Diabetes and the foot

Diabetes is a condition characterised by high amounts of glucose (sugar) in the blood. If you are a diabetic you are at risk of diabetic complications, particularly if your diabetes is not well controlled. Diabetic complications commonly affect the feet, and in the worst case can result in foot or lower limb amputation. It is important therefore that the feet are maintained in a healthy condition, and the signs and symptoms of complications are known and detected early so that problems are prevented. A podiatrist can help you in the management of your feet if you have diabetes.

What is diabetes?

Diabetes is a common condition that occurs when the amount of glucose (sugar) in the blood is too high. A person that has diabetes will either:

• Not produce enough insulin, which is the hormone that is necessary to turn glucose into energy.
• Produce insulin, but the insulin produced does not work effectively (this is known as insulin resistance).

The body will undergo detrimental effects if the amount of sugar in the blood is uncontrolled. High blood sugar will lead to short term effects, and long term complications. The short term effects of increased blood sugar include; thirst, blurry vision, tiredness, and a higher susceptibility to infection. The long term complications that untreated high blood sugar has on the body include; eye disease (retinopathy) and blindness, kidney disease (nephropathy), and nerve damage (neuropathy). Neuropathy is the leading cause of foot and lower limb amputation in those with diabetes.

Types of diabetes

There are two main types of diabetes; type 1 and type 2.

Type 1 diabetes

Type 1 diabetes is what is referred to as an autoimmune condition. An autoimmune condition describes a condition in which the body attacks itself. In the case of Type 1 diabetes the body kills the cells in the pancreas that produce insulin. The pancreas is the organ in the body that makes insulin. Insulin is a hormone that is required to turn sugar into energy. A person that has Type 1 diabetes, therefore, has a reduced amount of insulin because the cells that produce the insulin have been destroyed by the body.

Type 2 diabetes

Type 2 diabetes is a condition that occurs due to a number of factors combining.

Type 2 diabetes occurs when the insulin receptors stop responding to insulin. Insulin is a hormone that is required in order to control the amount of sugar in the blood. Insulin is needed to turn sugar into energy. The food that we eat is broken down by our digestive system, and nutrients, including sugar, go into the blood. In a healthy person without diabetes the pancreas produces the hormone insulin, which takes the sugar in the blood and puts it into cells in the body so that it can be converted into energy.

If you have type 2 diabetes the pancreas is unable to keep up with the demand for insulin, or, the insulin receptors of the cells that covert sugar into energy stop responding to the insulin.

Risk factors for developing Type 2 diabetes:

Certain risk factors increase a person's chances of developing type 2 diabetes, these include:

• Family history of diabetes
• High blood pressure
• High cholesterol
• Sedentary lifestyle
• Impaired glucose tolerance
• Gestational diabetes (diabetes during pregnancy
• Having a baby that weighed 9lbs or more at birth
• Obesity, particularly abdominal obesity (carrying weight around the waist)
• Being white and aged 40 or over
• Being black or Asian and aged 25 or over
• Metabolic syndrome
• Polycystic ovarian syndrome

The risk of developing diabetes increases the more risk factors you have. It is important to note that eating sugar does not cause diabetes, however, eating sugary foods and high fat foods leads to weight gain, and obesity is a risk factor for diabetes.

How does diabetes affect the feet?

If you have diabetes this means that you are at increased risk of developing problems with your feet, regardless of whether or not your diabetes is controlled by insulin injections, tablets, or diet alone.

Foot ulcers are the number one cause of hospital admission resulting from a diabetic complication. Foot ulcers are common in diabetics for two main reasons; the loss of sensation (neuropathy) in the feet and poor circulation, both of which are complications of diabetes.

Neuropathy affects the nerve supply in the feet. Neuropathy has different forms, these include: Motor neuropathy

Motor neuropathy affects the nerves that send messages to the muscles of the foot, which can cause the foot shape to change. Typically the foot that is affected by motor neuropathy has clawed toes and takes on a more flattened appearance, which can increase the amount of stress that is placed on the bones in the foot and they may fracture.

