Every 12 months people who have Type 1 & 2 diabetes should have his or her feet reassessed. These results should be compared with the baseline assessment and with the results of 12 months earlier to see if there has been any change, especially if this indicates that there is an increase of risk of foot problems.

The 12 monthly re-assessment we offer examines the most important areas that indicate the immediate risk or the potential of developing problems in the future. Areas covered are:

• Circulation
• Sensation
• Muscle and Joint function
• Dermatological status

The tests and the equipment used have been shown in research to be the best possible to provide you with valid and reliable results.

This information then becomes a baseline for comparison with the results of your regular 6 monthly foot check or 12 monthly foot health reassessment done by us, your regular podiatrist or GP .

We will provide your GP with a report and discuss with you the options if any areas need to be addressed.

1. Assessment of Your Blood Circulation

We use Doppler ultrasound to measure the blood flow velocity (speed), timing and amount over 2 areas in each foot. This gives us the status of the health of your present circulation

We combine this equipment with blood pressure measurement, comparing the pressure between the arm and at the ankle. This gives us an indication of the potential of future problems.

Both of these measurements are objective and thus directly comparable with previous assessments

2. Assessment of the Nerve sensation in your  feet

Nerve damage, often called neuropathy,  can occur in the long nerve fibers connecting your sense of feeling and pain in your feet, to your brain.

If this sensation pathway is damaged, you might not feel that your feet are sore or injured and infection may result if it is left unnoticed.

We use a monofilament device to assess the sensation in 10 areas on each of your feet. This gives us the status of the health of your present sensation and indicates where any risk of insensitivity may occur.
We also use a specially graduated tuning fork to measure the sense of vibration over 3 bony prominences of each foot. This gives us an indication of the potential of future problems, as vibration sense is the first sense to diminish.

Both of these measurements are also objective and thus directly comparable with previous assessments

3. Assessment of Muscle and Joint Function

One of the risk factors that recent research has shown, is that people with diabetes can often have a decreased range of motion in the joints.

This can increase the pressure under certain areas of the feet which increases the risk of injury to that tissue.

This risk will also be affected by the structural misalignments we all have and how your muscles and joints function.

4. Assessment of Your skin and nails       condition

The tone of your skin, development of hard thick skin, (callous), or Infection between the toes, is more than just a nuisance for people with diabetes. These may indicate a more significant concern.

For example, a callous formation, such as seen in this picture, may well indicate high pressure occurring under areas that are not designed to tolerate them. This could lead to tissue injury.

In your assessment, we will thoroughly examine your feet for nail or skin problems. This information helps to build a clear picture so we can recommend strategies, not only to address any immediate concerns, but to actively work towards curing any conditions you may have and prevent them reoccurring.

With diabetes, there can sometimes be other associated complications that occur, especially if your diabetic condition is not well controlled.

One of the most important areas where complications can occur is in the feet. We have all heard horror tales of people who have had foot problems with diabetes; removal of toes, feet and more …. not a pretty picture.

It is our aim at Total Care Podiatry to ensure that you have the very best foot health possible and if there are any areas which may lead to future concerns, that these are prevented wherever possible.

We do this through appropriate advice, assessment and treatment with the most up-to-date diagnostic equipment available.

There are two standard assessments: a comprehensive examination and an annual assessment. Further information about these assessments can be found in diabetes category.

We are also happy to work with other health professionals, including your present podiatrist.

The goals of the Podiatric Diabetic Evaluation are :

• To provide a clear picture of your foot health, to you and your ‘health team’
• Offer key recommendations:

=>To prevent any areas of concern becoming worse, and

=> To address any problem areas

• Assist you with various treatment options and a care plan if required.
  

Birth –2 years

The first year is a crucial time of development of your child’s feet, during this period they will grow to approximately ½ the full adult length and width.  So it is important that any observed abnormalities be referred to a suitably qualified and experienced podiatrist or health professional as problems noticed at birth will not always resolve.  It is recommended that these problems be assessed before the infant begins walking

As carer for an infant you can assist normal development by some recommended methods

(1)  Ensure that bed covers are loose enough to allow for normal movement

(2)  Exercising – kicking prepares the legs for weight bearing and walking

(3)  Alter the baby’s position frequently so legs and feet are not put under excessive and continuous pressure

WHAT IS NORMAL?

At the time of birth the baby’s legs will have a bow-legged appearance, this is normal and should disappear by the time the child reaches 2-3 years of age.

All babies have the appearance of “flat feet” during the first few months, this is due to the presence of a fatty pad within the arch, the arch is developing as muscles and bones strengthen so that it will develop till properly formed at about the age of 3.

WHAT IS ABNORMAL?

The position of the fetus in the womb can cause pressures on the feet, this or genetic predisposition may cause a baby to be born with its feet turned inward; this is may cause misalignment of the metatarsal bones and/or contraction of tendons and muscles.  This is known as Metatarsus Adductus.

Metatarsus Adductus

While severe forms of this condition are usually recognized immediately after birth, it may not be until your infant starts standing (8 – 12 months) that a less severe form of the condition is noticed due to in-toed shape and awkwardness on standing or stepping.

