Diabetes is a complex progressive condition. Normally your pancreas produces insulin after food to help digest and absorb nutrients. When you have diabetes this process doesn’t happen normally leaving various organs not functioning properly. The longer the problem is undiagnosed or has been poorly controlled the greater the chance of complications. The feet are one of the most severely affected as they are furthest from your heart and are affected by poor circulation. The long nerves are also at their most vulnerable in the feet. The combination of poor circulation; therefore poor healing, and being vulnerable to damage means feet are one the most likely parts of the body to get wounds and infections, this is sometimes called diabetic foot condition.

It is advised to have an assessment of your feet after being diagnosed to ascertain your foot health status. Annual checks can then help to monitor progress and guide you in your self care.

For general information on understanding diabetes visit:
http://www.leicestershirediabetes.org.uk/

Glucose intolerance/borderline diabetes

Lifestyle programs

For activities in our state or further advice on diet and lifestyle try the Heart Foundation:

Heart Foundation

 

Psychological support

“Diabetes counseling online” www.diabetescounselling.com.au is a web based specialist psychosocial counseling service for people with diabetes and their families. It’s free and funded under the National Diabetes Services Scheme (NDSS).

Newly diagnosed type 1

Diabetes Australia
Membership to Diabetes Australia can be helpful for support and information. See their website here:

http://www.diabetesaustralia.com.au/
The Queensland based diabetes association website can be seen here:

http://www.diabetesqld.org.au/

Reality check
Support for adults by other adults with type 1 diabetes can be found on the “reality check” website:

http://www.realitycheck.org.au/

Newly diagnosed Type 2

Diabetes Australia

Membership to Diabetes Australia can be helpful for support and information.

http://www.diabetesaustralia.com.au/

The Queensland based diabetes association can be found here:

http://www.diabetesqld.org.au/

IDF

For the latest updates on what’s happening in the world on diabetes see the International Diabetes Federation website here:

http://www.idf.org/

Tinea

‘Tinea’ or ‘athletes foot’ are names to describe a fungal infection of the feet. Tinea is more common in the diabetic foot.  The skin can have many different appearances from red and scaly to peeling skin or moist white skin between the toes. Skin conditions are complex and a skin scraping may be required to diagnose the problem. It is advisable if any changes in the skin are seen to contact your podiatrist or doctor for advice and treatment.

Neuropathy symptoms/control

Diabetic peripheral neuropathy is the term used when nerve damage occurs in the feet (and sometimes hands) caused by diabetes. It usually occurs because of poor glucose control and can become worse with sudden changes in control. The nerve damage means that you will not feel any damage to your diabetic feet. It can be painless or very painful with symptoms ranging from ‘feeling numb’, cotton wool, burning, pins and needles and sharp shooting pains. In the majority of cases painful neuropathy will become painless over a period of time. There are medications, which can help, or it may be necessary for your G.P. to refer you to a pain management clinic.

Foot check before starting exercise program

It is advisable to see a podiatrist for a foot check to determine status before starting a program, as peripheral neuropathy or foot wounds mean exercise needs to be modified.

Heel pain is a common presentation when starting exercise with diabetes, as connective tissues are tight. A podiatrist can help treat heel pain.

General advice for looking after your feet can be found in our brochure: “Foot care affected by diabetes” (pdf link)

Diabetes for Many years > 8

Complications/ tight control
The best way to prevent diabetic complications is to have tight blood sugar control using diet and prescribed medication with exercise.

For information on diabetes complications and feet in particular visit here .

Peripheral neuropathy

Some of the longer-term complications of diabetes only appear after some years of disease process. About 50% of people with type 2 diabetes (T2D) will have some degree of peripheral neuropathy after 10 years.

Diabetic peripheral neuropathy is the term used when nerve damage occurs in the feet (and sometimes hands) caused by diabetes. It usually occurs because of poor glucose control and can become worse with sudden changes in control.

The nerve damage means that you will not feel any damage to your feet. It can be painless or very painful with symptoms ranging from ‘feeling numb’, cotton wool, burning, pins and needles and sharp shooting pains. In the majority of cases painful neuropathy will become painless over a period of time. There are medications, which can help, or it may be necessary for your G.P. to refer you to a pain management clinic.

Charcot foot/ neuroarthropathy

When extensive neuropathy is present, the foot is at further risk of a type of arthritis called “charcot foot”. If you have peripheral neuropathy and one foot feels hot seek urgent medical assistance, as this could be the ‘neuroarthropathy’ process at work. Podiatrists are the health care practitioners that see the most of these conditions and can help diagnose and treat ‘Charcot feet.’

