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Diabetes: Importance of an annual foot exam

Diabetes: Importance of an annual foot exam

Last Reviewed : 03/02/2021
Diabetes: Importance of an annual foot exam

 

If one has diabetes, it is a must to be vigilant in many areas of one's health. The following is a list of activities that can be done on an everyday basis:

  • Eating a balanced and healthy diet.
  • Taking foot exams.
  • Taking prescribed medications.
  • Staying active.

 

For individuals with diabetes, proper foot care is vital to overall health. Statistics (given by Joslin Diabetes Center) indicate that one in four people will develop a foot condition (that requires intervention). The chances of developing foot conditions that result in serious complications can be reduced by proper foot monitoring. It involves both professional evaluations as well as self-exams. It is important to know that when one condition leads to further complications in the feet, it is termed as neuropathy. There is nerve damage, which causes an inability or difficulty to feel the feet or even other extremities. Neuropathy is more commonly seen in people with diabetes. It is due to the fact that high blood glucose/sugar is known to damage the nerve fibers in the body. Also, foot problems associated with neuropathy can result in foot injuries that are not normally realizable. Studies in this field (as stated in the Journal of Family Practice) indicate that nearly half of the patients, who have a sensory loss due to neuropathy, will have no symptoms at all and can lead to further foot damage. If one neglects to care for the feet or seek intervention for a developing condition, it can lead to worsening symptoms, resulting in more serious treatments.

 

Following is a list of other foot conditions that develop in those with diabetes:

  • Bone and joint pain.
  • Breakdown of skin.
  • Calluses.
  • Changes in skin temperature.
  • Deformities.
  • Infections.
  • Ulcers.
  • Vascular disease.

 

Foot self-exam for diabetes:

There is a need to monitor the feet to maintain foot health for people with diabetes. A self-exam of the foot should be checked for the following basic aspects:

  • Calluses
  • Changes in foot color
  • Changes in foot temperature
  • Changes to the shape and size of the foot
  • Cuts, cracks, blisters, or sores
  • Hammertoes or bunions
  • Infection
  • Ingrown toenails
  • Redness, tenderness, or swelling

 

For examination of the feet, in case of any difficulty with regards to viewing them, one can use a mirror. Another option is to ask a friend or loved one to help in such a case. If one wants to reduce more complicated conditions related to diabetes, one needs to opt for daily foot monitoring.

 

When should one see a doctor?

One needs to understand that several abnormalities of the feet cannot be treated at home; it requires the assistance of either a general practitioner or a podiatrist, especially when one notices changes to the feet. After evaluating the condition, the doctor will conduct the necessary tests to determine the diagnosis. To reduce the risk of further complications, it is best to get an early diagnosis. When visiting a doctor for a preventative foot exam for people with diabetes, the doctor shall do the following:

  • Take the history:

History includes information about the overall health of a patient. The doctor will ask regarding diabetes that includes its management and any other resulting complications. The doctor shall ask regarding the smoking habits as it is a prime factor that can lead to further foot complications (eg. issues with circulation as well as nerve damage).

  • Conduct a physical exam:

The exam includes a general review of the feet, as well as specific reviews regarding the following:

  • Musculoskeletal components
  • Nerves
  • Skin
  • Vascular system

The doctor can determine the risk for complications to the feet along with the development of the course of action based on the results of the above tests.

  • Educate:

It is seen that there is a decrease in further complications if a person with diabetes understands the risks as well as the possible outcomes from the foot exam. Statistics (from the Journal of Family Practice) indicate that around ninety percent of cases, which had recurring foot ulcers, were not having an understanding of diabetes control.

 

Treatment:

The severity of foot conditions caused by diabetes can differ from patient to patient. It is a known fact that the best defense for the treatment of foot conditions is prevention; however, it is not always possible to achieve this. There is a need for fewer invasive treatment options, in the case of early detection of foot conditions. For determining the best treatment plan, the help of a specialist is a must. One needs to know that serious foot conditions like bone deformity and ulcers can be treated with a cast (that protects the foot and heals it), only if detected at an early stage. There is a distribution of pressure on the foot when using a cast. For treating ulcers, on the other hand, the doctor may recommend either a brace or specialized shoes. Apart from this, more serious ulcers need surgical intervention. In this procedure, ulcers are removed and the affected area is cleaned. One needs to understand that it can take several weeks or months for the recovery.

 

Complications and outlook:

Diabetes is known to cause serious complications from foot conditions. Also, ulcers may require amputation, if not treated at the proper time. This includes the removal of the toe, the foot, or even the leg, where the condition cannot be treated in any other way.

One can see a reduction in developing serious foot conditions if one manages diabetes well. Self-management involves the following:

  • Conducting daily foot exams.
  • Engaging in daily exercise.
  • Managing the diet.
  • Monitoring blood glucose.
  • Taking the necessary medications.

Improved diabetes management and better foot care have shown a decrease in the number of amputations by over 50 percent since the 1990s.

 

Prevention:

Foot conditions for diabetes can be prevented in many ways as listed below:

  • An annual checkup with a doctor for professional foot evaluation is a must.
  • Clean the feet daily.
  • Conduct a daily foot self-exam and monitor any changes to the feet.
  • Manage diabetes through blood glucose testing, diet, exercise, and medications.
  • One should avoid walking barefoot.
  • It is advised to keep abrasive products away from the feet.
  • Stop smoking.
  • Trim the toenails regularly.
  • Wear well-fitting shoes or ask the doctor to request custom shoes or orthotics.
  • Wear socks, which keep moisture away from the skin.
  • With daily exercises, one can keep the blood moving in the feet.

 

Although monitoring one's feet daily is very important, it becomes a necessity to report any changes in the feet to the doctor immediately. This can easily reduce the potential severity of the condition.

Individuals who have diabetes, are at higher risk for a variety of foot problems that include bone abnormalities, infection, and injury. The most common causes of diabetic foot problems are neuropathy (nerve damage) and poor circulation (blood flow). The fingers, toes, hands, and feet may feel tingly, numb, and cause a loss of feeling in the case of neuropathy. One might not know about it, when one gets a foot injury, like a blister, a callus, or a deep sore (ulcer). Daily foot self-exam can prevent long-term foot complications.

 

 

 

References:

  1. Johnson, Rachel, Osbourne, Abe, Rispoli, Jessica, Verdin, Craig, The Diabetic Foot Assessment [Online] Wolters Kluwer  https://www.nursingcenter.com/ce_articleprint?an=00006416-201801000-00005 [Updated on November 13, 2017]
  2. Podiatry Care Specialists et al, The Importance of Diabetic Foot Care [Online] Podiatry Care Specialists https://www.podiatrycarespecialists.com/practice_areas/diabetic-foot-care.cfm [Updated on July 18, 2020]
  3. National Center for Biotechnology Information et al, Comprehensive Foot Examination and Risk Assessment [Online] National Center for Biotechnology Information https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2494620/ [Updated on August 31, 2008]
  4. Craig Kopecky, MD, The Importance of Diabetic Foot Exams [Online] Premier Family Physicians https://www.pfpdocs.com/articles/importance-diabetic-foot-exams [Updated on November 14, 2019]
  5. MedlinePlus Connect for EHRs et al, Diabetic Foot Exam [Online] MedlinePlus Connect for EHRs https://medlineplus.gov/lab-tests/diabetic-foot-exam/ [Updated on December 15, 2020]
  6. Andrew J.M. Boulton, Comprehensive Foot Examination and Risk Assessment [Online] Diabetes Care https://care.diabetesjournals.org/content/31/8/1679 [Updated on June 18, 2019]

 

 

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