.
How does Diabetes affect the feet?
Diabetes can reduce the circulation and sensation in your feet, diminishing awareness of changes in temperature, and of pain and touch. A complication of diabetes is reduced circulation (ischaemia), which reduces the blood flow to the peripheral tissues. When combined with poor glucose control, smoking, poor footwear and the feet not being examined, ischaemia can lead to an increased risk of foot lesions and infections, which may result in foot ulceration. In extreme cases foot ulceration may lead to amputation.
Of course, this is not always the case - if noticed in time the ulcer can be treated. The loss of sensation, which often starts at the toes, is known as Peripheral Neuropathy. As a result, foot problems may occur without you being aware of them. Diabetes is likely to affect the body’s ability to heal, so any minor cuts or blisters may turn into a more serious problem if left untreated.
Diabetes can cause nerve damage; this is called Neuropathy. Sensory Neuropathy mainly affects the nerves in the feet and legs. The main danger of sensory neuropathy is loss of feeling in the feet. This means you may be unaware of any injuries or changes to your feet, which, if left untreated, may lead to more serious problems.
Symptoms of Neuropathy
- A tingling sensation, similar to pins and needles, in the toes, feet or lower leg
- Numbness in the feet
- Pain - a burning sensation, pins and needles or shooting pains in the feet, which can extend into the legs
- Cracked & dry heels
- High arch on feet and/or clawing of the toes
What can your Podiatrist do for you?
A diabetic assessment will be carried out. This will involve noting your HbA1c (Glucose control), checking your blood supply, testing the feeling in your feet, checking for any other symptoms, and giving advice on any changes in your lifestyle that are required.
Both feet will be examined for:
- Condition of the toe nails
- Dry, flaky skin
- Evidence of fungal infection
- Colour of the skin on the feet and legs
- Abnormal skin lesions
- Corns, calluses and any other deformities
- Evidence of infection - ie. pain or lack of pain, numbness, inflammation or cellulitis (an infection of the skin and subcutaneous tissue)
- Sensitivity to touch
Your podiatrist will then carry out the necessary treatment, which may be carried out over repeated visits, and will also give advice on how you can look after your feet. Your podiatrist will also examine your shoes and give you advice on the correct type of footwear you should wear.
There are ways of keeping your feet healthy and preventing further damage
- Check your feet daily for blisters, breaks in the skin, signs of infection, heat or redness
- Carefully wash your feet in warm water and dry them carefully, especially between the toes, and dress any wounds on the feet
- Ensure your blood sugar, cholesterol and blood pressure levels are healthy in accordance with your GP
- If you smoke you are strongly advised to stop. Smoking affects your circulation and can lead to amputation
- Avoid temperature change - if your feet are cold, wear socks; do not get into a very hot bath or put your feet too close to a heat source. It is easy to burn the feet if you have loss of sensation
- Wear properly fitted shoes and always check them inside for no small objects before putting them on
- Exercise and eat healthy
- Always follow advice from your Podiatrist and GP