Total Care Podiatry

What is Diabetes?

You may be surprised to know that diabetes is now the world’s fastest growing chronic disease. Over one million Australians have diabetes. Alarmingly, about 50 percent of people with diabetes are not even aware they have it. While prevention is certainly ideal, early diagnosis and treatment are the next best thing.

If diabetes is left undiagnosed or poorly treated it increases the chances of complications, which include heart disease, kidney disease, nerve and circulation damage, erection dysfunction (impotence), blindness and lower limb amputation. Early detection and management of diabetes allows people living with diabetes to enjoy a healthy life.

Diabetes is present when there is too much glucose (a type of sugar) in the blood. A high level of glucose causes health problems. There are two main types of diabetes, type 1 and type 2.

What is Type 1 Diabetes?

With type 1 diabetes, the pancreas doesn’t produce enough insulin because the cells which make insulin have been destroyed by the immune system. Insulin injections are needed to control blood glucose levels. Type 1 diabetes was previously known as Juvenile Onset Diabetes or Insulin Dependant Diabetes and it usually occurs before the age of 30. It affects 10 percent to 15 percent of those with diabetes.

What is Type 2 Diabetes?

This is the most common type of diabetes affecting about 85 percent to 90 percent of those with diabetes. It often affects people over 50 who have a family history or who are overweight. With type 2 diabetes, cells in the body usually become insulin resistant; which means insulin is no longer able to control blood glucose levels effectively.

Healthy lifestyle changes including healthy eating and regular physical activity can often delay (sometimes permanently) the need for medication. In over 50% of people with type 2 diabetes, successful weight management may result in normalising blood glucose levels. Regular physical activity can also play a key role in helping to improve blood glucose levels. Some with type 2 diabetes may require tablets and/or insulin to manage their diabetes optimally.

How can Diabetes affect your feet?

Your feet are supplied with blood to keep them healthy. They also have a multitude of nerves that act as an emergency warning system. For example, if you have a stone in your shoe, nerves will send a message to your brain to investigate. However, if your diabetes is poorly controlled for a long period of time, this may lead to:

•   nerve damage, or ‘peripheral neuropathy’, which impairs sensation to  the feet.                                                                                                    AND / OR

• reduced blood supply,also know as ‘poor circulation‘.

Nerve damage may mean that you no longer notice the stone in your shoes, due to loss of sensation to your feet.  This could then lead to an injury you can’t feel, and possibly infection.  If you have poor circulation, any injuries or infections to your feet( i.e cuts, burns or scratches) will take longer to heal.  This is due to less blood flowing into the arteries in your feet.  Blood provides energy to working muscles and aids in healing any tissue damage.  If you have poor circulation, you will need to take extra care to protect your feet from injury.  Most foot problems in people who have diabetes occur when injuries – often infections – go unnoticed and untreated, or when healing is delayed due to poor circulation.

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.

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

           If required 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 various 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  tuning fork to measure the sense of  vibration over of each foot. This gives us an indication of the potential of future problems, as vibration sense is on of the first senses 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 including increase incedence of corns and callus.

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 of the skins or nails, 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 re-occurring.

  WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.

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.