Sensory neuropathy

Sensory neuropathy is the commonest type of neuropathy. Sensory neuropathy in the feet occurs when the nerves that that transport pain, temperature, touch, and other sensations to the brain are damaged. If you have sensory neuropathy you will not feel pain when the foot is damaged, and this can then lead to ulceration and infection. Blisters, burns, corns, callous, and injury caused by poor nail cutting are common causes of ulceration in those who have sensory neuropathy.

Autonomic neuropathy

Autonomic neuropathy affects the nerves that are in control of actions that the body does without us thinking about it, for example, sweating and temperature control. If you have autonomic neuropathy the feet will not produce sweat and the skin will become dry. Dry skin is an unhealthy skin; it will crack and is at risk of infection.

Circulation

The circulation can also be affected if you have diabetes. The arteries, which carry blood around the body can become clogged, this is called atherosclerosis. Atherosclerosis makes the artery narrower, and as a consequence the blood supply is reduced. If the feet do not have a good blood supply they will not heal if they are injured, this is because blood contains all the ingredients that are necessary for healing. If you have poor circulation you may also get cramps in the legs and feet.

It is vital that diabetes is controlled in order to prevent diabetic complications affecting the circulation and nerves. If you have diabetes it is a good idea to reduce the fat you consume, and stop or reduce smoking, as this further increases the risk of circulatory problems that can lead to amputation of the foot or leg.

What are the signs and symptoms of diabetes?

The signs and symptoms of diabetes include:

• Increased thirst
• Increased need to pass urine
• Weight loss
• Re-occurring infections
• Slow to heal
• Tiredness
• Weakness

If you experience any of the above signs and symptoms then visit your GP or pharmacist who will test you for diabetes.

The signs of diabetic complications in the feet include:

• Numbness
• Nerve pain
• Loss of sensation
• Ulcer formation
• Dry and cracked skin
• Cuts and sores on the feet that do not heal
• Altered foot shape

How is diabetes diagnosed?

Diabetes is diagnosed via a urine test and blood test. The tests are quick and can be carried at your GP surgery and some pharmacy's.

Diabetic neuropathy is diagnosed by a podiatrist. Your podiatrist will assess the nerves in the feet by performing a series of quick and painless neurological tests.

Benefits of podiatry for a person with diabetes

If you have diabetes you will benefit from podiatry. Podiatrists specialise in feet, we understand the effects diabetes can have on the body and the feet. The following benefits can be gained

• Foot health education
• Footwear advice
• Diabetic foot screening
• Skin and nail care
• Padding and shoe inserts

What would podiatry for my diabetes involve?

If you have diabetes the podiatrists at Chiropody.co.uk will begin the consultation with an assessment. The first part of the assessment is the medical history, which includes questions about your glucose control and your last HbA1c result, as well as the results of your last annual diabetic foot screen.

The podiatrist will then perform a vascular and neurological assessment in order to assess the blood and nerve supply to the feet.

The results of the assessment will provide the podiatrist with the information necessary to assess whether you are deemed 'high risk' or 'low risk' of diabetic complications.

At Chiropody.co.uk we will then assess what problems you are having with your feet, and will formulate a treatment plan, which will include education on how to maintain the health of your feet and prevent diabetic complications from developing.

When necessary we will refer you to other health professionals or your GP.

Summary

Diabetes is a condition that occurs when the amount of glucose (sugar) in the blood is too high, leading to problems elsewhere in the body. There are two main types of diabetes; Type 1 and Type 2.

If you have diabetes you are at risk of diabetic complications, particularly those affecting the feet. The risk of diabetic complications dramatically increases if your diabetes is poorly controlled.

If you are a diabetic and you would like help managing your feet please visit Chiropody.co.uk for an assessment.

To arrange an assessment with one our podiatrists please email office@chiropody.co.uk or call 0330 088 4222.

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