Diabetes and your feet
Diabetes is the most common metabolic disease in the UK. It falls broadly into two types:
Type I, usually affecting young people and frequently resulting in them having to use insulin.
Type II: Usually affecting older people and able to treated with diet and oral medications. However some type II use Insulin as well.
What can go wrong with my feet?
Three things can go wrong with diabetic feet
1. Reduced arterial blood flow. Diabetics are more prone to vascular changes in their arteries and capillaries resulting in less blood getting to your feet.
2. Reduced sensation or numbness can occur(Sensory Neuropathy) this results in you being more prone to injuries as you do not respond to pain. So a shoe rubbing or a bath that is to hot can cause damage.You can also develop Autonomic Neuropathy which can result in very dry skin.
3. Infection, Diabetics in general are more likely to get infections, so a wound on your foot is likely to get infected and take longer to heal.
Therefore if you have a reduced circulation and you get a wound it is likely to get infected and you are likely not to rest it because you can’t feel it.
I haven’t got these things should I worry?
- If your blood sugar is not well controlled you are more likely to go on to develop these things so taking care of your diabetes is paramount.
- If you smoke you should stop, even if you don’t want to, as this means your circulation is much much more likely to be affected.
- Remember 70% of amputations in the UK occur in diabetics, often starting with some trivial injury.
What else should I do?
You must have an Annual Foot Screen by a Podiatrist or at your GP.
A podiatrist will listen to the blood flow in your arteries using a Doppler scanner and check your sensation with a monofilament. They will also check you for any foot problems that could cause problems in the future and treat them to prevent a problem occurring.
In addition they will give you footwear advice and tell you what you should look out for and when you should be worried.
All the Diabetic patients treated at The Mackenzie Practice are offered foot screening with a written report for your GP.
If you do have a serious foot problem that requires hospital care we have good contacts with our Acute Podiatry and Consultant services in our local acute trusts, we will endeavour to get you seen promptly and appropriately.
Arthritis
The most common type of arthritis occurring in the foot is Osteoarthrits. This is the wear and tear arthritis associated with age which effects joints that take a lot of weight or do a lot of work, in short they wear out. Everybody will get some form of this arthritis as they age. It is typically painful in episodes and the joint may swell, the resulting inflammation can damage the joint further resulting in a limitation of movement.
In the foot toes and metatarsal joints are commonly involved however it can also attack the ankle and the joints of the midfoot. Any joint that has had an injury or a # is likely to develop this. The foot problems that arise from arthritis can be multiple to a problem with a deformed toe to more complex problems with walking. Podiatrists can advise you carefully on a range of treatment options.
Other Arthritis: Rheumatoid, Psoriatic, seronegative
These types of arthritis are systemic diseases and can affect young and old.
Rheumatoid Arthritis causes problems in the foot as it frequently attacks the small joints and the ankle resulting in severe deformity. Podiatrist can help in the management of this deformity and development of appropriate insoles and footwear to relieve pressure.
These diseases are often treated with drug therapies, which leave you open to infection and poorer healing. Thus any foot lesion should be carefully managed.
Common foot problems
Corns
These are localised area of thickened skin with a deeper central core of hard skin. They frequently overly bony promiences and can be multiple. They are caused entirely by excessive pressure, this can be simple from poor footwear or more complex with an underlying mechanical problem with foot function. Treatment involves physical removal aided by the application of caustic therapies
and pressure relief/removal. It is essential to establish the cause of the excessive pressure and where possible remove this otherwise the corn will repeatedly reoccur.
Callouses
These are areas of thickened skin. To a degree it is normal to have some thickening of the skin on you feet. It is skin that is under pressure and responds by thickening to make it stronger. However callous can become very thick causing localised inflammation and discomfort. In this case it should be professionally removed.
Fungal Nails
Nails can become infected with fungus, this is quite common and Nails with a history of damage are more prone to this. The fungi that cause these infections are often on our skin surface naturally. Your are more prone if you have damp sweaty feet. Treatments vary from topical appications to systemic therapy. We will be able to tell you if your nail has a fungus and advise you of the most appropriate course of action liasing with your GP if required.
Ingrown Nails
True ingrown Nails are very painful ,frequently infected with a tendency to bleed very easily.
In short these type of Nails reqiure surgery.
At The Mackenzie practice we offer partial or total nail avulsions with phenolisation ( to prevent the nail regrowing) under local anaesthesia.
It is offered as a complete package with all the surgery and postoperative care in one price.
You will be carefully assessed as to your suitabliity for this procedure and a range of treatment options will be discussed. If we feel that this is not the best option for you we will not proceed as you should never have any surgery unless you need it.
Nails that are thick and difficult to cut.
Nails tend to thicken naturally with age and get further away! Many people have difficulty cutting their Nails with simple scissors. Any nail that has been damaged will become thick and may appear to grow upwards rather than straight. We are happy to helpwith nail care and give you techniques for managing them yourself.