Do you know your foot health risk status? Have you had your feet thoroughly examined by a podiatrist? Experts Worldwide in their guidelines for the management of diabetes recommend an annual foot examination at the very least. This foot examination establishes the risk for complications or your Foot Health Risk Status. If you are aware of this, so many foot problems associated with Diabetes could be prevented.
These foot complications can be as simple as a painful corn or as complicated as an amputation. Of course if you have reduced sensation – peripheral neuropathy – there won’t be much pain and probably non at all.
As a podiatrist I would like to be celebrating an improvement in the foot health of South Africans, but unfortunately many people with diabetes have never seen a podiatrist, mistakenly believing that since they have no visible foot problems everything is fine.
Diabetes causes changes to the circulation and nerves to the legs and feet which often develop slowly and almost without notice. I have heard people say that they have the less serious diabetes “the second type.” Comments like this make me realise that the Foot Health message is still not reaching our patients clearly.
Managing diabetes is a team effort and the podiatrist is a member of the team. If you neglect your feet and have no idea if they are showing the effects of diabetes, you are probably going to develop, corns, callus, blisters, ulcers and worse. Do you know the quality of your circulation? Are you sure you can feel everything with your nerves?
Why not commit to better foot health today by making an appointment with a podiatrist for a diabetic foot assessment?
On July 28 2008, on this website I wrote about Dialysis and the diabetic foot, with a description of a foot ulcer patient.
Last week I was invited to speak to patients of the Cape Town Dialysis Clinics about foot care; during my preparation I came across some startling evidence proving that dialysis is an independent risk factor for foot ulceration if you have diabetes and require dialysis.
We already know that impaired kidney function increases the risk of foot ulcers – also referred to in my 2008 Blog – but this 2010 research proves that:
If you have diabetes and are receiving dialysis, you are 5 times more likely to develop foot ulcers, compared to someone with diabetes who is not on dialysis.
Scary but true clear evidence from a study completed at Manchester UK.
The research showed that patients on dialysis have more nerve damage, circulatory problems and a history of foot ulcers and amputations.
There is a 25% lifetime risk of people with diabetes developing foot ulcers so the key issue whatever your status is prevention.
Diabetic foot ulcers have multiple causes, some are: external trauma from footwear, neuropathy, arterial damage, poor self-care, lack of access to care, poor treatment.
However, as with all research you must ask – “so what?” This patient group did not include any people of colour, so it may not apply totally to South African patients.
So what to do? our objective is always to PREVENT complications.
Every person with diabetes must have an ANNUAL FOOT EXAMINATION so that they understand their level of risk for developing foot complications.
in addition individual education on self management of their diabetes. this is a team effort, paying attention to cardio-vascular health, eyesight, footwear selection and fitting, foot biomechanics (and possibly insoles or orthotics), plus probably the most important factor – can you invest in the care being offered?
Always “take care of your pair”.
Free foot screenings for people with diabetes are still available from certain podiatrists nationwide this week. Due to the demand, in our practice we will still offer them during next week too.
Protecting your feet from the complications of diabetes is a serious responsibility.
Managing your diabetes is the foundation of protection against complications that affect your eyes (Retinopathy), kidneys (Nephropathy) and feet (Neuropathy).
Feet can be severely damaged by diabetes and yet they are painless. This allows injuries to occur undetected and often leads to ulceration and amputation.
The purpose of the FREE FOOT SCREENING is to establish your risk level for developing foot complications, because many foot injuries can be prevented by being informed about the status of your feet.
Even people with severe loss of sensation can and do avoid problems by a combination of good blood sugar control and regular foot inspections by a podiatrist.
PLEASE DON”T BECOME A STATISTIC
World Diabetes Day takes place every November 14th. Diabetes is a serious chronic disease. It is estimated that 250 million people worldwide have diabetes (about 6% of the adult population between 20 -79 years). This number is expected to reach 380 million by 2025, (7.1% of the adult population)
Every 30 seconds a leg is lost to diabetes somewhere in the world!
Many diabetic foot ulcers and amputations can be prevented
Starting this week podiatrists nationwide will be promoting foot health awareness in various ways as their contribution to preventing the complications of Diabetes.
