Diabetes is a condition which can place a person at great risk of developing serious foot complications. If you are on medication for diabetes or have been diagnosed as diabetic, it is important to have an initial pedal neurovascular assessment on your feet. The results of this assessment will inform you of your risk status of developing pedal diabetic complications such as wounds and amputation. Depending on your risk status your podiatrist will suggest the frequency required for further assessments.
The main problems are caused by the systemic effect of diabetes on the lower limb:
- Decreased circulation to the feet: (reduced blood flow) The large arteries of the body can become narrower. If this occurs to the large arteries in the leg, less blood reaches the feet. This condition is called peripheral vascular disease. Reduced blood flow can lead to slower healing of wounds and cuts, and therefore an increased risk of infection. Reduced blood flow to the limbs and feet can cause multiple symptoms including cold feet, poor skin and nail condition, cramping and aching in the feet and legs. A pedal vascular assessment includes the palpation of pulses in the feet. Your podiatrist will also listen to your pulses with the use of an ultrasound machine. A final test to check circulation usually involves taking the blood pressure in your big toe. This gives your podiatrist a good overview of your circulation. These tests are usually performed on a regular basis to gauge any deterioration in vascular status.
- Decreased nerve function in the feet: Damage to the nerves in the feet is known as peripheral neuropathy. The nerve damage caused by diabetes can occur to sensory, motor or autonomic nerves in the feet. Sensory neuropathy is the loss of feeling in the feet. Patients can experience symptoms of numbness, pins and needles or burning in the feet. A person becomes a high risk patient when they begin losing the protective sensation in their feet. This means that they cannot perceive pain correctly. If a person with sensory peripheral neuropathy cuts or injures their foot, they may not feel this and continue to walk on the injured foot. The area can become more damaged and infected. Motor neuropathy can affect the feet in diabetes causing loss of muscle strength and control whilst walking. This can lead to the development of pressure lesions on the sole of the foot. If left unmanaged these areas may become ulcerated. Autonomic neuropathy affects blood vessels and sweat glands which can have a significant impact on skin texture and bone health. People with long standing, uncontrolled diabetes with neuropathy can be at a much higher risk of bone fractures and associated complications.
Sure Step Podiatry provides every patient who has Diabetes with a comprehensive neurovascular assessment and treatment according to individualised needs. Sure Step podiatry recommends that patients with diabetes should have regular checks of their feet.
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