What is Diabetes?
Diabetes occurs when the body is unable to maintain healthy levels of sugar (glucose) in the blood.
Usually, the amount of glucose in the blood is controlled by the hormone insulin, but people with diabetes have issues with insulin production or use, resulting in high blood sugar levels.
There are 3 main types of diabetes:
- Type 1 diabetes – where the body is unable to process glucose due to a lack of insulin.
- Type 2 diabetes – where the body can usually produce insulin but not use it efficiently.
- Gestational diabetes – which forms during pregnancy and can affect both the pregnancy and the health of the baby.
For more detailed information about diabetes, the role that insulin plays in blood sugar levels, and how diabetes can affect the rest of the body, please check out the excellent resources at Diabetes Australia.
How Does Diabetes Affect Your Feet?
Over time, having too much glucose in the blood can lead to many short-term and long-term complications. Many people do not realise how much of an impact diabetes can have on your feet! Let’s look at some of the potentially serious issues that can develop if a person with diabetes isn’t looked after properly.
Nerve Damage (Peripheral Neuropathy)
Over time, high blood glucose levels can cause damage to nerves in the lower leg. This nerve damage can alter the sensation in the foot and cause tingling, burning or numbness.
Not feeling pain in your feet might sound nice, however, we need pain to tell us when we have injuries such as cuts or blisters. Not realising that you have stepped on a foreign object is also a big problem – broken glass, stones and even sewing needles are all things we have had to pull out of feet, as the patient was unaware that these objects had embedded into their skin!
If we are not aware of injuries to our feet, these wounds can very quickly become a problem.
Reduced Blood Supply
Diabetes can also cause a reduction in blood supply to the foot, which can ultimately lead to peripheral vascular disease. Symptoms include pain in the calf muscles when walking, skin and nail changes, and wounds that heal poorly.
Nail & Skin Issues
Dry skin is another common problem in people with diabetes. It may seem like a minor issue, but if left untreated, fissures can develop in dry skin that will get progressively deeper. Dirt is easily trapped in the cracks, increasing the risk of infection.
Calluses and corns form naturally in areas of skin that are subjected to more pressure, for example with tight footwear. In diabetes, these areas are more susceptible to ulcers forming under the hard skin.
Fungal nail or skin infections are generally quite difficult to treat. With the added complications of diabetes, it makes it even harder to treat these issues.
Thickened nails are more likely to occur in people with diabetes due to the increased risk of trauma, impaired blood flow and fungal infections. This makes the nails more difficult to cut, increases the risk of the nail ingrowing, can make it more difficult to fit shoes, and the nail itself can cause more trauma to the skin underneath.
Wounds, Ulcers and Gangrene
In more severe cases, wounds and ulcers can form, increasing the risk of infection. Ultimately, this can lead to gangrene and amputation of the toe, foot or leg.
In severe cases of diabetes, we also see foot deformity (called Charcot neuroarthropathy) caused by demineralisation of the bones. This not only makes walking very difficult, but there is a huge risk for ulceration that ultimately can lead to amputation.
What Can You Do To Avoid Diabetic Foot Issues?
It’s not all bad news! Many of the foot complications in diabetes can be avoided by taking a few more precautions and acting straight away when problems arise.
Inspect Your Feet Regularly
Look for cuts, scratches and bruises, and monitor them to ensure they are healing well.
Check for signs of infection:
- Getting worse / not healing
If you are concerned about anything, please see your GP or podiatrist as soon as possible. For severe issues go straight to the hospital emergency department.
For the areas of your feet that are hard to see, you can use a mirror, ask a friend who likes feet to help you, or take a selfie!
Wear Properly Fitted Footwear
Essentially we want to find footwear that doesn’t crowd the toes (has a wide toe box), doesn’t rub or slip off your feet. Ideally your shoes need to fasten with laces, velcro or straps to hold your foot in place.
The shoes should also be supportive (or have a firm heel counter), and we can check that by pressing on the back of the shoe. If the back of the shoe collapses then the shoe is not supportive enough.
Have someone check the size for you. If you have no assistance, a good way to check is to remove the insole and stand on it – if your feet overhang the edges, these are not the shoes for you!
Inspect Your Footwear Regularly
Look for signs of wear like holes, not only in the shoe upper, but also in the sole. Also check inside your shoes for foreign objects like rocks, coins, pens, bunched up newspaper, nail clippers (yes, really!) – anything that shouldn’t be there.
Avoid Being Barefoot
Even at home you should wear shoes to protect your feet from injury. How many times have you accidentally kicked your toe on the corner of furniture? You’ll do less damage if you are wearing shoes.
