Diabetes is a chronic condition that affects the hormone insulin, which controls glucose in the diet. When diabetes is present, either the body produces less or no insulin (Type 1) or the body tissues are resistant to the effects of diabetes (Type 2). This results in higher levels of glucose in the blood, which can damage a whole range of body tissues and organs including the nerves (i.e. neuropathy) and hardening of the blood vessels (i.e. vascular disease).
Neuropathy or loss of sensation in the feet will result in a person being 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. This means that you may not feel a small cut or blister on your foot, and because there is not enough blood flow (vascular disease) to heal the small sore, it can become infected and turn into a much bigger wound very quickly. If an infection spreads to the bone, an amputation may be required.
Mint Foot Care’s podiatrists play a proactive role in the prevention and management of complications in diabetic feet. As well as nail care, callous and corn management, our podiatrists give in depth education on daily preventative self-care. Our podiatrists also perform neuroogical and vascular assessments to detect problems early and monitor health. Our clinic is equipped with state of the art vascular Doppler Ultrasound equipment that is painless and capable of mapping your blood flow and obtaining ankle brachial index and toe brachial index readings to identify circulation problems.
Neuropathy in diabetics first affects the small nerve fibres in the feet resulting in tingling, itching, burning or shooting pain, loss of coordination, numbness or a complete lack of sensation.
Neuropathy can affect the nerves that innervate sweat and sebaceous glands resulting in the loss of sweating and sebum causing the skin to be dry and prone to fissures and cracks as well as peripheral vessels leading to vascular rigidity and calcification resulting in decreased blood supply.
Peripheral neuropathy may also cause muscle weakness and loss of reflexes, especially at the ankle, leading to changes in the way a person walks. Foot deformities, such as hammertoes and the collapse of the midfoot, may occur. Blisters and sores may appear on numb areas of the foot because pressure or injury goes unnoticed. If an infection occurs and is not treated promptly, the infection may spread to the bone, and the foot may then have to be amputated. Many amputations are preventable if minor problems are caught and treated in time.
Our neurological assessments cover motor and sensory skills, balance and coordination and reflexes. The extent of the examination depends on many factors, including the initial problem that the patient is experiencing, the age of the patient and the condition of the patient.
Motor function and balance is tested by having the patient push and pull against the podiatrist’s hands with his or her feet/legs. Balance may be checked by assessing how the person stands and walks or having the patient stand with their eyes closed while being gently pushed to one side or the other. The patient joints can also be checked simply by passive (performed by the podiatrist) and active (performed by the patient) movement.
Sensory examination is performed by testing the patient’s ability to feel. This may be done by using different instruments such as monofilaments, dull needles, tuning forks, cotton swabs, or other objects. The podiatrist may touch the patient’s legs and feet have them identify the sensation (for example, sharp or dull).
Reflexes are examined with the use of a reflex hammer. The reflex hammer is used at different points on the legs and feet to test numerous reflexes, which are noted by the movement that the hammer causes.
If you are found to have any neural deficits, we will provide education on daily preventative care, advice on suitable footwear and custom orthotic devices to offload pressure areas and control imbalances.
Lower extremity vascular disease is commonly associated with diabetes, peripheral arterial disease, systemic inflammatory arthritis such as rheumatoid arthritis, systemic lupus erythematosus or scleroderma, wounds, systemic health conditions or if you have sustained a significant trauma to your foot or ankle. Our podiatrists can assess for peripheral arterial disease using non-evasive assessments such as palpation of pedal pulses and our Doppler Ultrasound equipment. Our state of the art vascular Doppler Ultrasound equipment is painless and capable of mapping your blood flow and obtaining ankle brachial index and toe brachial index readings. Vascular assessments can help prevent ulcerations, gangrene and amputations. We can refer to a vascular specialist if needed.