Diabetes, your feet and the podiatrist in Covid-19

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?

World Diabetes Day – November 14 2010 – Foot Screening

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.

May is World Foot Health Awareness Month

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.
PRETORIA:
30th May. Contact: Andrika Symington: 012 548 9499
CAPE TOWN:
9th May.Contact: Anne Berzen 072 342 9558
BLOEMFONTEIN:
13th June. Contact: Dr Willem de Kock 082 379 6231
DURBAN:
to be confirmed. Contact: Dr Paruk 031 241000-ask for speed dial
JOHANNESBURG:
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

Dialysis and the Diabetic Foot

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.

More Diabetic Foot Disasters

Two more diabetic foot disasters arrived in the practice and at my Hospital clinic this weekend. Another hot water bottle burn, plus a corn paste induced abscess.

Loss of sensation and lack of foot health education contributed to the elderly lady with Type 2 diabetes burning her left little toe and the lower part of her calf, plus blistering her right big toe. The lower calf is about 2mm deep and the blisters were still covering intact skin.

If you are in any way involved with people with diabetes this winter please warn them of the dangers of hot water bottles, heating pads etc. Remind them of the tips I put out recently for winter foot care.

When diabetes causes loss of sensation in the lower leg then putting hot objects like hot water bottles next to the skin can lead to serious damage.

Medicated corn plasters and pastes have been around for years and are usually used by desperate people who don’t know that a podiatrist can give them relief from their painful corns and calluses.

Sadly my patient is also a Type 2 diabetic, but without complications and therefore was in great pain.

I drained the abscess, applied appropriate dressings and prescribed antibiotics. This lady is booked off work for 3 days plus the weekend and I will see her again on Thursday.

That’s a big penalty in lost working time for a lady who was simply trying to take care of her feet but did not understand the value of taking professional advice until it was too late.

So who is to blame for these disasters? If the patients concerned didn’t know, then I am for not getting the good foot health message across to enough people. On the other hand the patients did know who to come to for help.

A Fresh Start At The Practice?

Fresh from the long weekend we welcome Ms Lauretta Zikalala to our podiatry practice. Lauretta is our new receptionist and will be the voice of the practice from today. Back at the practice today, (not exactly fresh!) after a tiring but stimulating weekend at the Diabetic Foot Working Group (DFWG) Congress. Armed with some new knowledge and revision of existing, Tshidi and I feel that we have more to offer our patients with diabetes.

We know that Podiatry and diabetes is not just about managing the serious complications such as foot ulcers. The key issue is the prevention of this complication and research shows that multidisciplinary interventions can reduce both ulcers and amputations. There is a major challenge in South African health care to educate everybody involved in diabetes about the need for proper foot health care.

Just to get patients and professionals to look at feet could prevent many complications. So many patients do not feel pain and are therefore misled into thinking that there is nothing wrong with their feet. Meanwhile they develop blisters from footwear, ulcers from objects like drawing pins, stones and other foreign bodies and burns and scalds from heaters or hot water. It is clear that we will have to develop innovative and cost effective interventions to reduce the numbers of amputations and to improve foot health awareness in South Africa.

For any health professionals reading this; do you know what an angiosome is? I’ll publish some references tomorrow. (I think you will be amazed). For the lay person, angiosomes allow vascular specialists and podiatrists, in the context of patient examination, to accurately assess the quality of blood flow to every part of the lower limbs and feet. This enables really accurate identification of those areas at risk due to inadequate blood supply. Most of us are familiar with the dermatomes which map out the nerve supply, but angisomes are something new. (Well they are to me!).

The Diabetic and the barley bag – part 2

Loss of sensation and reduced blood flow to the lower limbs and feet are a well known complication of diabetes. As winter progresses, people with diabetes are at increased risk from problems associated with damage caused by trying to keep the feet warm. The lady I wrote about on May 7 is still at high risk.

Fortunately she is sticking to her care routine and the toe has stabilised. The blistered skin dried and formed a hard crust – actually this is a dry gangrenous crust – has formed over the centre of the wound, but the edges are clean and pink. The primary key to a successful outcome is control of blood sugar and that is good. Secondary is the quality of wound care and hopefully we are up to standard.

The biggest problem we have when treating diabetic foot ulcers is to keep weight off, called off-loading. Naturally, this is very difficult for a patient who knows they have a foot ulcer, but doesn’t feel any pain. Remember, pain stops us from doing further damage to an injured body part.

Here are a few WINTER FOOT TIPS FOR PEOPLE WITH DIABETES.(It’s winter in the southern hemisphere).

Keep up the daily washing and drying -especially drying

Keep up/start a daily routine of gently massaging moisturiser into your legs and feet

Remember that your shoes may become tighter because you are wearing socks and closed shoes

When you take off your shoes, check your feet for tell-tale red marks – this means dangerous pressure

Check that your shoes do fit, you possibly haven’t worn then for some months

Thicker-soled shoes will keep your feet warmer

Don’t let your boots squeeze your calf muscles and reduce circulation

Keep your feet warm at night – wear socks. NOT nylon, but cotton or wool or mixtures

Heat your bed BEFORE you get in and turn off electric blankets and heating pads. Remove hot water bottles

Try to avoid sitting in draughts – difficult, because we have houses that are designed for coolness

Wrap a blanket around your legs and feet if you are in a cold room

Never sit too close to any fire or heater – (people have fallen asleep and burnt their legs & feet)

Try to keep your excercise routine going, even though it’s darker morning and evening

p.s. Cape Mohair make excellent socks

When did you last have a Holiday?

I had forgotten how well you can feel just by taking some time off. Having just spent 10 days away from the practice I feel really good and ready for anything. I have just asked my colleague’s patient when last did he have a holiday? His reply? “Holiday is a swear word.”

My colleague also says she hasn’t had a holiday in along time and needs to get away. The Eastern Free State and then the Drakensberg is beautiful in the Autumn. (Before I went away, our receptionist had resigned, the ADSL line had been out of order for 10 days and I hurt my back!)

However, it only takes a few days for reality to hit back in the practice. A patient of ours with diabetes and a history of ulcers, returned after an absence of two years because she had a problem. Some problem too!

An ulcerated bunion joint with a massive swelling and a local skin temperature of 37 Celsius. She said it happened just a few days ago after the foot began to swell. Unfortunately the skin damage was so severe that I decided that the best plan was to admit the lady for a full work up of blood tests, wound swabs and X-rays, plus the opinion of the diabetic foot team, but she requested to go to the local State hospital the following day!

This cavalier approach to diabetes and its complications is being researched as a probable additional complication of diabetes. The behaviour changes possibly being the effect of damage to the central nervous system.

Don’t delay that holiday.