An Article Written By Bonnie McNab
Podiatrist – New Step Podiatry.

In light of Diabetes Week, we’re hoping to demystify what a foot check-up looks like at New Step Podiatry and why this appointment is essential for people with diabetes. 

What is Diabetes ?

Diabetes is a complex condition that affects the whole body – even your feet. There are different types of diabetes but most common are type 1, type 2, and gestational.

Diabetes is a result of uncontrolled glucose levels circulating in the blood. Normally the body works to convert glucose into energy through a hormone called insulin. When there is not enough insulin being made or if the body is insulin resistant, high amounts of sugar will stay in the bloodstream.

Having diabetes increases the risk of foot complications which can include:

• Reduced circulation (blood flow) which means cuts and wounds take longer to heal increasing the timeframe and risk for a bacterial infection.
• Impaired nerve sensation (ability to feel). Not being able to detect feeling under the foot can lead to more damage before treatment is sought.
• Stiffening of the joints.
• Impaired nail and skin health.
• Decreased muscle strength.

These complications can put the feet at higher risk of developing bacterial and fungal infections, foot ulcers, and amputations. 

Podiatrists can help to reduce the risk of these complications occurring by identifying potential risk factors, with a foot risk assessment, and providing helpful tips to manage and maintain your foot health.

What is a Diabetes Assessment and what is involved? 

A typical diabetes assessment will include the following:

• History taking
• Inspection
• Nerve function
• Circulation
• Musculoskeletal
• Footwear
• Summary
• Education
• Report to the GP
  

The process can be divided into 3 sections

 

Question Time

First we ask – for symptoms of peripheral neuropathy such as numbness, burning, pins and needles, the feeling of insects clawing on your feet, poor balance and different types of pain. We also ask about symptoms of poor circulation like pain in the calf muscle when walking and cramping at night. We need to ask questions about your footwear, diabetes and cardiovascular health to determine if there are other potential causes to reduced circulation.

 

Assessment 

Then we look – we are looking at the condition of your skin i.e. dry skin, the presence of ulcers and then we look at the structure of your feet i.e. if you have any clawing of the toes or bony changes. We look at the shoes you have worn or brought into the consultation to check they are supportive and well fitting. 

Then we feel – we feel your pulses, check the range of motion of your joints and the strength and tone of your muscles.

Then we listen and assess – Our circulation study is done with a doppler ultrasound where we listen to ‘how’ your blood is flowing through your arteries. But ‘how’ isn’t enough. We do assessments called an Ankle Brachial Index and Toe Brachial Index which is assessing if you are getting enough blood to your feet. 

The we assess some more – using tools like monofilaments (pictured below), tuning forks, reflex hammers, sharp/dull touch, heat/cold recognition. 

 

Results and Report

The results of the above assessments are discussed and what specifically you need to do at home to prevent disease related foot complications. 

We determine if you need to return to the clinic for further assessments such as a biomechanical analysis or for footcare such as regular reduction of corns and calluses.

All clients attending with a referral form from their GP will have the results of the assessment sent to their doctor’s medical practice. Additional reports can be forwarded to other specialists as requested.

 

How often should a Diabetes foot risk assessment be performed?

More frequent assessments are required for feet that are more at risk. If the feet are assessed as having a high risk of complications, it is best to have podiatry appointments at least 3 monthly, which or may not include reassessment. Some patients choose to attend more often for skin and nail treatment.

Patients that can manage their own foot care, have no foot pain and have a low foot risk will require 12 monthly assessments.

How can a podiatrist help someone with diabetes and other chronic illnesses?

• We perform a Diabetes Foot Risk Assessment as above to determine what ongoing care is required based upon your risk classification and personal situation
• Diagnose foot conditions associated with diabetes and other chronic illnesses
• Provide ongoing skin and toenail treatment to prevent pressure related-wounds
• Provide orthotic therapy for certain types of foot pain and pressure redistribution
• Provide education regarding self care, footwear and overall diabetes management
• Perform wound management for ulcers with the aim to assist healing and prevent infection and amputation
• Correspond and collaborate with your GP, diabetes educator and other health professionals to ensure the safe and effective management of your type I or II Diabetes

 

Watch the video above to hear Bonnie explain what a Diabetes Assessment is.

Do you have Diabetes or do you know somebody that does? Call us or book an appointment online today!