If you suffer from diabetes, your GP may have spoken to you about visiting a podiatrist for a foot check up. Diabetes can affect your feet in a number of ways and can be quite complex. In short, the increased amount of sugar (glucose) within your bloodstream can affect your blood and nerve supply to your feet. A change or loss of sensation in the feet, coupled with a poor healing ability due to reduced blood flow can be very problematic for the diabetic foot! This is where we podiatrists step in. We are trained to perform an extensive diabetic foot check to make sure that your feet are in the best working condition possible and to help prevent further complications. Below, we have outlined the different aspects of your foot health that we examine.
Vascular Assessment – Checking Your Blood Supply:
The blood supply to your feet is very important and this can be compromised in those with diabetes. First, we conduct a visual assessment of the skin to check the aspects that are influenced by the blood supply including the skin colour, temperature and appearance. We also check for venous insufficiencies (issues taking the blood back to the heart) and ask a few questions about other signs of vascular dysfunction. Next, we check for the 2 main pulses in the feet. One sits on top of the foot roughly between the 1st and 2nd toes called the dorsalis pedis pulse, and the other sits behind the inside of the ankle called the posterior tibial pulse. We check for whether these pulses are ‘palpable’ or present, and note down their characteristics (strong, weak, regular, irregular etc). Once we have checked for these pulses, we use a doppler ultrasound to further assess the blood flow through the arteries. We will place a small amount of conductive gel on top of the pulses to allow the doppler to pick up the waveforms easily and then listen to the pulses.
Neurological Assessment – Checking The Sensation In Your Feet:
During a neurological assessment, we will ask you some questions relating to the sensation in your feet, including feelings of numbness, pins and needles, burning sensations or hypersensitivity. The first test that we will perform is called the monofilament test, whereby we use a device to apply 10 grams of pressure onto different spots of your feet. You will be asked to close your eyes and say “yes” when you can feel the monofilament, and given a score out of 10.
Next, we will perform vibration testing on different spots on your feet to test your sensation. We use what is called a ‘neurothesiometer’ which is placed onto 4 different spots on your feet, with the readings being produced in volts. Again, you will be asked to close your eyes and say “yes” when you can feel the vibration sensation.
The combination of these 2 tests will allow us to determine whether your neurological sensation is intact.
Dermatological Assessment – Checking The Health Of Your Skin & Nails:
This involves a thorough assessment of the skin to identify any potential areas that need to be addressed. The skin is an organ which requires adequate blood supply to maintain its health and integrity. We assess the skin for any corns, callus, warts or lesions that may require maintenance and treatment. The nails are also assessed to check for fungal infections, ingrowing nails or nails that are too long/short. Patients with impaired sensation may not be able to feel these various problems on their feet which can become problematic. Any damage to the integrity of the skin, coupled with an impaired healing ability can lead to the creation of wounds, some of which are extremely hard to heal. While checking the condition of the skin and nails, we also check for any bony abnormalities such as bunions, hammer toes and other bony prominences that may affect foot function. Often, pressure can build up on areas that aren’t designed for this and the overlying skin may be affected.
Top Tips To Keep Your Feet Healthy If You Have Diabetes
- Ensure that you see your podiatrist at least every 12 months for your diabetes assessment. This allows us to monitor any changes and intervene or refer you to other health professionals if need be.
- Check your feet daily. This is particularly important if you have reduced sensation or blood flow in your feet. If you notice anything out of the ordinary or something that concerns you, contact us for an appointment.
- Visit your podiatrist regularly for general foot care if you struggle to do this yourself, particularly if you have reduced blood supply or sensation. This will ensure that any foot problems are dealt with properly and safely.
- Ensure that you are wearing appropriate and comfortable footwear. This will help to keep your feet supported and assist with proper foot function.
- Moisturise your feet regularly. This will help keep your skin healthy and reduce your risk of skin breaks.
- Be active. This will not only help with your overall health and fitness, but will also help with managing your blood glucose levels.
Read more about diabetes, podiatry and your feet in our blog post – Why Am I Seeing A Podiatrist If I Have Diabetes?