13 Aug Diabetic Footcare: Diabetic risk status
Do you know your diabetic risk status? And did you know it may assist to detect foot ulceration?
With the prevalence of diabetes diagnosis increasing so is the need for quality diabetic footcare. What are the best ways to screen for complications? And why are so many people seeing a podiatrist?
There are increased risks to the foot and ankle in diabetic sufferers; which can be prevented if screening occurs early. Feet are usually the first area to display changes since the foot nerves are furthest away from the body.
Examples of risks that can be prevented with appropriate diabetic footcare:
- Peripheral neuropathy (nerve damage)
- Peripheral arterial disease (PAD, poor circulation)
- Biomechanical changes (Increased pressure points and bony changes)
- Skin and nail (Dry skin and thinner toe nails)
- Foot Ulceration (Foot wounds)
- Foot Amputation (Remove of the foot or part of the foot)
Why see a podiatrist for diabetic footcare?
Studies show that if podiatrists/ health professional screen for cardiovascular history, perform blood flow studies (palpating pulses, hand held doppler wave formation and blood pressure) and loss of protective sensation (LOPS, nerve damage) can prevent diabetic wounds. These tests can be highly suggestive of diabetic foot complications based of high-level research.
Here at Quay health, we do perform a comprehensive subjective history so we can understand your experience with diabetes. With the main aim of early identification of risk factors that can increase the risk of foot ulceration.
What will a podiatrist do?
What is included during the initial diabetic foot assessment:
- Skin and nail assessment to look for pre ulceration signs (early signs of wounds forming)
- Sensory testing via 10g monofilament test and 128hz tuning fork test to screen to nerve damage
- Blood flow testing via Hand held doppler test to screen to reduced circulation to major arteries.
- Biomechanics testing to see if joints are becoming increasingly stiff or changes in morphology.
- Footwear assessment to screen if they are the right shoe for your given task and to offload prominent areas.
Based on the results from the screening we can stratify your risk of foot ulceration.
How often should you see your podiatrist when you have diabetes?
According to the international working group diabetic foot, based off expert opinion below may be the best frequency based off the stratification:
- Category 0) (Very Low risk) No LOPS or NO PAD screening every 12 months
- Category 1) (Low Risk) LOPS or No PAD screening every 6-12 months
- Category 2) (Moderate Risk) LOPS+PAD, LOPS+ foot deformity, or PAD+ foot deformity screening every 3-6months
- Category 3) (High risk) LOPS or PAD + one of the following (history of foot wounds, lower extremity amputation minor or major, end stage renal disease). Every 1-3 months.
A person’s risk status may change over time hence routine continual monitoring is needed. The stratification is a guide and we will tailor from person to person. What is also included is further education, support and management plans to help you understand the whole screening process.
What to expect in a diabetic foot assessment in regards to education
Structured education should be given to persons who are experiencing diabetes. This may help to reduce stress, anxiety and improve their understanding of self-management behaviours. There are many forms of education such as one of one consultation, video education, quizzes, motivational interviewing etc.
At Quay Health the podiatrist will work with you to find which means of education suits you best. Unfortunately, education alone cannot prevent foot ulceration and works best along routine diabetic foot screenings.
Some take home messages on foot care which may be discussed are:
- What do foot wounds look like?
- What are the possible consequences if left untreated?
- How to perform self-care at home?
- Which activities may we not want to perform barefoot?
- What are adequate support features of a shoe?
- What is proper foot hygiene?
- When should I see a podiatrist in a timely manner after finding a foot problem?
Easy self-management tips for diabetic footcare:
- Check your feet daily for any changes, the changes are anything that differ from the day before.
- Know your signs of infection: pain, redness, increase in temperature, pus or odours if you experience 2 or more, please contact your podiatrist
- If you have loss of protective sensation do not walk barefoot or in socks without shoes or in thin/narrow sole shoes
- Wear adequate width, length and depth footwear that do not cause any friction or pressure points.
- Practice good foot hygiene, wash feet daily and clean between toes.
- Moisturise your feet daily top and bottom of foot expected between toes.
- See a podiatrist in a timely manner after you identify any foot concerns.
A majority of diabetic foot concerns can be prevented with early detection and education. If you need any guidance, please get into contact a health profressional
If you are interested in a diabetic foot assessment with one of our podiatrists, feel free to book online or call our team on 02 9252 2825.
Post by: Podiatrist Richard Ching