Diabetes may affect your feet in a number of ways. One of the first ways is through the loss of sensation within your feet, often starting at the toes. You may experience a cotton wool like feeling or numbness in your feet, this is called neuropathy. Your chances of losing feeling in your feet increases with the number of years that you have diabetes and research suggests that up to one in three people with diabetes have some loss of sensation. The onset of neuropathy is gradual and often people who develop this complication are unaware of it in the beginning. It normally occurs between 7 and 10 years of having diabetes, although in some cases it can occur sooner where blood sugar levels have not been so well controlled.
If you have lost feeling in your feet then it is possible that you may unknowingly damage your feet. You may stand on sharp objects like a nail, piercing the skin even down to the bone without realising. If unnoticed and not treated appropriately this can have potentially serious consequences and could lead to an amputation. Such an outcome is less likely if you seek expert advice from your Diabetic Clinic or Podiatrist.
Occasionally people with loss of feeling can sense a burning pain in their feet. This can be severe and worse at night, even contact from socks and shoes can cause discomfort. This is called painful peripheral neuropathy. If you experience these symptoms it is advisable to consult your Diabetic Clinic or Podiatrist, since it is possible in many cases to alleviate the symptoms.
Diabetes can also affect blood supply to and within your feet, this can delay healing and increase your risks of infection. The implications of poor blood supply can have serious consequences for your feet, your podiatrist can routinely screen your feet for signs of poor blood flow. If necessary you may be referred on to a Vascular Surgeon.
What does the Podiatrist Look for?
Your Podiatrist will advise that you should have an annual assessment, however if you are at increased risk of an ulcer, these inspections may be more frequent. Blood supply will be checked by looking at the colour of the skin, checking the pulses in the feet and by asking questions about certain kinds of pains in your feet and legs. Normally people have two pulses in their feet, one of the top (dorsalis pedis) and one on the inside of the ankle (posterior tibial), most often the podiatrist will check these pulses by feeling the pulse with their fingers. Sometimes they will use a small hand held scanner (called a doplar) to listen to the pulse. Sensation will most commonly be checked with a monofilament and tuning fork. The monofilament is a plastic probe that is designed to buckle at a given pressure, and is a good indicator for loss of feeling. The podiatrist will also be looking for any foot deformity or signs of excessive loading that may warrant either footwear advice or in some cases an insole.
Check your feet, hosiery and shoes daily. If there are signs of redness in any part of the foot or leg, or if the foot feels warmer than usual, this might indicate infection of inflammation, which needs prompt professional attention. Awareness of pain and injury may be diminished, so inspect the inside of your shoes daily for objects like nails or torn linings, which might cut the skin.
You should urgently consult your podiatrist or seek medical attention, if you see any of the following in your feet:
*A break in the skin or a discharge
*The skin changes colour, becoming redder, bluer, paler, blacker over part or all of foot.
*New swelling in your feet