People often know that it is important for people with Diabetes not to cut their own toenails but when I ask they rarely know why this is.  
If you do not see a podiatrist regularly e.g. every 6-8 weeks, it is important to go for an annual foot check. There are several reasons why. 
Increased blood glucose levels 
• can affect the circulation to the feet and legs causing cramps, restless legs and poor oxygen levels to the skin and muscles. 
• can cause damage to the long nerves that reach your feet. This can mean a loss of sensation (peripheral neuropathy) or heightened sensation (painful neuropathy). The longer you are Diabetic the more chance you have of developing neuropathy. 
• cause poor healing and increased chance of bacterial infection. In combination with loss of sensation this means that a minor cut can become infected very quickly. 
• create the perfect environment for fungal skin and nail infections. 
Poor healing combined with loss of sensation can allow skin to ulcerate due to poor healing, pressure or a combination of both. Ulcers are notoriously difficult to heal and can lead to amputation. 
A podiatrist will carry out a visual check each time you see them. They will check the colour, temperature and hair growth on the feet and lower leg and note any swelling. They will check for any cuts or signs of bacterial or fungal infections. They will advise on hosiery and footwear, trim the nails and remove callus or corns which may cause pressure points. In addition to this they will observe any structural changes within the foot, for example nerve damage can cause the toes to claw and this in turn can cause pressure points. Prescribed insoles can help prevent deterioration in the foot structure and offload pressure points. 
In an annual diabetic assessment, the podiatrist will carry out additional examinations. They will check the foot pulses. Most people have two pulses in each foot and a doppler ultrasound test will tell the podiatrist the how good these are. They will check the sensation and compare this to previous annual assessments. In addition, they will check the range of motion in the foot and mobility overall as well as assessing the skin condition and noting any points at risk of ulceration. 
As with most things prevention is better than cure and keeping a very close eye on your feet and legs and calling a podiatrist if you have any concerns no matter how small can prevent a problem leading to infection, ulceration and ultimately amputation. 
Next week I shall chat about how you can look after your feet and legs. 
Tagged as: Diabetes, Neuropathy, Ulcer
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