DIABETIC FOOT HEALTH - WHAT YOU NEED TO KNOW

Having diabetes means you need to take extra care of your feet, in particular it can affect the sensation and circulation of the lower limb and foot. Podiatrists are foot specialists with indepth training and knowledge in lower limb conditions and play a key role in the prevention and management of preventing and treating foot complications, especially those exacerbated or complicated by diabetes.

Understanding how and why diabetes can affect your feet is important, as is knowing how to check them daily and how to take simple steps to care for them, preventing complications.

The two main types of diabetes

Type 1 - which means you need to take insulin because your body doesn't make any. Type 2 - which is most common and usually affects people as they get older, lifestyle, genetics, medical conditions and being less active can contribute to developing type 2 diabetes. Type 2 diabetes is where the insulin your body produces is insufficient or doesn't work as it used to. Type 2

diabetes is often controlled by either changes to lifestyle and diet, to reduce weight helping your body use insulin better and also increasing physical activity or by taking tablets and other medication to help your body take up the glucose better. Every cell in the body needs glucose for energy in order to function.

Diabetes makes it difficult for your body to get glucose into the cells of the body where it can then be used for energy. Glucose is essentially a type of sugar which is obtained from the food and drink that is taken in and digested. In diabetes this sugar from food remains in the blood stream and can start to rise dangerously instead of going into your cells as it should do. You can have too little glucose in the blood with diabetes as well. However, having too high glucose levels in the blood over time can irreperably damage the blood vessels and nerves of all of the body leading to damage and disease of the circulation (heart and blood vessels) eyes, kidneys and can lead to peripheral vascular disease. When nerves become damaged they can stop functioning properly so sensation is affected and nerves that supply muscles are affected too. This can cause peripheral neurpoathy. This can have some serious implications if loss of sensation causes someone to injure themselves unknowingly, or cannot get about as they used to.

With impaired cirulation and nerve function feet can also change shape, because the nerves that supply the muslces are also affeted, legs and feet can become weaker, affecting walking and calluses can develop on the feet if they have changed shape. The skin can become drier and less resilient and is more prone to cracking. This can cause infections to get in and lead to serious problems.

How can foot problems be avoided with diabetes?

Looking after yourself by watching what you eat, losing weight and keeping active can go a long way to reducing the risk of developing diabetes.

If you have diabetes you can prevent or slow down changes to the blood vessels and nerves by keeping your blood glucose levels within the recommended ranges. diet and keeping active plays an important role.

Looking after your feet if you have diabetes

It is important that you take good care of your feet if you have diabetes, even if you have no other medical conditions, and are classed as 'low risk'

Check your feet daily, look at them with the aid of a mirror if you can't see them underneath. Get to know what they look like so you can pick up a problem quickly and take action.

Every day wash and dry your feet thoroughtly in warm water, using a mild soap and dry them thoroughly, make sure you wash inbetween your toes and dry there too.

If you have dry skin then daily use of a special foot cream with a 10% urea content such as Flexitol cream is essential. If your feet are really dry and you have hard skin and calluses a 25% urea content cream should be used initially to get the dry skin under control. You should seek treatment from a HCPC Podiatrist who can safely reduce thick callus to prevent skin fissures developing and provide you with insoles to help if necessary.

Probems can start from something as simple as a rub from an ill fitting pair of shoes, or bumping your toe on something hard. It is important not to walk around barefoot, to avoid bumping your feet, or causing damage to the skin. This is especially important if you have loss of sensation to your feet.

Get your feet checked regularly by a medical professional such as a podiatrist/chiropodist, diabetic nurse or your GP. Having regular professional footcare to have nails trimmed and any calluses removed is also important.

Wear well fitting shoes that do not rub your skin or cause pressure. Your podiatrist can check and advise you on suitable footwear.

It is also important to know who you should seek for advice if you think you have a problem with your feet.

If you notice anything that doesn't look or feel right make and appointment with your podiatrist and get them checked as soon as possible. Do not delay seeking help, especially if you notice any of the following:

You start to find walking more difficult
Your shoes become uncomfortable or you struggle putting them on
You have any breaks in the skin or wounds splits/cracks or blisters or there is a smelly discharge from the skin
The colour of your skin changes - you might notice they become redder than usual, look blue, or paler or look blacker. Skin temparature may change becoming warmer or cooler than usual. This may be a part or all of one or both feet.
You notice a tingling sensation, or pins and needles or pain in your feet.
Swelling develops in part or all of a foot or feet.
You develop calluses or your skin becomes drier or starts to crack or peel, or itches
When walking you start developing cramp in your legs or calves and have to rest to relieve it or you get pain in your legs which becomes a problem that wasn't there before.
Your skin becomes shiny and the hair on your legs and feet stops growing or you lose it.

What happens when you see me for foot care?

When you see me for a foot health check your feet will be thoroughtly checked for any signs of a problem that may need further attention. Annual or more frequent checks should be carried out depending on your risk cagegory and other medical conditions.

A vascular and neurological assessment of your feet should be carried out annually if you have either type 1 or 2 diabetes as per NICE guidelines. This can easily be carried out within a routine foot care appointment or at your ititial appointment if required. This involves a vascular assessment to check blood circulation to the foot, by using a doppler to check blood flow in the arteries supplying the foot. A neurological assessment can assess pain and sensory receptors and detect any deterioration. The condition of your skin can be assessed and footwear checked, along with your general health and wellbeing. This allows me to determine your risk factor in developing any diabetes related problems. I can advise you on how to check and take care of your feet to help you keep them in the best possible condition and help prevent any problems developing. If indicated appropriate advice can be given or a referral can be made to the NHS multidisciplinary diabetes team.

I have Flexitol foot creams available to purchase at the clinic or you can obtain this via your GP.