Our guest speaker at our November diabetes get-together in Co. Clare is a podiatrist from the local health centre (Thank you, Doireann). And I know that most people with diabetes know the basics of taking care of your feet, especially if you have been around diabetes for a couple of decades.
The reason I decided to post about our meeting is that the pathway to podiatry has changed a little in recent years and that is worth sharing this information (IMO).
But I have included an article which, coincidently, was published online this week, and contains some of the basics to lead up to the local information.
So, why do healthcare professionals stress the importance of good foot care?
“In almost all high-income countries, diabetes is a leading cause of cardiovascular disease, blindness, kidney failure, and lower limb amputation.” (from International Diabetes Federation). But a simple annual foot check can prevent or reduce your risk of developing serious problems with your feet.
“People with diabetes have special reason to take good care of their feet. High blood glucose levels may make feet susceptible to injury and infection. This is because the protective sensation in the toes or feet – your “pain alarm system” may slowly disappear with long term high blood glucose levels.” (from Diabetes Ireland)
The Foot "Issues".
The two feet problems that podiatrists (and people with diabetes) are on the lookout for are;
Nerve Damage
Nerve damage can cause you to lose feeling in your feet. You may not feel pain, heat, or cold in your legs and feet. You may not feel a pebble inside your sock that is causing a sore. You may not feel a blister caused by poorly fitting shoes.
Sores on your feet can become infected. If your blood glucose is high, the extra glucose feeds the infection in those sores and the infection gets worse. Nerve damage can also cause pain and lead to foot deformities, or changes in the muscles, bones, and shape of your feet.
Poor Blood Flow
Poor blood flow means not enough blood flows to your legs and feet through your blood vessels. Poor blood flow makes it hard for a sore or an infection to heal. This problem is called peripheral artery disease, also called PAD.
Sometimes, a bad infection never heals. The infection might cause gangrene. If you have gangrene, the skin and tissue around the sore die. The area becomes black and smelly.
Too much glucose in your blood from diabetes can cause nerve damage and poor blood flow, which can lead to serious foot problems.” (from the American National Institute of Diabetes and Digestive and Kidney Diseases)
Everybody with diabetes in Ireland should have a foot check by a podiatrist, children included, every year.
I know that some doctors and consultants might perform a brief foot check at your clinic appointment but our podiatrist (and lots of other reputable websites) state that if your foot check does not include a test using a tuning fork and a Monofilament tool.
Monofilament Tool
At your annual foot exam your healthcare professional will;
Look at your feet for signs of problems, especially if you have nerve damage
Test the sense of feeling in your feet using a Monofilament tool.
Test how well blood is flowing to your legs and feet
Show you how to care for your feet
How do access Diabetic Foot Care?
Referrals to your local podiatry service for people with diabetes are available from your GP, Public Health Nurse, Community Nurse, or Diabetes Clinic.
In Co. Clare, you can avail of a self referral form which is available at the Health Centre on Bindon Street in Ennis. It’s not available online. And we believe that this option is only available in Co. Clare.
Your very first foot screening with your podiatrist will assess you and place your feet in one of three categories; Low, Moderate or High risk.
If you are low risk, you may be referred back to your GP’s surgery for your annual foot exam. If this is the case then it will be your responsibility to schedule this. If you are referred to your GP, it’s really important that you keep a record of when your last foot check was and when to schedule your next one.
If you are Moderate or high risk of diabetes foot disease then you will probably continue to be seen in the Diabetic Foot Clinic, where they will send out your appointment to you in the post.
However, there are instances where the clinics fall behind in their appointments and it would be wise if you kept a record of when your last foot exam was and when your next one should be.
You can find more information from the HSE's Model of Care for the Diabetic Foot document, which was revised in October 2014.