Early recognition may be corrected with stretching and manipulation, modification of sleeping habits or specialised booties.

An overriding 2nd digit is a common condition, especially in pre-walkers, it may correct itself as the infant begins to walk but it is advisable to seek professional assessment for this condition as if unresolved, future footwear fitting may be a problem. Early intervention can include taping or splinting.

An overriding 5th digit, is generally congenital and generally no treatment is required though future considerations can be corns or callous that will need ongoing attention.

FOOTWEAR NOW?

When your toddler begins to walk, shoes are not necessary to be worn indoors; in fact walking barefoot (or in socks) helps develop muscle strength. As toes grasp the ground, also it assists in normal foot development.

When walking outside feet need to be protected, so shoes that are light and flexible and are made of natural fibres are recommended.  It is not advisable for toddlers to walk barefoot outdoors as this exposes feet to cuts, contusions, also to viruses such as plantar warts.

Ages 2-4

WHAT IS NORMAL?

In this age group a child should be developing a more steady and confident walking. The bow legs posture normally is present by 3-4 years of age.  The child should be able to alternate feet while climbing upstairs, kick a ball, pedal a tricycle, climb and hop on one foot.

A child may exhibit signs of “toe walking”.  It is not uncommon in 2 and 3 year olds, but normal heel-strike should be demonstrated by the age of 4. Most commonly it is from weak muscles as part of their normal growth phase.

Toe walker

WHAT IS ABNORMAL?

If “Toe-walking” is present between 3-4, it is advisable to have the child assessed by a podiatrist or other qualified health professional as this condition may be due to

(1)  Muscle imbalance

(2)  Or may be related to a neurological disorder

Another common problem is of an “in-toeing or pigeon toe” gait style. It is important to note what part of the leg the internal rotation is coming from. Have your child stand in front of you in their underwear in a relaxed position.

• If the knees point straight or outwards and the lower legs and feet point inwards, your child needs to be seen before 4 years old.
• If the knees rotate inwards, this indicates it is from the hips and will probably self correct with age

If not sure seek qualified and experienced podiatry advice.

Ages 4-6 years

WHAT IS NORMAL?

A child of this age may have an appearance of knock-knees. If this doesn’t resolve by the age of 7, it may continue into adult life.  Therefore an assessment by a suitable health professional is advised.

As part of this, (as noted above), there may be an internal rotation of the legs from the hips. This can especially happen after or during a marked growth phase, as the hamstring muscles often become tight and as a result internally rotate the legs on the hips.

WHAT IS ABNORMAL?

If a child is still demonstrating structurally “flat feet” at the age of 4 –5 then this should be assessed by a podiatrist. Structural problems such as abnormally joined bones may be present, so tests such as X-rays, CT scans or other imaging techniques may be indicated.

Keep in mind that early diagnosis often means early treatment.

If the arch of your child’s foot excessively ‘rolls-in’, (pronates), it is advisable to have that cause of this identified by a podiatrist qualified and experienced with young children’s foot and leg conditions. Once the cause of the flattening is discovered, the condition can be addressed. This process of diagnosing WHY the foot rolls-in rather than just supporting the foot to improve it’s posture is most important for the future development of our child’s foot.

Ages 6-12 Years

WHAT IS NORMAL?

A child of this age should be growing out of the knock-knee posture by 7-8 years old.

Sudden growth phases or spurts can lead to unusual walking patterns and postures, which while understandable taking into account the resultant tight and weak muscles, does increase the risk of injuries occuring.

Picture of excess pronated stance

Pronation

WHAT IS ABNORMAL?

If your child begins to complain about having pain in their legs or feet, especially during activities or has frequently trips or falls, it may indicate an issue that needs a podiatrist’s assessment.

Injuries such as a ‘pulled muscle’ or a ‘rolled ankle’ that occur regularly, especially for no known reason, or an injury that doesn’t fully get better is other indications of dysfunction.

Sometimes pain or problems occur in the leg from poor foot function, such as:

• knee pain
• shin pain
• ankle pain
• calf muscle cramps
• achilles tendonitis ( for more conditions see common foot problem section)

Treatment can include, stretching and strengthening of muscles, joint mobilisation, taping, footwear modification and orthoses.

It is actually very unusual for an infant to have structural flat feet even though it often appears that their feet are flat.
The flattened appearance of infant’s feet can be due to the following:

1. Up to the age of approximately 3 years there is a fat pad located in the arch and this can often mask the arch shape.

2. The joints of a child’s foot are incredibly mobile and its supportive musculature is weak, so if the body is heavy, the foot will tend to collapse to some degree;  so long as it is not extreme, this is normal.

3. There may be some structural issues in the legs or feet, where the body will use the large mobility to compensate.

When do I seek advice?

If the condition is normal and is just due to the first or second point above, you will note that the arch will be present when the infant or child is not taking any weight on their feet,  but becomes flat only when they are weight bearing.

If you note that the arch is always flat whether they are standing or not, an assessment from an appropriately experienced podiatrist should be sought.  Also if your child regularly trips over, has an awkward gait or  complains when walking for more than a slight distance,  an assessment would be appropriate.