A Guide On Diabetic Foot Examination

​Transcribed from video.

It has been estimated that worldwide, one lower limb is amputated every 30 seconds as a result of diabetes. In Singapore, an estimated 11.3% of the population has diabetes, with diabetic food complications accounting for approximately one-fifth of all emergency admissions. It is a growing concern, as diabetic foot problems present health risks to a diabetic patient. In a healthy person, wounds tend to heal quickly. However, in a diabetic patient, wounds may not heal as easily.

Some diabetic patients may suffer from nerve damage, which causes their feet to be insensitive to trauma or pain. They may also experience concurrent symptoms such as numbness or pins and needles sensation. In a foot with no sensation, patients may not be aware that they have traumatised their foot or have a wound on their foot, and they may continue to walk on it. This further traumatises the wound on the foot and with negligence, wound deterioration and infection may result. The foot or lower limb may become red, hot and swollen as a result of the infection and may spread if left untreated. 

In addition, patients with poor blood flow to the foot may notice the foot turning black. In such cases, further intervention will be required and amputation may be unavoidable. In diabetic patients with or without wounds on their foot, changes in the foot structure or shape may be observed over time. Areas of high pressure on a deformed foot are likely to break down and form non-healing wounds. It is therefore important to recognise the risks involved in a diabetic foot and manage them to prevent infections and amputation.

This could be carried out on a daily basis with self-care of your foot, wearing appropriate footwear to prevent blisters or wounds and having your foot assessed regularly by a healthcare professional. On a daily basis, you may carry out the following assessment and footcare measures:

  1. Check your feet daily for any cuts/wounds. You can use a mirror to assist you to check the bottom of your foot.
  2. Wash your feet daily with soap and water and dry them thoroughly, especially between the toes.
  3. Apply foot moisturizer on a daily basis, taking care to avoid wound areas and the areas in between your toes.
  4. Trim toenails straight across, avoid cutting down the sides.
  5. Avoid peeling/cutting the skin on your feet and avoid using corn plasters for corns or hard skin. Use a foot file or see a podiatrist instead.
  6. Wear appropriate shoes at all times, within the house, and when you are outside.
  7. Seek medical help immediately when you notice any redness, swelling, warmth or pain.

It is also important to recognise the role of shoes in the prevention and formation of diabetic foot wounds. Poor fitting or unsuitable footwear may result in the development of blisters or wounds. A good pair of shoes should have the following features:

  1. There should be one thumb's width from your longest toe to the front of the shoe.
  2. The width should fit the widest part of your foot to prevent rubbing against the shoes.
  3. Shoes should be deep enough to accommodate any foot deformities.
  4. The front of the shoes should be flexible to assist you with your walking.
  5. The middle of the shoe should be rigid enough to give you maximum support in your arches.
  6. There should be a firm heel counter for increased support.
  7. Shoes should have laces or velcros to prevent excessive movement of the feet within the shoes. It is preferable that you choose a covered pair of shoes as this will provide better protection for your feet.
  8. Regular assessment of the diabetic foot may reduce risks of ulceration, infection and amputation.

During the podiatry session, diabetic foot screening, treatment and/or any education may be provided. Diabetes is a condition which may result in severe complications of the foot. If you have not had a diabetic foot screening or would like further assessments and advice, speak to your podiatrist. But remember, do obtain a referral letter from your doctor.

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