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A diabetic foot assessment will include:

Assessment of foot pulses and blood flow

Neurological assessment using vibration and neuro filament testing

Foot pressure measurements

Having regular foot checks as a diabetic - even if you have no foot symptoms will allow early detection before problems arise

Diabetes mellitus (DM) represents several diseases in which high blood glucose levels over time can damage the nerves, kidneys, eyes, and blood vessels. Diabetes can also decrease the body's ability to fight infection. When diabetes is not well controlled, damage to the organs and impairment of the immune system is likely. Foot problems commonly develop in people with diabetes and can quickly become serious.

  • With damage to the nervous system, a person with diabetes may not be able to feel his or her feet properly. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired. These factors together can lead to abnormal pressure on the skin, bones, and joints of the foot during walking and can lead to breakdown of the skin of the foot.
     
  • Damage to blood vessels and impairment of the immune system from diabetes make it difficult to heal these wounds. Bacterial infection of the skin, connective tissues, muscles, and bones can then occur. These infections can develop into gangrene. Because of the poor blood flow, antibiotics cannot get to the site of the infection easily.
     
  • People with diabetes must be fully aware of how to prevent foot problems before they occur, to recognise problems early, and to seek the right treatment when problems do occur. Although treatment for diabetic foot problems has improved, prevention - including good control of blood sugar level - remains the best way to prevent diabetic complications.

Several risk factors increase a person with diabetes chances of developing foot problems and diabetic infections in the legs and feet.

  • Footwear: Poorly fitting shoes are a common cause of diabetic foot problems.
    • If the patient has red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new properly fitting footwear must be obtained as soon as possible.
       
    • If the patient has common foot abnormalities such as flat feet, bunions, or hammertoes, prescription shoes or shoe inserts may be necessary.
  • Nerve damage: People with long-standing or poorly controlled diabetes are at risk for having damage to the nerves in their feet. The medical term for this is peripheral neuropathy.
    • Because of the nerve damage, the patient may be unable to feel their feet normally. Also, they may be unable to sense the position of their feet and toes while walking and balancing. With normal nerves, a person can usually sense if their shoes are rubbing on the feet or if one part of the foot is becoming strained while walking.
       
    • A person with diabetes may not properly sense minor injuries (such as cuts, scrapes, blisters), signs of abnormal wear and tear (that turn into calluses and corns) and foot problems.
  • Poor circulation: Especially when poorly controlled, diabetes can lead to accelerated hardening of the arteries or atherosclerosis. When blood flow to injured tissues is poor, healing does not occur properly.
  • Trauma to the foot: Any trauma to the foot can increase the risk for a more serious problem to develop.
  • Infections
    • Athlete's foot, a fungal infection of the skin or toenails, can lead to more serious bacterial infections and should be treated promptly.
       
    • Ingrown toenails should be handled right away by a foot specialist. Toenail fungus should also be treated.
  • Smoking: Smoking any form of tobacco causes damage to the small blood vessels in the feet and legs. This damage can disrupt the healing process and is a major risk factor for infections and amputations. The importance of smoking cessation cannot be overemphasised.