Diabetes is a condition affecting the body in two different ways depending on the type you have. Based on a study done by the Australian Institute of Health and Welfare, an estimated 1 in 20 (4.9% or 1.2 million) Australians had Diabetes between 2017-2018. Although the condition sounds bad or has been labelled poorly, when Diabetes is controlled correctly and monitored, a person can live and go about a normal healthy life without any complications.
What is Diabetes?
Diabetes affects the body’s ability to both produce and use insulin depending on the type you have. Insulin is an important part of the body as it helps to transport and use sugar in the blood throughout the body in areas like the muscles and organs. There are 2 types of Diabetes:
Type 1 – Is an autoimmune disease in which the body destroys what is known as islet cells. These basically produce insulin, meaning if these are destroyed, the body can no longer produce as much or any insulin on its own. Type 1 is more commonly diagnosed when we are younger but can develop in the later years.
Type 2 – This is where the body has islet cells and insulin, however the body is resistant to insulin. Meaning the insulin will try to bind to fancy receptors in the body but there aren’t enough of them or the body simply won’t accept them. This is more commonly diagnosed than type 1 and can develop any time throughout our life.
Diabetes essentially causes high blood sugar levels in the bloodstream. It is these elevated levels of blood glucose which can further cause problems in the future if not appropriately managed.
how does diabetes affect the feet?
Diabetes can affect the feet through many ways. It is often affected through multiple ways, rather than simply one of the following:
- Reduced nerve sensation
- Reduced blood flow
- Increased risk of falls
- Lack of hair, skin colour and skin temperature
- Reduced healing time of wounds/cuts and grazes
When the body sustains a high level of blood sugars, the nerves and blood vessels struggle to work well. This can cause the nerves to be affected, resulting in numbness starting underneath the sole of the foot but can extend further towards the knee.
This increased level of sugar can also cause the lining of blood vessels to become thickened and harder. This can affect larger blood vessels as well as smaller ones, resulting in slower healing times of any wounds. A combination of the two can result in non-healing wounds which a person might not even know is there. These can become infected and in severe cases cause infection in the bone leading to amputations.
diabetes foot assessments
A Diabetes foot assessment with your podiatrist, we will assess a number of different things with your feet. These tests include:
- Monofilament – This is a nerve sensation test we do under the foot. We test the bottom of the foot with a piece of bendy fishing line which provides 10 grams of pressure (enough to break the surface of the skin). We assess 10 spots with the goal of having all spots having sensation.
- Tuning Fork – This is a tool used to test your proprioception or balance. It is a piece of metal which vibrates to which we hold against the toe and see how long you feel it vibrate for.
- Reflex Hammer – A small rubbed hammer is tapped in two spots of the ankle and knee to see if your reflexes are working correctly. We are sure you have done this on yourself before.
Vascular (blood flow)
- Large Blood Vessels – We assess these larger vessels, the 2 main ones in the foot by palpating or touching them. Healthy arteries will be felt through the skin. The two locations are on the top of the foot between the 1st and 2nd metatarsals (long bones) and behind the inside of your ankle. If we can’t feel them we will then get the doppler ultrasound out to listen to them instead
- SVPFT (small blood vessels) – This test is simple, we squeeze the big toe for 3 seconds and count how long it takes for the colour to return to normal. Typically this is less than 3 seconds, but depending on poor blood flow it can be longer
- Hair, skin and colour – Visually we check for hair growth, the colour of the skin on the foot compared to the rest of the body, and the temperature of the feet compared to the leg. Reduced blood supply may result in poor colour, no hair growth and reduced temperature
On top of these, we will also ask basic questions around night time pain, cramping when walking, previous history of wounds not healing, family history of diabetes and many other questions.
Nail and Skin Assessments
- Toenails – this commonly includes thicker nails, ingrown toenails, colour changes in the nail plate and fungal nails. If your toenail is painful, red and sore please present to a Podiatrist immediately
- Callus– callus refers to hard, cracked or thickened skin on the feet
- Corns – are dense cores of skin that are often painful or uncomfortable.
- Skin and nail infections – your Podiatrist will assess any skin conditions and advise on best management
What are possible foot issues with diabetes?
Possible foot issues with Diabetes typically arise in those who poorly control their diabetes.
- Slow healing of wounds, cuts and grazes
- Increased chances of infection
- Numbness in the feet, toes and ankles
- Increased risk of falls
- Cold skin on the feet and toes
- Being unable to feel heat or cold in the feet
- Pressure areas of hard skin or corns on the feet
diabetes foot management
At this stage in modern medicine, there is no cure for diabetes. However with Diabetes foot management there are a number of different options to help manage it to the best of our abilities. Following the right guidelines set out by your Podiatrist and diabetes educator will allow you to enjoy and live a happy and healthy life without the worries of any complications arising.
Wearing the correct shoes is super important. Appropriate fitting shoes should be comfortable, supportive, free from hard seams or edges which could cut into the skin and have an adjustable lacing system.
Blood Sugar Levels
Normal blood sugars should be around 7.8 – 11 mmol/L. Your bloods should be tested regularly with a HbA1c test being done every 3 months by your GP.
Nails & Skin
Skin can become very dry or fragile with the effects of diabetes. Therefore we should be using some form of moisturiser or heel balm to help with keeping the skin hydrated and stop cracks forming. Your Podiatrist will manage your skin care by gently tidying hard skin and advising on best care ahead
Ongoing Podiatry care is highly important in maintaining your foot health. As podiatrists, we can help do ongoing assessments and hands on treatments to ensure you looking after your foot health well
what are warning signs in diabetic feet?
There are many warning signs for those with diabetes. Below is a list of symptoms which may be present in uncontrolled diabetes or those who have yet to be diagnosed with the condition.
- Slow healing wounds
- Pain in the feet or legs when resting at night
- Cramping in the feet or calves with walking
- Numbness under the feet or tracking up higher
- Loss of hair, colour and foot temperature
- Infection – redness, pus, pain, swelling – see a Podiatrist immediately!
If you have diabetes and have not yet seen a Podiatrist, we would strongly recommend that you do.
Great education and care of your feet can make the world of difference and has been proven to have the best health outcomes for you and your feet!