Foot Screening for Diabetes

A diabetes foot screening takes approximately a ½ hour and when it is finished the podiatrist will be able to identify the level of risk for diabetic foot complications. In addition, if referral to another member of the diabetes care team is required it will be done. Because foot problems are one of the main complications of diabetes, the podiatrist is able to manage non-ulcerative problems and foot ulcers.

The podiatrist treats all skin and nail related foot problems. Treatment includes appropriate foot health advice, cutting of nails, reducing calluses, enucleating corns, measuring for a simple insole, moulding for a foot orthotic, or even an operation to remove an ingrown toenail – this is carried out under local anaesthetic, usually in the podiatrist’s rooms and you go home straight afterwards. The podiatrist may decide on referral to another health care professional, such as an orthopaedic surgeon or physiotherapist. 

Although most podiatrists will manage any patient who consults them, modern podiatry has seen the development of practitioners with special interests in particular foot problems, these include chronic diseases like arthritis and diabetes, sports injuries and children’s’ foot problems. Therefore it is a good idea to find out if the podiatrist has a special interest in your problem.

No referral is necessary to see a podiatrist, although many patients are referred by their health practitioner.

What Does a Podiatrist Do?

A podiatrist diagnoses and treats foot disorders and disabilities. The primary objective is to return the foot to optimum health as quickly as possible. This is achieved by combining a thorough examination of the feet with skilled practical treatment, padding, insoles, orthotics and foot health advice.

When you visit a podiatrist the type and duration of examination depends on what is wrong with your feet – so how you describe your problem is very important.

A biomechanical examination and gait analysis is an assessment of the structure and function of the foot and the effect this has on the lower limbs. This takes about 1 hour and is usually necessary to assess sports-related injuries, the effect of arthritis or children’s foot problems. This enables the podiatrist to plan an appropriate treatment programme, provide detailed foot care advice or to prescribe the correct shoe, insole or orthotic.

If your problem is more medical than mechanical then your podiatrist will consider other factors.

Where Can I Find A Podiatrist?

There is a serious shortage of podiatrists in South Africa at present, with less than 200 registered with the HPCSA and about 160 in private practice. Some of the major hospitals have a podiatrist either full or part-time.

The South African Podiatry Association represents most podiatrists in matters of ethics, business and publicity. 

You can use their website at www.podiatrist.co.za and the link under ‘Find a podiatrist in YOUR area’ to find the listing of registered podiatrists. 

If you dont have web access then the Podiatry Association can be contacted at 0861 100 249 or Email: sapa@podiatrist.co.za.

You can also look in the Yellow Pages under Podiatrists.

What is Podiatry?

You may be more familiar with the name chiropodist, but the names chiropody and chiropodist were officially change changed to podiatry and podiatrist in 1984. This reflects the more scientific approach to the practice of the profession by the modern podiatrist. 

The podiatrist diagnoses and treats foot disorders and disabilities.

A consultation and treatment by a podiatrist is more medical and is not a pedicure, for which you see a beauty therapist.

A professional board for podiatry was established in 1976 and since 1982 it has been compulsory for all podiatrists to register with the Health Professions Council of South Africa (HPCSA), to be allowed to practice, so always make sure that your podiatrist is properly registered.

Podiatrists in private practice must also register with the Board of Healthcare Funders, to obtain a practice number. This enables Medical Aid Schemes to recognise individual practitioners when claims are made and to reimburse against the new Recommend Price List for podiatry, which is put out by the Commission for Medical Schemes. Most medical aid schemes recognise podiatry and members can submit claims for reimbursement in accordance with the rules of each scheme.

Foot Care For People With Diabetes

My last two posts have been a clinical assesment of foot care for diabetics.  For those suffering from this complaint the following advice should help to protect your pair of feet and minimise the risks of deterioration.   And always get professional advice whenever you suspect anything may be wrong.

• Inspect feet daily for cuts, bruises, or any changes in shape
• Always wear shoes & socks even indoors
• Chemical agents or plasters to remove corns or calluses should not be used
• Wash feet daily & dry thoroughly, especially between the toes
• Wear correctly fitting shoes; always feel & look inside them; look for red areas on the feet
• Cut toenails to the curve of the nail; file with an emery board
• Don’t soak feet
• Protect your feet from very hot or very cold conditions
• Try to avoid putting pressure on the legs with tight sock tops, knee highs or garters
• Moisturize dry skin to make it more flexible
• Don’t be afraid to ask – get professional advice early
• Take good care of your pair

One Pair Must Last A Lifetime – The Diabetic Foot (2/2)

