Diabetes affects the body's ability to maintain healthy levels of sugar (glucose) in the blood. Our bodies require the glucose we absorb from food in conjunction with optimal functioning insulin (hormone) to covert into energy to fuel your body. People with diabetes do not produce insulin or not enough needed to complete the conversion process. For both type 1 and 2, diabetics have malfunctioning insulin which results in uncontrolled, high or low blood sugar levels due to issues with processing glucose. If these blood sugar levels are uncontrolled for prolonged periods of time it can result in long term complications not only affecting the feet but other parts of the body as well.  

Diabetic Foot Problems

Poor glucose control generally causes two main complications in the feet:

• Nerve damage that results in peripheral neuropathy
• Poor blood supply & circulation

If nerve damage occurs, you may experience some of the following symptoms in your feet:

• Numbness or altered sensation
• Pins & needles in the feet
• Burning pain in the legs and feet, usually more noticeable at night
• Coldness in the legs and feet. 

If you do not address these symptoms and control your blood glucose levels, it is highly possible you will lose all feeling in your feet, starting with your toes. This is very dangerous as you will no longer be able to feel pain. 

If your feet are not getting adequate blood flow, you may experience some of the following symptoms:

• Sharp cramps in the back of your legs after walking short distances or upstairs. This pain is relieved with rest.
• Pain in the feet, often at rest
• Delayed feeling 
• Cold feet 
• Change in colour appearance 

Reduced blood flow to the feet and legs means that your tissues are not receiving the necessary oxygen and nutrients. This can impact your body's ability to heal cuts or abrasions, and fight secondary infections that may occur at the wound site.

With reduced or no feeling in your feet and or reduced circulation you are at a greater risk of developing a foot ulcer from cuts, grazes and pressure points on your feet. These ulcers are vulnerable to infection and if left untreated or poorly managed they can lead to surgical intervention.  

Diabetic Assessment

Diabetic assessments involve examination of the neurological, vascular, musculoskeletal, and dermatological systems of the feet and legs to determine your diabetic foot risk status of developing a foot ulcer or complication. 

Your diabetic foot risk can be classified as:

• Very Low 
• Low 
• Moderate
• High 
• At Risk: current ulceration 

Your foot risk status determines how our podiatrists can best implement a management plan for prevention of diabetic foot ulcers and complications. Unfortunately the higher your risk of ulceration the more frequently assessments and care is required. 

Outcomes from a diabetic foot assessment include:

• Determining your diabetic foot risk status classification
• Thorough vascular assessment
• Diagnosis and treatment of any nail and skin conditions e.g. corns, calluses or cracked heels
• Detection of skin cancers
• Reducing risk of infection sites
• Wound prevention & management
• Education about diabetic feet

At The Feet People, our Brisbane based podiatrists offer comprehensive diabetic assessments and ongoing general nail and skincare that are in line with the: 

• International Working Group for Diabetic Foot (IWGDF) Guidelines
• The Australian Guidelines for National Evidence Based Guidelines on Prevention, Identification and Management of Foot Complications in Diabetes
• General nail and skin care

The Process

1. Diabetic Assessment

During this initial appointment, the podiatrist will use the following validated assessment tools to establish a foot risk status:

• Neurological Assessment 
• Vascular Assessment
• Footwear assessment 
• Dermatological Assessment
• Screen for skin cancers
• General foot and Nail care 
• Diabetic foot health education and information 

Once a foot risk status is determined, the podiatrist may make recommendations based on the results. This may include recommendations for footwear modifications and orthotics to reduce high plantar pressure sites that are at risk of ulceration. 

Recommendations are made to help you achieve your goal and follow up appointments are scheduled based on your specific needs and desired outcomes.

2. Ongoing diabetic dermatological management appointments

In this consultation, we continue to screen for skin cancers and other skin and nail pathology.

General foot and nail care is also provided to keep your feet in tip-top shape.  These appointments are commonly recurring appointments from four (4) to eight (8) weeks apart.

Foot care products we normally recommend

• Customised silicone toe props/interdigital wedges - to prevent the pressure that is causing a corn or ulceration
• Custom-made orthotics - to prevent the pressure that is causing a corn, callus, cracked heels or ulceration
• Moisturising lotion - Lotions that are pH balanced (5.5) will absorb easily into the skin to help maintain optimal skin integrity.
• Footwear - to improve the fit and prevent pressure that can cause corns, callus, ingrown toenails or ulcerations
• Heel balm with active ingredient of urea - to treat dry cracked callous skin. Creams with at least 20% Urea in them are more effective than standard moisturisers. 

How to care for your diabetic feet

• Check your feet daily for any possible problems, specifically looking out for redness, swelling, cuts, splinters, blisters or pus.
• Wash and thoroughly dry your feet daily, especially between your toes. 
• Moisturise your feet daily to avoid dry skin (but not between the toes)
• Avoid walking barefoot
• Avoid using over-the-counter corn pads or razors — it may cause marked maceration to the skin.
• Cut your toenails straight across, with good quality nail clippers, and file the corners and edges. 
• Wear comfortable and well fitted shoes. 
• Wear diabetic or bamboo socks 
• Avoid having your feet in close contact with direct heat including: heaters, hot water bottles & electric blankets
• And most importantly, have your feet checked at least once per year by a podiatrist

Visit one of our Brisbane Podiatry clinics

If you would like to talk to one of our team, visit us at one of two Brisbane based locations, CBD & Newmarket.

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