Podiatry and the Diabetic Foot
When I went to university to study podiatry one of my lecturers used to often say:
‘Fools aim to cure and the wise aim to prevent’
It is an expression which has always stayed with me. As a result this is what I practice in Foot Solutions, Australia – preventing issues, or when problems have arisen, identifying and treating the underlying root cause rather than just superficially treating symptoms. We believe that a complex disease such as Diabetes is best managed using a multi-disciplinary team (a range of health care professionals with a spread of specialisms such as Opthalmologist, Podiatrist and Diabetologist or GP) and early intervention is the best prevention of potential complications of diabetic foot disease.
The Podiatrist’s role in the Diabetic foot
A Podiatrist should monitor the diabetic foot from the very start time of diagnosis and then throughout the patient’s lifetime. Categorizing the foot as Low, Medium or High risk – if the foot is low risk we will monitor the foot annually, if the foot were medium or high risk, further assessments will be completed throughout the year.
We examine the foot for the following;
- Sensory neuropathy – Each foot has FIVE sensory nerves which innervate different parts of the foot. If there is a sensory deficit then we can give further foot education and treatment, and also advise the affected persons Doctor for further management.
- Motor neuropathy– is the foot changing shape and developing ‘hot spots’ which would create callous? Are your toes beginning to claw, when they once were not? Do you have hard skin on the sole of your foot, where you once did not? These are all things podiatrists are trained to monitor and manage.
- Autonomic neuropathy – is your skin becoming increasingly dry – fissuring/cracking at the heels? Although sometimes dry heel are increasingly common during the summer months and is not a reflexion on neuropathy advancement.
- Circulation – Podiatrists fully assess each person’s medical history and circulation of the lower limb. Diabetes which is poorly controlled may affect the blood going down to the foot/toes.
Poor circulation will devitalize the skin and affect wound healing; your foot will be at risk of serious diabetic complications such as amputation.
- Biomechanical alignment and muscle strength. Poor biomechanics and muscle strength in the lower limb will affect the way you walk and cause overloading at certain points in your foot. This can create unequal weight distribution through your foot, which may lead to callous and possible tissue breakdown.
Identifying the foot at risk is how we aim to prevent diabetic foot ulcers and wounds, which can unfortunately lead to more serious complications.
Taking prevention one step further
At Foot Solutions we specialize in custom-made orthotics. This is where prevention comes in. Our custom orthotics are designed to allow normal foot function, stabilize the foot and ankle, allow better function of the tendons and muscles in your foot and remove any high areas of pressure on the plantar aspect (sole) of your foot. This is turn will prevent, painful hard callous, corns and muscle and tendon damage.
I am diabetic – should I see a Podiatrist?
It is very important for those with diabetes to see a podiatrist as soon as they are diagnosed, as well as other health care professionals to effectively manage the diabetic foot and prevent, preventable foot problems. You should see your Podiatrist at the very least annually. You should see your Podiatrist more frequently if they advise it or you are at medium or higher risk, or if you notice any changes to your foot or signs of injury.
Last but not least
“In Australia, diabetes affects over 1,000,000 people and, as of 2011, an estimated 19.6% of these individuals experienced peripheral neuropathy (loss of sensation) or peripheral arterial disease as a result. Annually, there are around 10,000 hospital admissions due to diabetes-related foot ulcerations and recent evidence suggests that, each year, in excess of 4,300 amputations are due to diabetes. Each of these amputations costs the Australian healthcare system $26,700, plus aftercare costs.
Best practice research indicates that improved access to podiatry services for patients with foot complication from diabetes would prevent future hospitalisations and amputations, recouping the costs of these services in turn. Cost savings from the implementation of best practice research were estimated in 2012 as being up to $397 million annually.”
Australian Podiatry Association, SA. Diabetes: Foot Treatments and Complications. August 25th 1214