Check your local press for details of free screenings, talks, fun walks etc., often with Diabetes SA.
In our practice free screenings can be booked via Lauretta. 011 726 6363.
Nationwide contact the South African Podiatry Association; 011 7943297
Screening is a short observation of key signs to identify the risk level of your feet.
Not every person with diabetes is at risk, but some are and have no idea that they are.
If you know that you are at risk, the podiatrist will become a key person in your life.
Act now – your life might depend on it!
Take this opportunity to finf out your risk status.
Neglected feet can become a serious problem. So to0 can neglected patients or visitors using this website. Welcome back to all of you – feet as well as people!
Good time management has never been one of my strengths and over the past 2 months I have had a struggle to make time for this fascinating communication channel with my blog visitors as well as the core professional duties of my daily practice and some additional duties on behalf of the podiatry profession.
So, look out for replies to all the comments posted. Do keep posting comments – the warning is only there because one person posted a comment with too much personal detail – failing to realise that what you post EVERYBODY reads.
Anyway, what has been going on? The “chairpersonship!” of the SA Podiatry Association(SAPA) is proving to be an enormous task; fortunately the Executive are really dedicated people and have taken up the challenge of a new (& very different chair with enthusiasm). We are developing a new website that will be more interactive for podiatrists and public. You should see podiatry visibilty in future.
Podiatry has been featured on SABC 3 with Noleen, Talk Radio 702 with Redi, chai fm community radio in Johannesburg and I understand there is something in the November edition of ELLE magazine.
The University of Johannesburg has also been active, honouring the top achievers of 2008 – guess where the top podiatry student is – yes, you’re right, emigrated to Australia!
By the way, it’s not too late to apply for a place on the course for 2010. However, tomorrow sees the start of the exams – more time pressure as I am an examiner and moderator for a couple of subjects.
Then come some big events. First up is the birth of our second grandchild, due in 2 weeks, followed by a trip to Harrogate in the UK for the Society of Chiropodists and Podiatrists Annual Conference – I am presenting a Poster on the work we have done at Chris Hani Baragwanath Hospital, Paediatric Rheumatology clinic.
Meanwhile, in the practice recently a lady with a classic case of neglected feet was brought in by her daughter. The lady lives in Limpopo Province north of Johannesburg; she had no idea how she damaged her foot so badly that the tendons were showing through the top of her foot! She felt no pain either (undiagnosed neuropathy?).
X rays revealed the bones inside were infected and had collapsed to create a very fat, swollen shape. (Charcot neuroarthropathy). As there was no pain it had been left under the care of the patient and her GP. Basically because the lady had poor access to health care, but more importantly no insight into her diabetes what would you expect? A classic example of poor communication all round.
Talking of communication, look out for activities associated with World Diabetes Day on November 14th. Check what your local podiatrist or clinic is doing. There is a big event in KZN, with a SAPA presence, there are events in Cape Town too.
As the Southern Hemisphere is into “exams fever,” I’ll leave you with this thought from a postcard that I bought in Oxford some years back.
The more I study, the more I know.
The more I know, the more I forget.
The more I forget, the less I know.
So why study?
Foot Health Awareness is vital for people with diabetes.
PEOPLE WITH DIABETES ARE 25 TIMES MORE LIKELY TO LOSE A LEG THAN PEOPLE WITHOUT THE CONDITION
Today I want to issue a timely reminder to people with diabetes who want to wear ‘Crocs’.
Last Friday, I saw a patient who “lived in her ‘Crocs’.” That was until she got splinters which penetrated the soles and stuck into her big toe, as she was walking across the university campus. The splinters were removed by her GP and today she told me there was a small remaining piece that also had to be removed. Fortunately, although she has neuropathy, the wounds are healing well.
Last Christmas, a family member (with no diabetes) also had a piece of metal go through the sole of his ‘Crocs’, whilst walking across the garden.
Previously, I have not taken a strong stand on this, but these two events have prompted me to express my opinion in the form of a WARNING.
If you have diabetes, think very carefully about wearing ‘Crocs’. If you have poor circulation or reduced nerve sensation; do not wear them outside the home.
