Diabetes-related foot disease is a widely feared complication among people with diabetes. Once diagnosed with diabetes, people often quickly become aware and concerned about the risk of amputation, without fully understanding how to reduce their risk. 4400 Australians have an amputation associated with their diabetes every year, and 85% of these amputations would have been preventable with early intervention and appropriate care (diabetesaustralia.com.au). Whilst across Australia, and indeed the world, the rate of diabetes-related foot disease is increasing, so too is the research and understanding of podiatrists and other health professionals in how to avoid complications. As a seasoned podiatrist, I’ve witnessed firsthand the devastating impact that poorly controlled diabetes can have on foot health. However, I also know that foot complications, such as ulceration and amputation, are avoidable. In this blog, we’ll explore how diabetes can affect foot health, delve into preventative measures, and, of course, sprinkle in a few puns to lighten the mood.
How does diabetes affect my feet? (or another heading just to split it up?)
Diabetes, particularly when poorly managed, can lead to a myriad of complications across the body, not least impacting your nerves and blood vessels. When these changes occur, the first place you might notice these changes is in your feet. The blood flowing to your feet has travelled the furthest away from your heart, and the tiny nerves, so important for sensation, balance and movement, are as far from the control centre (your brain) as they can get! Here, at the furthest point on their journey, the minute changes in health can be catastrophic.
How common is diabetes-related foot disease?
In Australia, a person is diagnosed with diabetes every 5 minutes, and at least 1 in 5 people with diabetes develop diabetes-related foot disease in their lifetime (diabetesaustralia.com.au). So what is diabetes-related foot disease? According to McNeil et al (2023), it is the ulceration and/or infection of the foot associated with peripheral neuropathy and/or peripheral arterial disease in people with diabetes.
What is peripheral neuropathy?
Peripheral neuropathy, a condition where nerve damage occurs, results in a loss of sensation in the extremities. Imagine dancing through life without being able to feel the ground beneath your feet – sadly, that’s the reality for many diabetic individuals. On top of balance changes, this lack of sensation can lead to unnoticed injuries, blisters, or ulcers, paving the way for infections that may escalate into serious complications. If, or when, a wound is eventually recognised, peripheral arterial disease (reduced blood flow to the feet) hinders the body’s ability to heal, making what may have been a minor injury, a cause for major concern.
Once either peripheral arterial disease or peripheral neuropathy are present, the chance of infection, ulceration or amputation increases. But knowledge is powerful – if you know the health status of your feet, you can understand (and mitigate) the risks, greatly reducing your chance of further complications.
So how do we prevent complications?
- Daily foot inspection: Just as a seasoned dancer inspects their shoes for wear and tear, individuals with diabetes should make daily foot inspections a non-negotiable routine. Check for cuts, blisters, or any signs of redness, and if anything seems amiss, consult with your podiatrist promptly. Early detection is the key to preventing complications.
- Regular foot health check-ups with your podiatrist: The experts in foot health have done quite a bit of research in understanding how diabetes impacts your feet, and what can be done to avoid complications. Some of the best available evidence shows that regular foot health assessments to monitor for minor changes in your nerves and blood flow, can go a long way to avoiding serious complications. Although you don’t need a referral, your GP may be able to refer you for a yearly assessment with a Medicare rebate, just like at the optometrist. And that yearly appointment won’t cost an arm or a leg, but it just might save you one!
At this appointment, your podiatrist will assess both the blood flow to your feet, and how accurately the nerves are reporting sensations to you. Alongside an assessment of your skin, joints, balance and muscle strength, your podiatrist can give you a rating of risk – based on an internationally agreed upon scale. They can then tell you what that risk means for you – dancing merrily until your next check-up, or implementing daily habits to avoid the worse.
- Fun, functional footwear: Finding the perfect pair of shoes is akin to a dance partner that complements your every move. Diabetic individuals should opt for shoes that provide adequate support, cushioning, and room for toes to wiggle without constriction. If you are higher risks of complications, your podiatrist might also recommend a shoe with minimal internal seams or stitching; a bevelled sole for balance, or a custom-made orthotic to reduce pressure on your foot. As for many foot concerns, avoid high heels or shoes with pointed toes – think of it as a graceful waltz rather than a tight tango. A tango might be nice for a romantic night out, but it’s not something you want to be doing every day.
As a podiatrist, I’ve learned that a balanced dance occurs with quality diabetes management, healthy weight-bearing exercise, beautifully comfortable shoes and regular, just-in-case foot health check-ups. By incorporating preventative measures and staying vigilant, individuals with diabetes can keep their feet happy and healthy.
References:
Diabetes Australia (2017). 4400 reasons to end amputation. Diabetes Australia: Canberra, ACT, Available at https://www. diabetesaustralia. com. au/4400-reasons
Kaminski, M. R., Golledge, J., Lasschuit, J. W., Schott, K. H., Charles, J., Cheney, J., … & Australian Diabetes-related Foot Disease Guidelines & Pathways Project. (2022). Australian guideline on prevention of foot ulceration: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease. Journal of foot and ankle research, 15(1), 53.
McNeil, S., Waller, K., Lorenzo, Y. S. P., Mateevici, O. C., Telianidis, S., Qi, S., … & Galligan, A. (2023). Detection, management, and prevention of diabetes-related foot disease in the Australian context. World Journal of Diabetes, 14(7), 942.