In people with diabetes, the tiny nerves and arteries in the feet can become damaged with long-term elevated blood sugar levels.
There are many signs, symptoms, and clinical tests to determine your level of diabetic foot risk; at minimum, the following neurological and vascular testing will be assessed:
1) Neurological Testing: This will include checking the sensation in your feet to assess your protective sensation (without which a cut or wound may form unawares)
2) Vascular Testing: This includes checking signs of adequate circulation to your feet, including doppler ultrasound testing to check whether sufficient arterial blood flow is getting from the heart all the way down to the feet.
Neurological Testing:
Part of a diabetic foot check includes testing with a ‘10gram monofilament’ to check the protective sensation
Vascular Testing:
As part of your vascular assessment, (arterial) blood flow to the feet is assessed using a doppler machine on the ‘Posterior Tibial’ artery (top right in this diagram), and the ‘Dorsalis Pedis’ artery (on the left).
A strong-sounding regular flow can be seen on the doppler’s digital display, and it’s sounds (either mono-phasic, bi-phasic or tri-phasic) indicate the efficiency of that artery’s 1) opening, 2) it’s blood flow, and 3) it’s closing respectively.
Your Level of Risk for Diabetic Foot Complications:
Our diabetic foot assessment is carried out to assess your level of risk for foot complications associated with diabetes. You will be classified as either low, intermediate, or high risk.
What Should You Do?
Check your feet every day for any changes such as cuts, scratches, blisters, skin irritations, corns, or callous. Corns and callous should be filed gently with an emery board or pumice stone, with the appropriate emollient cream used to reduce their build-up.
Control your blood glucose (sugars) well. High or fluctuating blood sugar levels cause damage to the smaller nerves and blood vessels, including those in the eyes, kidneys, and feet.
Make sure your feet are clean and dry, including drying between your toes.
Moisturise your feet every day as dehydrated skin is easier to break
If you have peripheral neuropathy (numbness in any area on your feet), wear a well-fitting closed-in shoe to avoid a skin injury that you cannot feel.
Keep toenails a tidy length. Use nail clippers if you are able to do so safely, or use a gentle file/emery board instead. High-risk diabetics should avoid using any sharp instruments on their feet.
Have a wound care plan and an easy-to-access first aid kit. All cuts and scratches should be dressed with an antiseptic and a band-aid immediately, then checked every day for signs of infection until completely healed.
See your podiatrist regularly – and if you notice any worrying changes to your feet, seek professional advice from your podiatrist.
Regardless of your risk status, it is strongly recommended that all people with diabetes have their foot health checked annually at a minimum.
Written by Mark Dooley, Podiatrist