Why is podiatry important in diabetes?
Why is podiatry important in diabetes?
Diabetes is a chronic condition that affects the way the body metabolizes sugar often characterised by high blood sugar levels. Either the body does not produce enough insulin to store sugar as energy or the body resists the effects of insulin.
There are two main types of diabetes:
Type 1 diabetes, also called Insulin Dependent Diabetes Mellitus usually occurs in people under 30 years of age, but can occur at any age. In type 1 the insulin producing cells of the pancreas (beta cells) have been destroyed leaving no insulin available to help the glucose enter the body’s cells resulting in no energy and excessively high blood glucose levels. Represents 10-15% with diabetes
Type 2 diabetes, also called Non-Insulin Dependent Diabetes Mellitus (NIDDM). The beta cells of the pancreas are still producing insulin but it is ineffective in removing glucose from the blood stream. Usually occurs in people over 40 years of age, inactive, family history of diabetes and being overweight. About 85 to 90% of people have diabetes.
All types of diabetes are associated with high levels of glucose in the bloodstream. The clinical term for this is hyperglycaemia which leads to health problems
The two main health problems that can arise from hyperglycaemia are decreased blood supply and peripheral neuropathy.
Decreased blood supply and peripheral neuropathy may lead to leg ulcers, serious foot problems and limb amputation. It is estimated that amputation is 15 times more common in people who have diabetes than in people who do not.
Decreased Blood Supply
When blood sugar levels are poorly managed, the high levels of glucose causes inflammation of the blood vessels rendering them thicker and less flexible, also known as Atherosclerosis. As a result, it’s harder for the blood to flow through them. This is especially true of the smaller blood vessels that are so important for good circulation in the lower legs and feet. As an added concern, diabetics have a natural tendency toward higher cholesterol and triglyceride levels. Together, these problems put diabetics at a greater risk for Peripheral Vascular Disease.
Good blood supply is vital for adequate oxygen and nutrients to be carried throughout the body. This oxygen and nutrient supply is what allows our body to repair damaged tissue and fight against infection. Even the most minor cut or infection can be detrimental if blood supply is diminished.
↓ Decreased blood supply = ↑ Increased risk of infection
High levels of glucose are toxic to nerves resulting in nerve damage. 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
• 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.
Why Visit a Podiatrist?
Diabetes Australia recommends visiting a podiatrist annually for a check-up or more frequently if your feet are at high risk.
At Mint Foot Care we perform comprehensive vascular (i.e. Ankle Brachial Pressure Index Doppler tests) and neurological assessments (i.e. monofilament, vibration tuning fork) to assess if blood vessels and nerves have been damaged by diabetes.
Our Podiatrists will provide necessary treatment at the time of the consultation for nail care and skin problems such as ingrown toenails, corns & calluses, or ulcer debridement and in more advanced cases recommend customised orthotics to offload pressure areas.
We can recommend appropriate footwear and stock a large range of Dr Comfort Footwear suitable for diabetics.
A written report on your foot health can then be forwarded onto your General Practitioner or specialist Endocrinologist.