EVERY 30 SECONDS A LOWER LIMB IS LOST TO DIABETES SOMEWHERE IN THE WORLD
The International Fedaration of Podiatrists, headquartered in Paris, France, has declared May to be World Foot Health Awareness Month. I join them in calling the attention of the public and health care providers to the importance of good foot and ankle care. It’s time for all South Africans to stop and take a look at their feet!
The importance of good foot health and the role played by the podiatrist cannot be overstated, since, most South Africans will develop some foot or ankle problem during their lifetime. World Foot Health Awareness Month is a marvellous opportunity to stop and consider the value and importance of our feet.
Winter is nearly here and we will be spending more time in closed shoes. Do last year’s boots really still fit? Are they going to cause pressure calluses?
Don’t wait for your foot problem to become severe. Remember that the average person takes about 8,000 to 10,000 steps per day and while you’re walking, your feet are taking a pounding; often enduring more than your body weight with each step.
As part of World Foot Health Awareness Month 2009, there is a special focus on Diabetes and the Diabetes Health Care Team. In support of this initiative, the South African Diabetic Foot Working Group (DFWG), will be presenting free patient-oriented symposia nationwide.
30th May. Contact: Andrika Symington: 012 548 9499
9th May.Contact: Anne Berzen 072 342 9558
13th June. Contact: Dr Willem de Kock 082 379 6231
to be confirmed. Contact: Dr Paruk 031 241000-ask for speed dial
to be confirmed. Watch this space!
These symposia will offer a unique opportunity for people with diabetes and their families to ask questions of the members of the health team directly involved in foot care.
MAY 2009 is WORLD FOOT HEALTH AWARENESS MONTH
Every person who has diabetes, should have an annual foot examination. Feet, along with kidneys and eyes, form the “terrible triad” as it is sometimes called in medical circles; because people with diabetes can develop peripheral arterial disease or peripheral neuropathy(feet); nephropathy(kidneys) and retinopathy(eyes). I have spent the past two days conducting the Annual Foot Examination for people who attend the Potchefstroom Centre for Diabetes (CDE).
How many people with diabetes undergo this annual examination? Who knows? What is certain is that CDE members have to comply with rules which gives them access to all the basic health care professionals they need. (CDE is a Managed Health Care network of over 250 medical practices contracted to certain medical aid schemes).
The benefit of this annual examination is that patients, families and health carers know if the feet are at risk of developing futher complications associated with diabetes. The examination involves checking vascular, neurological, dermatological and orthopaedic status. Footwear is also checked and commented on. The International Consensus for managing the diabetic foot states that early identification of vascular insufficiency and referral to the vascular specialist does save many limbs.
Worldwide of course there is evidence that smoking damages your health, but even in the group at Potchefstroom there were smokers. All of whom had diminished circulation, plus the typical signs of cool feet, absent hair, discoloured pink/blue feet – especially when hanging over the side of the examination couch – and a cough.
Checking the state of sensation is vital for good diabetic foot health. The loss of sensation – neuropathy – is often an insidious process, not being fully appreciated by the patient until they are aware of “funny feelings” in their feet. Patients describe sensations of “pins and needles,” “shooting pains,” “ants running over my feet,” “I thought my sock was folded over under my foot, but it wasn’t,” “it feels like I’m walking on cotton wool” and many others. This could be the first step to damaging the foot and developing an ulcer.
People with diabetes get all the conditions that affect the rest of us. However, if not identified and managed properly an area of callus(which indicates increased local pressure) can easily develop into an ulcer. Various nail conditions are common amongst people with diabetes, especially fungal infections and they are difficult to get rid of.
They structure of any foot affects its function and so in the diabetic foot assessment we look at the alterations in shape that could cause load increases and potential blister or ulcer sites. In addition disorders such as gout are very often associated with diabetes.
Footwear is responsible for at least 50% of foot ulcers, so this is examined very carefully. Unfortunately, many people do not have suitable footwear, so it’s important to check it and give good advice.
