High Risk Feet

Diabetes mellitus is a chronic disease that affects the lives of many people in the UK. Type 1 diabetics is stable at around 1% of the population. Type 2 is rising very fast, with experts estimating that as many as 1 million people are undiagnosed. Unless you have severe symptoms it is usually found by accident  Many people have diabetes for up to seven years and have already begun developing complications before they are diagnosed.

The disease is marked by the inability to manufacture or properly use insulin, and impairs the body's ability to convert sugars, starches, and other foods into energy. The long-term effects of elevated blood sugar (hyperglycemia) are damage to the eyes, heart, feet, kidneys, nerves and blood vessels.

Symptoms of hyperglycemia may include frequent urination, excessive thirst, extreme hunger, unexplained weight loss, tingling or numbness of the feet or hands, blurred vision, fatigue, slow-to-heal wounds, and susceptibility to certain infections. People who have any of these symptoms and have not been tested for diabetes are putting themselves at considerable risk and should see a physician without delay.

Part of keeping your diabetes in control is testing your blood sugar often. Ask your doctor how often you should test, and what your blood sugar levels should be. Testing your blood and then treating high blood sugar early will help you to prevent complications.

The socio-economic costs of diabetes are enormous. Diabetes accounts for many  diabetes complications, which are largely preventable. Two out of every five with diabetes will develop a complication. Sadly, in the  UK amputations caused by diabetes: 9 per 100,000 of the population.

Foot Health Practitioners can help people with diabetes manage this disease more closely, improving their quality of life. While there is no cure for diabetes, there is hope. With a proper diet, exercise, medical care, and careful management at home, a person with diabetes can keep the most serious of the consequences at bay and enjoy a long, full life.

Comprehensive diabetes management with your health management team (family physician, Foot Health Practitioner, optometrist and ophthalmologist, dietician and community health diabetes nurse) could:

• Reduce kidney disease by up to 56 per cent
• Reduce strokes by up to 44 per cent
• Reduce eye disease by up to 76 per cent
• Reduce diabetes deaths by 33 per cent
• Reduce  1,000 amputations per year

HOW DO YOU GET DIABETES?

The exact cause of diabetes is not yet known, although scientific advances show more and more promise every day. It is a hereditary disorder, and certain genetic indicators are known to increase the risk of developing diabetes. Type 1, previously known as insulin-dependent diabetes mellitus or juvenile-onset diabetes, afflicts five to 10 per cent of diagnosed cases of diabetes. This type occurs most frequently in children and adolescents, and is caused by the inability of the pancreas to produce the insulin needed for survival. Type 2, previously called noninsulin-dependent diabetes mellitus or adult-onset diabetes, affects the other 90 to 95 per cent of all diagnosed cases of diabetes, many of whom use oral medication or injectable insulin to control the disease. The vast majority of those people (80 per cent or more) are overweight; many of them are obese, as obesity itself can cause insulin resistance.
Certain characteristics put people at a higher risk for developing Type 2 diabetes. These include:

• A family history of the disease
• Obesity
• Prior history of developing diabetes while pregnant
• Being over the age of 40
• Being of Asian, Polynesian, Aboriginal, African or Latin American descent

People of Aboriginal descent are three to five times more likely than the general population to have or develop diabetes. Two-thirds of people with diabetes are women. Aboriginal women have more than five times the rate of diabetes compared to women in the general population and men have more than three times the corresponding rate for men.

THE ROLE OF YOUR PODIATRIST

Because diabetes is a systemic disease affecting many different parts of the body, ideal case management requires a team approach. The podiatrist, as an integral part of the treatment team, has documented success in the prevention of amputations. The key to amputation prevention in people with diabetes is early recognition and regular foot screenings, at least annually, from a Foot Health Practitioner.