Another place you should also wear footwear is the beach. If you think everyone is being a little dramatic hopping over the hot sand or concrete while you walk comfortably, you may not realise that you are probably cooking the bottom of your feet! If you have unknowingly stepped on a hot surface, get your thongs on straight away and see your podiatrist or GP as soon as possible.
Avoid Direct Heat Sources
Another way to accidentally cook your feet is to put them close to a heater to warm up. If you are cold, extra layers of clothing or blankets is a much safer option.
Dry Between Your Toes
If we don’t dry between our toes after a shower or getting our feet wet, the skin can become soft (macerated) and start to break down.
If you are having trouble getting down to your feet to dry them, you can use a drying spray like deoderant, antifungal spray, or methylated spirits. Sometimes the skin can be too sensitive for chemcial dryers, so we recommend an air dryer (which we have at our clinic for your convenience).
Moisturise Your Feet
Regularly applying moisturising cream to the dry skin on your feet will slow down the process of hard skin formation, reducing the painful fissuring and cracking that can be an infection risk.
If you are having difficulty getting down to your feet, we recommend using a long-handled sponge applicator (which we have at our clinics for your convenience).
Get Some Exercise
Regular exercise is an excellent way to keep the blood flowing to your feet (and is also an important part of maintaining healthy blood sugar levels). Aim for at least 30 min of moderate activity every day.
Try to choose activities that do not put extra stress on your feet (such as running). However – if higher stress activities are already an important part of your lifestyle, please discuss this with your GP and podiatrist so we can develop some strategies to minimise the risk to you and your feet.
As always, please discuss any activities with your GP before you start them. Some good suggestions for exercises to discuss with your doctor that also have low impact on your feet are as follows:
- Cycling / exercise bike
- Weight Training
- Tai Chi
- Water Aerobics
This is especially important in the colder months as the lower temperatures will slow down your circulation even more than in the warmer months.
Don’t forget to drink water! This is important to help reduce pain, and ensure your muscles and joints are strong, and are protected from the effects of dehydration.
Manage Your Diabetes
Keeping your blood sugar levels under control is very important to avoid foot complications. See your GP, a diabetes educator, or an endocrinologist to help you control and manage your blood sugar levels.
Seek help from a dietician to understand the role that your diet plays in your diabetes.
See Your Podiatrist!
Regular podiatrist visits can help with the assessment, treatment and maintenance of diabetic foot problems. It also reduces the risk of amputation in diabetes-related problems.
You should come to see us for a thorough foot check at least once a year. See below for more details about what your podiatrist can do for you.
What Can A Podiatrist Do For You?
During a diabetes assessment, we will:
- check your blood supply
- test your nerve function
- examine your skin and nail condition
- assess your foot shape
- check your footwear
- provide education on looking after your feet
- determine your risk for more severe complications.
We recommend that you see us at least once a year for a diabetes assessment if you are low risk, and more frequently if you are higher risk.
Provide Education on Complication Prevention
Depending on your needs, we can teach you things like how to safely cut your own nails at home, how to spot problems early on, how to prevent wounds from occurring.
Relieve Pressure on the Foot
To ensure that areas of pressure do not start to ulcerate and cause issues, you may need a change of footwear, foot orthoses, callous and corn removal, or paddings.
If you are having difficulty finding footwear to suit your feet, we can also assist with that.
If you are experiencing pain in your feet, you can also book in for a biomechanical assessment to see if your feet need extra support like orthoses.
General Foot Care
You can see us regularly to provide safe routine care, especially if you are finding it difficult to get down to your feet to attend to them. During a standard appointment we will cut and file your nails, remove calluses, corns and other hard skin.
If ingrown toenails are an issue for you, we can address that through the variety of treatment options we have available, including gentle packing, Onyfix nail correction system, and toenail surgery.
If you are experiencing pain in your feet, you can also book in for a biomechanical assessment to see if your feet need extra support.
Wound Prevention & Care
If you have had a wound form, we can assess your risk and refer you to the hospital high risk foot clinic for regular wound care. There can sometimes be a long wait to be seen in the public system, but we are able to provide you with regular wound care in the meantime. On several occasions, we have even been able to resolve the wound before a place in the high risk foot clinic even became available!
Some patients also prefer to stay away from the hospitals (especially during a pandemic!) and we are happy to provide regular wound care for you for as long as required.
We are also able to help with management of more complicated nail, toe and foot deformities.
During your assessment, we might determine that you would benefit from more specialised services, such as preventative surgery or high risk wound care, and will be happy to prepare a referral for you.