Diabetes is a life-threatenting disease, but modern medicine has moved to early diagnosis and treatment and an important part of this is recognition by podiatrists of the signs in the feet. However for the person with diabetes one of the simplest acts to ensuring long life is to have your feet examined annually and know your foot status or risk.
Talk Radio 702 in Johannesburg and 567 Cape Talk present a nightly series of talk shows devoted to specific topics. On Tuesdays it is A Word on Medical Matters and this coming week the topic is going to be feet. Hosted by Leigh Bennie and Prof. Harry Seftel, the programme is broadcast from 7.00 pm. For this programme I have been asked to be the guest on the show!
Anything can happen as it is an open line phone-in programme linking the sister stations of 702 & 567. It is great fun although a bit scary since you have no idea what questions are coming until you see them on the computer screen in front of you. Nevertheless it is an excellent forum for publicising the role of the podiatrist in providing health care in South Africa.
Maybe that role will become more recognised and change for the better, now that we have a new Minister of Health. Perhaps now we can also get a sensible line of communication to the Minister concerning the scale of fees payable for our services.
Today was another busy day in the practice culminating in the latest visit of the patient I wrote about with gangreous feet and undergoing dialysis. Well, the toes are still attached although black and dry – but the gentleman is really unwell. I have arranged for his wife to do some dressings, so that he could reduce the number of visits he needs per week. This is an important factor of the International Consensus on the Diabetic Foot, where the patient, family and health care professionals get involved in care. The intention is to develop an interactive and educated team.
Yesterday was another Paediatric Rheumatology clinic at Chris Hani Baragwanath – every week there is something new and we are beginning to have success in managing the painful foot complaints of some of the children. Incorrect footwear is still one of the main obstacles to achieving success though, because I can’t put an orthotic into a shoe that is already 2 sizes too small. This happened yesterday; the shoes in question were a pair of stylish Lacoste sneakers – bought at considerable cost by a loving mother but they were too small after a few months. With the result that the toes were buckling and painful – nothing to do with arthritis of course.
As summer approaches there has been an increase in ‘sweaty foot disorders’ so in the next week I’ll give some advice on how to recognise, treat and possibly avoid them. But if you can’t wait, listen to A Word on Medical Matters on Tuesday 30 September where the topic is Feet ard Podiatry, because the question always comes up.
In the meantime – TAKE CARE OF YOUR PAIR
The diabetic foot is often associated with patients who are on dialysis for kidney failure as a result of their diabetes. There is a well known ‘triad’ of eyes/kidneys/feet. What health professionals call retinopathy/nephropathy/neuropathy.
We are managing a gentleman who is suffering the effects of many years of poorly-controlled diabetes, acompanied by smoking. The effect of this has been serious damage to the circulation to his legs. As a result, he has needed arterial bypass surgery and now, three times a week he comes to the hospital for dialysis, because his kidneys are malfunctioning,so his specialist asked us to look after his feet.
On first view we got a real shock – the three outer toes on his right foot were dry, shrivelled and black – typical of dry gangrene. These toes will probably fall off by themselves! The back if the left heel is one large blood blister, fortunately it’s dry and not infected.
The principle of managing cases like this is to keep the areas clean and dry. For the patient they have to do their best to control their blood sugar. The targets for good blood sugar control for a person with diabetes are between 5.5 and 7.0 mmol/litre, so you can imagine my concern at the last visit when I found out that this gentleman was running 15mmol/litre.
Every time the dressings are changed there is the opportunity for bacterial infection and high blood sugar usually worsens the situation. Of course the state of the feet and limbs in an obvious potential cause for the raised blood sugar too.
So what’s the lesson? Mismanage diabetes at your peril! Damage to the nerves and circulation will have a major impact on your life the longer you live. The complications of diabetes are largely preventable, yet vast amounts of money are spent worldwide on managing the complications of diabetes.
Control of blood sugar and not smoking will protect both arteries and nerves from serious damage. Nephropathy or damage to kidneys is life threatening and not everybody can access a dialysis unit. Loss of sensation or neuropathy, where there is no sensation in the feet, allows for injuries to happen without the person noticing.
Don’t become a victim of circumstance – take control of your diabetes now – and avoid dialysis later.