In addition to these check ups, there are warning signs that you should be aware of so that they may be identified and called to the attention of the family physician . They include:

• Skin colour changes
• Elevation in skin temperature
• Swelling of the foot or ankle
• Pain in the legs
• Open sores on the feet that are slow to heal
• Ingrown and fungal toenails
• Corns and calluses
• Dry cracks in the skin, especially around the heel

WOUND HEALING

A diabetic ulcer is a common occurrence with the diabetic foot, and should be carefully treated and monitored by your local surgery to avoid infection, which could lead to amputation. Poorly fitted shoes, or something as trivial as a stocking seam, can create a wound that may not be felt by someone whose protective sensation is diminished. Left unattended, such ulcers can quickly become infected and lead to more serious consequences. Your Surgery Practice Nurse  knows how to treat and prevent these wounds and can be an important factor in keeping your feet healthy and strong. New to the science of wound healing are remarkable treatments including skin grafts, the use of enzymatic debriding agents and platelet-derived growth factors.
If You Have Diabetes Already . . . DO:

INSPECT FEET AND TOES DAILY.

Check your feet every day for cuts, bruises, sores or changes to the toenails, such as thickening or discolouration. If age or other factors hamper self-inspection, ask someone to help you, or use a mirror.

WASH FEET DAILY.

Using mild soap and lukewarm water, wash your feet in the mornings or before bed each evening. Test the water temperature with your elbow, because your feet and hands may be affected by loss of protective sensation. Dry carefully with a soft towel, especially between the toes, and dust your feet with talcum powder to wick away moisture. If the skin is dry, use a good moisturising cream daily, but avoid getting it between the toes.

LOSE WEIGHT.

People with diabetes are commonly overweight, which nearly doubles the risk of complications.

WEAR THICK, SOFT SOCKS.

Socks made of an acrylic or wool blend are well suited, but avoid mended socks or those with seams, which could rub to cause blisters or other skin injuries.

STOP SMOKING.

Tobacco can contribute to circulatory problems, which can be especially troublesome in people with diabetes.

CUT TOENAILS STRAIGHT ACROSS.

Never cut into the corners, or taper, which could trigger an ingrown toenail. Use an emery board to gently file away sharp corners or snags. If your nails are hard to trim, ask your Foot Health practioner for assistance.

EXERCISE.

As a means to keep weight down and improve circulation, walking is one of the best all-around exercises for the diabetic patient. Walking is also an excellent conditioner for your feet. Be sure to wear appropriate athletic shoes when exercising. 

SEE YOUR Foot Health Practioner.

Regular checkups by your Practitioner at least annually-are the best way to ensure that your feet remain healthy.

BE PROPERLY MEASURED AND FITTED EVERY TIME YOU BUY NEW SHOES.

Shoes are of supreme importance to diabetes sufferers; poorly fitted shoes are involved in as many as half of the problems that lead to amputations. Because foot size and shape may change over time, everyone should have their feet measured by an experienced shoe fitter whenever they buy a new pair of shoes.

Try shoes on near the end of the day. New shoes should be comfortable at the time they're purchased and should not require a "break-in" period, though it's a good idea to wear them for short periods of time at first. Shoes should have leather or canvas uppers, fit both the length and width of the foot, leave room for toes to wiggle freely and be cushioned and sturdy.

DON'T GO BAREFOOT.

Not even in your own home. Barefoot walking outside is particularly dangerous because of the possibility of cuts, falls, and infection. When at home, wear slippers or sandals. Never go barefoot.

DON'T WEAR HIGH HEELS, SANDALS AND SHOES WITH POINTED TOES.

These types of footwear can put undue pressure on parts of the foot and contribute to bone and joint disorders, as well as diabetic ulcers. In addition, open-toed shoes and sandals with straps between the first two toes should also be avoided.

DON'T DRINK IN EXCESS.

Alcohol can contribute to neuropathy (nerve damage), which is one of the consequences of diabetes. Drinking can speed up the damage associated with the disease, deaden more nerves, and increase the possibility of overlooking a seemingly minor cut or injury.

DON'T WEAR ANYTHING THAT IS TOO TIGHT AROUND THE LEGS.

Tights ,  girdles, thigh-highs or knee-highs can constrict circulation to your legs and feet. So can men's dress socks if the elastic is too tight.

NEVER TRY TO REMOVE CALLUSES, CORNS OR Verrucas/ WARTS BY YOURSELF.

Commercial, over-the-counter preparations that remove warts or corns should be avoided because they can burn the skin and cause irreplaceable damage to the foot of a diabetic sufferer. Never try to cut calluses with a razor blade or any other instrument because the risk of cutting yourself is too high, and such wounds can often lead to more serious ulcers and lacerations. See your Practitioner for assistance in these cases.