People with diabetes suffer from the same problems as those without diabetes, such as pes cavus (a high-arched foot), flat feet, bunions, deformed toes, corns, calluses, blisters, fungal infections etc. The risk is that often the foot is unable to respond to the stresses placed upon it. The body weight transmitted through a local area causes high pressure and leads to callus formation. If neuropathy is present, you won’t know that the callus is pressing on the softer skin underneath and eventually the skin can break down and an ulcer forms. Sometimes a foot with neuropathy becomes swollen and deformed and changes shape permanently, this is a serious condition called Charcot foot

The first signs of neuropathy could be strange sensations such as pins and needles, stabbing or shooting pains, or tingling, As the condition worsens, some people describe "ants or water running down the legs," or "a feeling of walking on cotton wool."

The circulatory changes which affect the feet are caused by hardening (arteriosclerosis) or narrowing (atherosclerosis) of the arteries. These conditions starve the tissues of blood. Occasionally a vessel becomes completely blocked and there is intense pain and the tissues begin to die due to lack of oxygen. Immediate referral to a vascular specialist is required. Other typical symptoms of PVD include pain in the calf of the leg when walking short distances or climbing stairs. Cold feet or legs. Red or blue toes. Loss of hair on the toes. Dry shiny skin on the feet and lower leg.

Unfortunately, far too many people with diabetes and their families are not well informed about the value and importance of footcare. Being informed and aware of the presence of any of the changes mentioned, will enable you to take appropriate action to prevent the serious complications of the diabetic foot.

The current approach to footcare for people with diabetes involves 5 key points:

• Regular inspection & examination of your feet
• Find out your risk level
• Be informed 
• Use appropriate footwear
• Have any foot problem treated

To lower your overall risk:

• See a podiatrist 
• Don’t use over the counter corn removers
• Don’t do bathroom surgery
• Keep your feet clean and dry
• Check you feet every day
• Keep your blood sugar level under 8

Footcare for people with diabetes is a team effort. In the case of PVD, early referral to a vascular specialist frequently saves a limb and restores the circulation to a limb or foot. An annual assessment by a podiatrist monitors how diabetes has affected your feet and enables the provision of appropriate treatment of foot problems.

One Pair Must Last A Lifetime – The Diabetic Foot (1/2)

The foot has been referred to as "the mirror of the diabetic state," but amongst health professionals mention of the diabetic foot usually produces visions of ulceration, infection, gangrene, and amputation. For someone with diabetes, foot problems are very significant because they can be life threatening. There are two main reasons for this.

• Nerve damage may cause numbness of the feet, so that the warning signals of pressure and pain no longer function properly – this is neuropathy.
• Circulation to the feet can be poor, causing slow healing – this is peripheral vascular disease (PVD)

The so-called diabetic foot develops because high blood glucose levels – hyperglycemia – damage nerves and blood vessels. Looking after your feet could save a limb and possibly your life, particularly if you are over 40 years old or if you have had diabetes for more than ten years.

Many serious and costly complications can affect the health of people who have diabetes. These can affect the heart, kidneys, and eyes, but it is the foot complications, which take the greatest toll. It has been reported that 40-70% of all lower extremity amputations are related to diabetes mellitus.

The diabetic foot is also a significant economic problem, especially if amputation results in prolonged hospitalization, rehabilitation, plus an increased need for social services and home care. In addition there is loss of income and emotional stress. Fortunately there is increasing evidence from countries such as Brazil, Sweden and the United Kingdom that amputations can be reduced considerably (in some cases by 50%), by implementing certain strategies. These include:

• Regular inspection of feet & footwear by trained people
• Preventive foot & shoe care for high risk feet
• Teamwork between patient, family and carers – getting informed
• Early detection of & intervention for PVD
• Continuous follow-up of patients with previous ulcers
• Registering amputations and ulcers

These strategies are important in today’s health care environment, because avoiding amputation can save large amounts of money. A British report estimated that for each amputation avoided, 4000 British pounds were saved, excluding indirect costs (e.g. loss of productivity, increased need for social services, etc.). There are good reasons to "take care of your pair" since research has shown that during their lifetime 1 in 10 people with diabetes will develop a foot problem.

More to follow….

Andrew Clarke, Podiatrist

Andrew will be posting his observations on the world of podiatry as well as hints and tips in his specialist areas of diabetes, arthritis and children’s foot problems.

You can read about Andrew’s qualifications and background on the page ‘About Andrew Clarke’ and locate his clinical practice in the ‘Practice’ page.