For more information on this matter – see: mydiabetesmyway.scot.nhs

Connective tissue/ bone density

There are many different parts of the body that the constant high blood sugars affect. The normally elastic connective tissues can become more rigid and are therefore prone to problems. There is some evidence that bone density can be reduced and therefore more prone to small fractures. A podiatrist can help diagnose these sorts of problems; prescribe x-rays and make pressure-relieving insoles.

Peripheral vascular disease (P.V.D)

Reduced blood flow to the feet can be a complication of diabetes; this can lead to cramping pain in the calves and buttocks and/ or pain while resting in the feet. Smoking causes closure of the small blood vessels in the feet and reduced oxygen supply to the skin. Even though the skin is warm and red it is also shiny, slightly swollen and tight. Correct diagnosis and treatment if possible through vascular examination. A podiatrist is part of your care team that can help with diagnosis and foot care advice when you have PVD.

Gangrene

Gangrene occurs when there’s insufficient blood flow to supply the skin. It usually starts at the toes and works backwards towards the foot. The skin turns a black colour, and also may develop an ulcer. If you have any doubt about an area of your foot it is best to seek advice early from your podiatrist or medical practitioner. Not all things that are dark in colour on the foot are gangrene.

Infection/immune system changes

Simply having diabetes leaves your feet at higher risk of developing infections. The immune system that normally fights disease is not as effective when you have diabetes. Tinea is a common presentation of a fungal infection. Most wounds will have multiple bugs living in it. It is important to seek timely medical help when infections are present. Your podiatrist can help alert you to what changes to look out for.

What can be done

Daily diabetic foot check:
Nerves act as our bodies early warning alert system. When the nervous system doesn’t work properly such as with ‘peripheral neuropathy’, a complication of diabetes we need to rely on our other senses to act as the back-up early warning system.

It is advisable to check your feet, or have someone else take a look every day to notice any changes and act on them quickly. Acting quickly to any changes can mean the difference between a minor treatable condition and something that can become limb threatening. Check feet daily for cuts, blisters, bruises, or colour changes, swelling and open sores.

If you think something might be wrong and wish to contact us:
Phone 5445 1376
e-mail: reception@buderimpodiatry.com.au

 

Annual foot assessment

Changes will occur over time with ageing or the progression of the diabetes. An annual foot check is recommended to evaluate the risk status of developing foot complications and ultimately of amputation.

Things checked in the annual assessment are: circulation, nerve supply and other known risk factors that can lead to ulceration such as toe or boney deformity.

Risk levels vary from low risk with intact nerve supply and circulation to high risk after a previous amputation or ulceration.
Advice on foot-care can then be tailored to meet your needs.

We can send out a postcard reminder when your foot check is due if you are not a regular patient.

Vascular treatment

The supply of blood to the feet is crucial to maintaining foot health. Walking is one of the best exercises that uses all of you leg muscles and forces the blood into all of the tissues.

If you experience cramping in your legs when walking that is relieved with rest, consult your doctor.

If you smoke and have diabetes, you can improve the circulation in the small blood vessels in your feet by stopping smoking. This may make the difference between keeping and loosing your leg. Most amputations as a complication of diabetes are in people with peripheral vascular disease.

If referrals are required to a vascular surgeon, this is done through your general practitioner.

If you need help stopping smoking see you general practitioner.

Or contact the quit line 131 848
Quit Now

Footwear

Shoes are the best means of protection of your feet. If shoes are worn out, uppers distorted, soles worn thin or the inside lining of the shoe worn away; They may actually cause injury to your feet.

Leather uppers breath better than synthetic/ rubber or canvas and are therefore preferred to reduce the chance of tinea etc.

If your toes are raised, clawed or your feet have arthritis or bunions special depth shoes may need to be fitted. Your podiatrist can discuss your footwear needs.

Insoles/deflective pressure devices

If your feet have excessive pressure over a boney prominence a callus forms. This is a large yellowy circle of hard skin. If there is insufficient padding under the boney prominence or if your feet have poor circulation or neuropathy these areas often break down to hard to treat sores (ulcers).

The relief of pressure form the sore/ ulcer is essential to a longer term recovery. Shoe padding and insoles are an important treatment and can be preventative of further injury if you have an established ‘high risk’ foot. (see annual assessment)

Wound care/specialist clinics

If a sore/ulcer develops keeping it covered with appropriate dressings is very important. Most wounds respond given the right environment, adequate circulation, no infection and relief of pressure. Wound care is complex and needs to be addressed by an appropriate nurse. There are specialist nurses trained in wound care and stomal therapy who can offer appropriate care.

This can reduce the length of time you have an ulcer and reduce infection rates and therefore reduce the likelihood of amputation. At Buderim Podiatry we are pleased to help you with all stages of foot wounds from early detection to footwear and insole advice, to wound debridement and dressing selection/advice.