Diabetes Foot Care & Assessment

When a patient is diagnosed with Type 2 Diabetes, our role as their Podiatrist is to monitor the feet, and reduce the chances of complications from the condition affecting the health of their feet.

We become one of a group of specialists who help support patients once they have received their diagnosis. This often means that, as well as treating any issues with the feet themselves, we’re also providing education for our patients as they learn about their condition and how it may affect their feet.

How Does Diabetes Affect Your Feet?

Blood flow to feet may reduce over time as a consequence of diabetes if blood sugar levels are not controlled adequately over an extended period. This can occur in patients with either Type 1 or Type 2 Diabetes; however, as Podiatrists we most often treat patients with Type 2 diabetes.

Type 1 diabetes usually occurs, and is diagnosed, from an early age. Therefore, patients become used to managing the disease early in life. Type 2 diabetes, however, usually has a much later onset – people can be in their 40s, 50s, 60s and the causes of the disease tends to be lifestyle-related.

Altering these habits later in life, in order to manage the condition, can therefore be more challenging. It might require a new exercise regime, change in diet and eating habits, stopping smoking or a number of other dramatic changes to a person’s daily habits.

The two main ways in which diabetes can affect the feet are:

Nerve damage – leading to numbness
Reduction in blood supply – meaning slower healing

We as Podiatrists play a vital role in assessment and prevention of foot complications associated with diabetes

Symptoms Affecting Your Feet & Legs

Nerve damage and a reduction in blood supply to the feet can cause numbness in the feet. This loss of sensation means that patients are more at risk of accidental damage because they can’t feel any pain.

Without regular monitoring, what starts out as a small injury or cut, goes unnoticed and therefore, un-treated. Because the blood flow is not adequate to heal the wound, it becomes worse. Over time, this can develop into an ulcer on the bottom of the foot which can penetrate to the bone. This could lead to infection of the bone (osteomyelitis) and joints. If the infection isn’t treated at the onset, it could result in ulceration (an infected open sore) and eventually necessitate amputation of a toe, foot or limb.

How to Avoid Diabetes Complications

Many of the most severe issues result from delayed treatment of foot injuries. So avoiding complications of this condition relies on proactive, preventative care.

There are two main areas of focus when it comes to preventative maintenance and protection of the feet for patients with diabetes:

Patient-led care – controlling blood glucose levels consistently to reduce chances of complications
Podiatrist-led care – preventing opportunities for infection to get into the feet.

Once someone has been diagnosed with type 2 diabetes, daily, preventative checking is the focus of Podiatry. We start by conducting a thorough assessment and review of the health of the nerves and blood flow to the feet. A comprehensive report is compiled and forwarded to the patient’s team of doctors and specialists.

Those patients most at risk (those with minimal feeling in their feet) should avoid walking around in bare feet as this is how small cuts or damage to the feet can occur. For example:
Standing on a surface that’s too hot and burning the bottom of the feet
Stepping on sharp objects causing cuts on the feet.

Balance can also be problematic if there is loss of sensation to the feet, and shoes can provide the additional stability and support that is required.

Patients should check feet regularly at home. We recommend using a mirror to check the bottom of the feet
Check inside shoes to make sure there is nothing inside which could cause a cut on the foot.
Avoid ingrown toenails, corns and calluses and these take longer to heal because of the reduced blood flow.

What to Expect From Your Diabetes Foot Check?

Type 2 diabetes requires patients to adjust their lifestyle. One of those changes is introducing regular visits to a Podiatrist.

It’s usually recommended that patients with Type 2 Diabetes visit their Podiatrist once a year for a foot check. Patients can expect us to undertake a number of different assessments during their annual Diabetes foot check-up where we look for two main signs of deterioration: loss of feeling and poor blood flow:

Testing the nerves for sensation

We use a Monofilament on different areas of feet to check for any numbness that may be occurring. It’s important to understand if Diabetes is affecting the feet in this way because numbness can mean they are more susceptible to an injury on the foot going unnoticed and leading to additional problems over the long term.
A vibration test using a tuning fork is used to assess whether a patient may have diabetic peripheral neuropathy. This type of nerve damage can cause pain and/or numbness

Reading of the blood flow in the feet

Using a Doppler, we take readings from two areas of the feet as a measure of the strength and quality of blood flow.

Looking at and comparing the feet from previous appointments

A thorough visual check of the condition and appearance of the feet from year to year to make sure there are no significant changes that may indicate a deterioration in the feet
A walking and movement assessment to check for areas of pressure that cause (or have caused) corns or calluses to occur. The aim is to prevent or minimise continued pressure on any single areas of the foot as this could cause the skin to break. We may make recommendations to change shoes, add insoles, or orthotics to reduce the repetitive pressures on the structures of the feet.

At a diabetic foot check, patients have the chance to ask questions about their condition and we speak to them about the things they can do to protect and care for their feet on a daily basis.

High risk patients, such as those who have already had ulcers on the feet or an amputation, should have more regular check-ups every six to eight weeks.

Questions your Podiatrist may Ask You

As part of a patient’s long term care with us, we will ask questions to make sure we get to know each individual patient well and understand how the Diabetes might already be affecting them. Patients can expect us to ask the following types of questions during the appointment. Knowing these in advance can help prepare for the consultation with us:

When were you diagnosed with Type 2 Diabetes?
Have you been to a Podiatrist before?
Have you been experiencing any problems or discomfort with your feet?
What shoes do you wear most of the time (you may also be asked to bring your shoes into the Clinic)?
What is your usual skin and nail care routine?
Who else are you seeing as part of your Medicare plan for your Type 2 Diabetes?

Overall we aim to reassure patients and help them learn how to self-manage with basic foot care at home, establishing good routines to keep the feet healthy in the first place and avoid injury.

Questions to Ask Your Podiatrist

Why are the feet so susceptible when someone has diabetes?

Such small fine vessels in the feet that get diminished quicker if blood glucose levels remain abnormally high for an extended period of time.

Is it just my feet that might be affected by diabetes?

The neuropathy that can result from Diabetes if not managed well, can spread. So what starts as a loss of feeling in one or many toes, can spread to the middle of the feet, ankles and mid shin right up to under the knees.

How long after my diagnosis will my feet be at risk?

Many factors can affect how the feet are impacted by Type 2 diabetes. Controlling the blood glucose levels will significantly reduce the chances of any serious complications. If a patients’ lifestyle factors, such as diet, lack of exercise, or smoking, continue to be poor for a prolonged period of time and the blood glucose level is beyond the normal range on a daily basis, then it can lead to the issues with the feet that we are seeking to avoid occurring.

What can I do to make sure diabetes doesn’t make my feet get any worse?

The main thing patients are told when diagnosed with Type 2 diabetes is the importance of lifestyle changes and maintenance of their blood sugar levels within the normal range. In terms of foot care, patients can undertake daily or weekly checks at home to look for signs of injury, soreness, cuts or other changes to the feet and toes that may indicate issues with the feet.

Why Choose Your Foot Clinic?

Many of the patients we see and treat at our Clinic who have Diabetes, are referred under a medicare plan. This plan includes five funded visits per year, providing patients with access to a group of specialists from optometrists, endocrinologists, exercise physiologists and/or Dieticians.

We are one of this team of specialists who help support patients over the long term to manage their condition in order to prevent additional complications from occurring in the feet. We have three, easy to get to Clinics in Ferntree Gully and Doncaster East. Our team of five Podiatrists have over 36 years of experience in total and treat a wide range of foot, ankle and lower limb issues with specialist knowledge and equipment on-site.