Diabetes And Feet

What is diabetes?

Diabetes is a condition where the human body does not permit the use of insulin to break down sugar.This causes increase of glucose (sugar) level in the blood.

What are the effects of diabetes?

Sugar damages the inside walls of the blood vessels.This damage makes the blood vessel hard and inelastic.Fat in the blood sticks to the walls of the damaged blood vessels.Over time the width of the damaged blood vessel reduces due to fat deposits. Consequently less blood flows through the blood vessel (Peripheral Vascular Disease). The smaller the artery the faster they block. The smallest arteries in your body are in the feet, eyes and kidneys.

Blood contains nutrients (oxygen, WBC, RBC) which it delivers to different parts of body. If less blood flows, less nourishment (via nutrients) are carried to the body parts, not allowing the body’s natural infection fighting defense systems to be delivered to the wound site.

If there is a cut, due to insufficient nutrients (via blood) being carried to the wound site results in in ncreased healing time and a greater risk of infection. Infection can spread. This can lead to infection in the bone(s).To prevent further damage amputation may be required.

Nerves:

Nerves are like electrical cords, wires (conductors) on the inside and insulation on the outside.Increased sugar level in the blood eats away the insulating layer of the nerve. Without this layer, conduction of signals via the nerve gets disrupted.This causes a loss or reduction of protective sensation (Peripheral Neuropathy).

Symptoms:

• Pins and needles
• Numbness
• Burning
• Cuts, bruises or other injuries to your feet that you did not notice

Loss of sensation normally starts at the toes and gradually works up the feet and legs.There is a risk, as you will not sense any damage to the affected area. Reduced sensation can have an impact on healing. Reduced blood could increase risk of infection.

How can a Podiatrist help with diabetes?

A Podiatrist can help by carrying out the following:

• Assessment of blood flow
  • Palpating pulses in your feet
  • Performing Doppler Assessment
• Assessment of nerve function
  • Testing protective sensation
• Bio Mechanical assessment of foot
  • Identify areas of high pressure
  • Bunions, Hammertoes, High Arch, Low Arch
  • Treat corns and calluses before they become a wound and get infected
  • Cut Nails to avoid ingrown toe nails which could lead to infections
  • Attend to other foot related concerns that could lead to wounds and infections

Can my treatment be covered by medicare?

If you suffer from a chronic disease (such as diabetes or arthritis) which affects your feet, your General Practitioner(GP) may put you on a Team Care Plan. Under this plan, Podiatry can be covered by Medicare. If you are having trouble looking after your feet,discuss this matter with your Doctor(GP) at your next appointment.

For example: Mr. Smith is a 62 yr old gentleman who has recently had a hip replacement. He finds it difficult to bend down and cut his toe-nails. Furthermore, Mr Smith has diabetes. This places him at a higher risk of infection in case something goes wrong while he is cutting his toe-nails.If Mr Smith discusses this concern with his Doctor(GP),the Doctor may nominate him to be a part of the Team Care Plan under which Mr Smith could be entitled to up to 5 visits to the Podiatrist in a year. This plan is revised annually.

Case Study 1

Ethel born 1940, has Diabetes. Ethel has arthritis in her knee joints and finds is extremly difficult to bend her knees. Ethel has a history of a triple bypass and suffers from cataract. Ethel has a painful corn on her right second toe. She treated the corn with a corn pad herself. The corn pad macerated the healthy tissue (skin) around the corn and infected the toe. Because of poor eye sight (cataract) and limited mobility, Ethel could not see or feel the infection. The infection got worse and led to an ulcer. Ulcers in patients with diabetes take very long to heal (Due to lack of blood supply - less nutrients)If the infection was to spread, it could lead to amputation of the toe.

The infection could have been avoided if Ethel had consulted a qualified Podiatrist who would have removed the corn and provided on going care.

Case Study 2

Harry is 75 years old. Last year he had a hip replacement. This helped in reduction in pain in the hip joint but limited his mobility.Has has very thick toe nails and has a fungal infection on his left foot He is diabetic which has lead to reduction in feeling/sensation in his feet. While cutting his toe nails, he accidently left a nail spike in his right toe. The nail spike punctured his skin and caused a wound Due to reduced sensation in his feet Harry did not feel the nail spike. The wound got infected. Harry had to be admitted to a hospital as the infection had travelled further. He is at a risk of losing his toe due to diabetes

This also could have been avoided if Harry had seen a Podiatrist for skin and nail care. The Podiatrist would have helped Harry in trimming his toe nails and advised him on different treatments for his fungal infection.