One of the long term complications of Diabetes is the damaging effects that raised blood sugar levels (hyperglycaemia) can have on the foot and the nervous and vascular systems that allow the foot to function without injury. Below there is useful information on the Diabetic foot which may help you understand more about what you can do to lower your risk of serious foot complications such as ulcers.
How can Diabetes affect my feet?
Over a long period of time high blood glucose levels can cause damage to different areas of your body and this includes your feet and legs. High blood sugar levels can damage the nerves in the feet leading to a loss in protective sensation. If we lose the sensation in our feet injury may go unnoticed and that alert to take action is lost. This leads to a higher likelihood of wounds developing on the feet. High blood sugar levels can also reduce the quantity and quality of the blood reaching the feet. This means healing of any damaged areas on the feet may be delayed, and the skin is more likely to be more easily broken as the skin is thinner. Infection rates are also higher for people with diabetes.
Damage to the nerves in your feet
High blood glucose levels can cause damage to the nerve systems in your body, which stops important messages getting to and from your brain. The nerves in your body that are most likely to be affected are the longest ones – those that have to reach all the way to your feet and legs. Damage to the peripheral nerves is the thing most likely to affect your feet if you have diabetes. Nerve damage may also be described as neuropathy. When it affects your feet it can lead to the following:
- Damage to sensory nerves. You may lose the ability to feel when there is a problem with your feet
- Damage to motor nerves which can cause a weakening of the muscles within the foot. This can lead to the foot changing shape and reducing the foots ability to absorb shock and pressure.
- Damage to autonomic nerves. The feet become drier as the nerves which control sweat production are damaged. Dry skin is less supple and is more easily broken.
It’s advisable to have your feet checked at least once a year by a Podiatrist or GP Practice
Damage to the blood supply to your feet
The other important reason why some people with diabetes develop foot problems is because high blood glucose levels can also damage your blood vessels. This can affect the blood supply (circulation) to your feet and legs and may mean that less blood gets to your skin, muscles and tissues. Having a reduced blood supply to the feet can cause delayed healing of a wound and can cause the skin to become thinner thus, less supply means breaks in the skin are more likely.
Make sure you know your Diabetic Foot risk level
Diabetes affects people to differing degrees and it is important for you to know your “risk level” to enable you to ensure you are receiving the right level of podiatric care and receive the appropriate level of advice. There are four risk levels which act as a guide to predicting the likelihood of developing foot problems – Low, Moderate/Increased, High and Active . Your risk level is largely determined by measuring the sensation and blood supply as well as a visual assessment of your feet.
When caring for your feet, what sort of problems should you look out for?
Damage to your nerves might be indicated by
- tingling sensation; pins and needles
- pain (burning)
- sweating less
- feet that are red and hot to touch
- changes to the shape of your feet
- hard skin
- loss of feeling in your feet/legs.
Damage to your blood supply might be indicated by
- cramp in your calves (at rest or when walking)
- shiny smooth skin
- loss of hair on your legs and feet
- cold,pale feet
- changes in the skin colour of your feet
- wounds or sores that do not heal
- pain in your foot/feet
- swollen feet.
If you notice any of these things, or have concerns about your feet, tell your GP or diabetes team. Do not wait until your annual foot check. Information provided by Diabetes UK (2015).
Diabetic Foot Assessment
Diabetic Foot Assessments are available at James Hogg Podiatry however you should have your feet examined by your GP surgery as part of your overall annual Diabetic check. James is a Diabetes Specialist Podiatrist with many years of experience working in Hospital Diabetic Foot Clinics in the NHS. James is familiar with the complications of Diabetic foot disease and is able to provide advice which is tailored to your individual need. During a Diabetic Foot Assessment our podiatrist will perform a series of tests as part of a thorough vascular and neurological assessment. A report of the assessment can be sent to your GP.
Treating the Diabetic Foot
It is important that you have your feet treated by a Podiatrist or Chiropodist who is registered with the Health Professions Council (HCPC). This helps to ensure that the practitioner treating your feet is fully qualified to do so and is working to the standards set by the governing body (HCPC). There are minimum standards of decontamination procedures, clinical proficiency, levels of training and insurance that HCPC registered podiatrists and chiropodists must adhere to to keep their registration. James Hogg is HCPC registered and is a member of the Society of Chiropodists and Podiatrists and has substantial experience in treating patients with diabetes.
How to look after your feet?
- Know your diabetic foot risk level
- Have your feet checked at least annually
- Never walk barefooted
- Wear well fitting shoes
- Check your feet daily
- If your feet change shape see you GP or Podiatrist
- If you are unsure about something on your foot get it checked out as soon as possible (with GP or Podiatrist)
If you would like to book in for a diabetic foot assessment and treatment of your feet by our diabetes specialist Podiatrist then a routine podiatry appointment is appropriate for you