Diabetes: The Impact on the Foot
November 14th 2017 is World Diabetes Day, so I thought I’d write my first blog today.
Diabetes is a condition where the body is unable to process the energy it consumes correctly, resulting in a lack or insufficient amount of insulin. Insulin is the substance that allows sugar (glucose) to enter into your cells to create energy. When there is a lack of insulin, sugar stays in the blood stream causing high glucose levels and damaging essential elements throughout the body.
My main concern as a podiatrist is obviously the health of the diabetic foot. Poorly controlled diabetes can result in damage of the nerves affecting the feet, causing a condition called peripheral neuropathy. The combination of these neuropathies or the presence of just one can have severe and devastating affects to the foot and the life of a person with diabetes. Ulceration, cellulitis, osteomyelitis and amputation are the most concerning consequences of poor foot health and lack of diabetes control.
| Warning Signs of Peripheral Neuropathy | |
| Sensory | 1) Nerve pain – pins and needles
2) Sensations in your foot that are new 3) Missed placement of foot 4) Unable to feel changes in temperature |
| Motor | 1) Muscle weakness – tripping over your feet
2) Cramps 3) Muscle wasting |
| Autonomic | 1) Reduced sweat production in the feet – leads to dry cracked skin. |
The most recent records of foot health from 2016 shows an increase in ulceration and amputation throughout the country, unfortunately Wexford is seen to have the worst increase in these occurrences, (https://www.diabetes.ie/diabetes-footcare-statistics-2014-2016).
| CO. WEXFORD | 2015 | 2016 | Increase |
| Ulcerations | 100 | 119 | +19 |
| Amputations | 13 | 29 | +16 |
What do we do about it and how can we alter the trajectory of these devastating consequences of diabetes?
What can you do as a patient with diabetes?
There are 10 daily steps recommended for people with diabetes to follow to ensure they maintain good foot health.
- Nail care – cut nails regularly but cut straight across
- Apply moisturiser daily – build it into your routine e.g. leave a bottle of moisturiser on your bedside table and apply before you go to bed every night.
- Footwear – lace up or Velcro fasten footwear – a good sensible shoe! No slip on, court shoes or high heels (sorry ladies).
- Complete a daily examination of your feet – checking for changes in skin colour or temperature.
- Do not walk with bare feet.
- Check inside of your footwear before putting them on.
- Wear socks inside out.
- No hot water bottles.
- Checking bath and shower temperature.
- Avoidance of home remedies e.g. corn plasters
Checking and looking after your feet is only one area of foot health; continued control of blood sugars and implementing positive lifestyle changes can have the most beneficial effect on long-term foot health and prevention of the more serious foot conditions. If you have any concerns or worries you should contact your GP or podiatrist.
What can we do as Health Care Professionals working with diabetic patients?
We need to continually educate and empower our patients with knowledge and confidence in their diabetic control and general foot care. Advising our patients on how to look after their feet, checking them daily, watching for changes in skin health and wearing appropriate and well-fitting footwear.
In relation to foot health, risk categories should be established and the appropriate plan implemented. The HSE has a Model of Care for the Diabetic Foot (www.hse.ie/eng/services/publications/Clinical-Strategy-and-Programmes/Model-of-Care-for-the-Diabetic-Foot-.pdf) which provides recommendations for managing foot health for our patients. Even though all health care professionals, including podiatrists and diabetic teams are working their hardest, lack of funding and podiatrists within the community make this nearly impossible to implement unless patients can access care privately.
Patients have so much information to take on board regarding their diabetes; blood sugars, diet, eye health, kidneys and feet but sometimes one little daily change can make such a difference to long term outcomes.
Hope this of some help to someone.