Diabetes is a world wide issue with 1.5 million people thought to be living with this disease in Australia alone. This condition refers to having too much glucose in our blood which can cause serious damage to arteries and nerves in our body if left untreated. There are considered to be three types including Type 1, Type 2 and gestational diabetes.
Diabetes significantly increases the risk of developing complex conditions such as peripheral arterial disease and peripheral neuropathy. These conditions can precede serious foot related complications such as delayed healing, infection, ulceration and amputation.
Here at Be Podiatry, we are able to perform assessments that can help to screen for these conditions to reduce the likelihood of diabetes foot complications. It is recommended that these tests should be performed at least once per year. However, if any issues are detected more frequent podiatry treatment would be advised.
Dermatological assessments involve examining the feet and performing general skin and nail care. This is important to identify any potential issues such as involuted or ingrown nails, corns, callous, skin tears or blisters. It is recommended if any of these issues are identified to contact your podiatrist. All of these issues have the potential for the skin to break down and lead to infection and ulceration.
Furthermore, dermatological issues may be caused or exacerbated by biomechanical factors or foot deformities. Conditions such as bunions, clawed or hammer toes, fat pad atrophy, haglund’s deformity, bony prominences, flat or high arched feet and reduced joint range of motion can lead to increased pressure in certain areas of the feet. When there is an increase in pressure our body starts to lay down more skin to protect itself leading to hyperkeratosis (callous) formation. If this is left too long the skin underneath the callous can lose its elasticity and moisture and break down underneath forming ulcers. Treatment such as footwear recommendations, padding, taping, orthotics, toe separators and wedging may be necessary to address these issues.
Vascular assessments are performed to check circulation to the feet. Our podiatrists will examine the feet and look at nail growth, hair growth, skin colour and temperature as well as assess pedal pulses. All of these factors can paint a picture and reveal a lot about overall foot health. Pedal pulses can be examined using doppler ultrasound. This device enables the podiatrist to listen to the sound and pitch of the pulses in the feet along with the associated waveforms. These results are recorded so they can be compared to future assessments. Based on the findings, your podiatrist may recommend to your doctor that further vascular imaging is required if they suspect the presence of peripheral arterial disease.
Neurological assessments are important to ensure the nerves in your feet are functioning correctly. In the clinic we can check for protective sensation and the ability to detect pressure. This test is performed by applying a 10g monofilament to specific sites on the foot and determining whether the patient can detect this with their eyes closed. If the patient is unable to detect the monofilament, this means that there is a loss of protective sensation and the patient cannot perceive pressure accurately and is therefore at a greater risk of injury. The ability to perceive vibration is also tested as part of our neurological assessment. This is completed using a 128Hz tuning fork and tests nerves associated with proprioception/balance. If there is a diminished or inability to detect vibration people are at a greater risk of falls and injury.
Based on assessment results and previous medical history, categories have been developed by the University of Texas to classify the risk for developing a diabetic foot ulcer. This will determine whether you are low, medium or high risk and enable an appropriate treatment plan to be developed.