Diabetes is fast becoming a major heath concern, with 6% or 1.2 million Australians reported to have diabetes (types 1 and 2) in 2014-15 (1). Podiatrists play an important role in preventing complications in the feet of people living with diabetes. Because the feet are the furthest point from the brain and the heart, complications from diabetes often occur there first. This is one of the many reasons doctors may recommend foot checks as part of routine diabetes care (2).
What an assessment involves
Podiatry is an integral part of health care in the management of diabetes. We’ve also written about why you should get your feet checked here. In an assessment, a set of routine questions are asked to assess overall all health.
These questions will also explore how well your diabetes and blood sugars are being controlled, and to see if there are signs of complications. The clinical tests performed in an appointment are aimed at detecting change in nerve function, circulation/blood flow, movement and flexibility of feet (3).
Circulation and Blood Flow Assessment
As with the blood vessels in your heart, the arteries in your legs can become hard or clogged with fatty deposits. This can reduce circulation to your feet and affect the delivery of nutrients and oxygen to the muscles and tissues.
To assess blood flow to the feet, a podiatrist may feel for pulses on your feet, or look at the colour and health of your skin and nails. A Doppler (ultrasound device) may also be used to listen to the blood flow in your arteries to see how well the blood is travelling from your heart to your feet. Depending on the findings of these tests, the podiatrist may look to take your blood pressure in your ankle.
This happens exactly the same as how your doctor takes your blood pressure on your arm. This is called an Ankle Brachial Index or an ABI. By taking blood pressure at the ankle, podiatrists are able to compare the reading against the blood pressure in the arm. If the pressures are the equal (or close to equal) that indicates your feet are getting healthy blood flow.
Neurological (Nerve) Examination
Nerves are responsible for movement, feeling (sensation) and protective responses such as reflexes. They also have other important functions which are less well known, including; sweating, blood flow and proprioception (knowing the position of the body in space).
Diabetes may become problematic for nerve function when blood sugar levels are not well controlled. If sugar levels are too high for a prolonged period of time the nerves and nerve insulation (myelin) can be damaged.
Neurological examinations are designed to test these different functions. The most important neurological function for a diabetic, is to have protective sensation or the ability to feel light touch.
This is tested with a device called a monofilament which applies only 10 grams of pressure when touched to the skin. 50% of diabetics have lost this protective sensation. This is also referred to as peripheral neuropathy (4).
Other nerve functions a podiatrist may check include; reflexes, ability to feel vibration and detection of joint position. These tests should be performed with eyes closed so its only the nerves which can give your brain the information!
How to Prevent Complications
There are a number of easy things you can do to prevent complications with your feet.
Check your feet daily.
Scratches or blisters can become serious quite quickly. Particularly when you have poor blood flow or a loss of sensation as mentioned previously. It is as simple as setting up a mirror on the ground to have a look at the soles of your feet.
Alternatively, try using a phone or camera to take photos of your feet. This was you can see them in more detail and zoom in if required!
Dry in between your toes.
Moisture in between your toes can cause the skin to break down. This is important particularly when you have swelling, suffer from fluid retention or live in hot, humid climates. Once there is a breach in the skin, this can become painful and leave the foot prone to infection.
Being sure to dry in between your toes after every shower is a good way to prevent any of these complications. You could consider an application of metholated spirits (wiped over area with a cotton ball). Alternatively, a foot soak in Condy’s Crystals (potassium permenganate) to help dry out problem areas (5).
Wear appropriate footwear
Good shoes plays a very important role in preventing complications in diabetes. Particularly if there are problems with sensation. Footwear provides protection from trauma such as splinters and scratches.
It is crucial that the shoes must fit well as to not cause issues such as blisters from rubbing or pressure sores from being too tight. Remember, before putting your shoes on check that they are free from rocks and any other loose debris!
Your podiatrist should make recommendations on how frequently you should have a foot assessment. Depending on their findings it may be recommended that your feet are assessed either annually, 6 or 3 monthly.
These time frames are based on test results and are aimed at monitoring for changes and preventing complications. Complications can become serious suddenly, so your podiatrist may refer you to be managed by your GP or outpatient clinics at hospitals.
If managed in the hospital system, specialists such as orthopedic or vascular surgeons can be involved in care quickly if required.
Even if you do not have diabetes but are concerned about your feet, consider getting them checked by a podiatrist. Symptoms such as tingling or numbness in your feet, cramping while walking or when lying down, or a sore which is slow to heal should be checked out.
Remember, complications from diabetes can be prevented with appropriate care. When it comes to your feet, if in doubt – get them checked out!
We’re currently running a special offer for Diabetes Foot Assessments. Please contact our friendly reception staff on 6262 4464, to find out more!
- Australian Institute of Health and Welfare 2017. Burden of lower limb amputations due to diabetes in Australia: Australian Burden of Disease Study 2011. Australian Burden of Disease Study series no. 10. BOD 11. Canberra: AIHW. https://www.aihw.gov.au/reports-statistics/health-conditions-disability-deaths/diabetes/overview
- National Evidence-Based Guideline on Prevention, Identification and Management of Foot Complications in Diabetes. (Part of the Guidelines on Management of Type 2 Diabetes) 2011. Melbourne Australia
- International Working Group for the Diabetic Foot: http://iwgdf.org/
- Dros J, Wewerinke A, Bindels PJ, van Weert HC. Accuracy of Monofilament Testing to Diagnose Peripheral Neuropathy: A Systematic Review. Annals of Family Medicine. 2009;7(6):555-558. doi:10.1370/afm.1016.