What is the diabetic foot?
The diabetic foot is a chronic condition caused by hyperglycemia (high blood sugar levels over a prolonged period), which leads to blood circulation dysfunctions, immune system damage, musculoskeletal deformities, loss of sensation (neuropathy) and potential infections.
What are the risks, symptoms and complications?
Just because you have diabetes doesn’t mean you automatically have a diabetic foot at risk. Your podiatrist will be able to determine your risk by performing a vascular, neurological and dermatological examination. When blood sugar levels are well controlled, the risk of developing a diabetic foot in the long term is minimized.
Sugar levels can therefore cause, among other things, loss of sensation in the feet, altered skin flexibility, dry feet, muscle/joint deformities that increase pressure points and reduced blood circulation. All these symptoms are gradual and do not necessarily lead to pain. That’s why it’s important to have yourself assessed a few times a year, to make sure you’re not amplifying an injury without realizing it. Your podiatrist is your ally in keeping your feet healthy.
Here are some important statistics to consider when promoting diabetic foot prevention:
- 25% of diabetic patients will develop a diabetic foot ulcer in their lifetime.
- 85% of lower-limb amputations are preceded by a diabetic foot ulcer.
- The mortality rate within five years of a diabetic foot ulcer is up to 70%.
(References: Blanchette V & al. Effect of contact with podiatry in a team approach context on diabetic foot ulcer and lower extremity amputation: systematic review and meta-analysis. Journal of Foot and Ankle Research (2020).
What are home tips for preventing diabetic foot injuries?
- Good blood sugar control
- Avoid walking barefoot
- Examine your feet and shoes daily
- Wear good espadrille-type shoes with good support
- Apply moisturizing cream to your feet; avoid creams between the toes (unless prescribed by a health professional).
- Dry between the toes when getting out of the bath or shower
- Wear protective dressings for corns in moderation (Avoid drugstore products containing salicylic acid or other Dr. Scholls-type medication).
- Eat well and avoid smoking
How does the podiatrist assess your feet, and what’s his role?
An analysis of plantar foot pressure is very important, and thanks to static and dynamic analysis with a pressure plate (see Figure 1), we can assess and quantify the pressure in each of your feet to limit possible tissue damage. In fact, when a region of the foot is recorded at over 20 N/cm2 statically and over 50 N/cm2 dynamically, the risk of developing a diabetic foot ulcer is higher.
Figure 1
The podiatrist analyzes your VIP, dermatological status (general condition of your skin and nails) and monitors blood sugar levels. The podiatrist works closely with an interdisciplinary team, including the family physician, vascular surgeon, infectiologist, microbiologist, nurse, etc., to provide the best possible patient care.
1- V : Vascularization
Doppler evaluation of foot circulation
2- I : Infection status
Treat and prevent infection with oral/topic antibiotics as needed
Ensure good asepsis in foot treatment
3- P : Pressure distribution (Evaluation of shoes and insoles)
Relieve pressure areas with off-loading boots, specialized footwear, orthotics and insoles as required (see Figure 2).
4- Dermatological assessment and treatment
Remove calluses/corns, reduce nail thickness and moisturize skin.
5- Dressing change and assessment
6- Wound treatment and assessment
Pressure is the most important factor in preventing the onset of ulcers, and in preventing recurrence when there is a history of diabetic foot ulcers. Here’s an example of the different tools used clinically to prevent pressure:
Figure 2 (Pressure relief and pressure distribution tools)
How often should I come to the podiatric clinic?
Patients can also come in for dermatological treatment of their nails and hyperkeratosis (horn) every three months, and their feet will also be assessed for prevention.
Here’s a little chart to help you figure out how often you should come in for a consultation. The podiatrist will help you determine which category you fall into.
| Risk category | Follow-up frequency | |
| 0 | No neuropathy (normal) | 1x/ year |
| 1 | Loss of protective sensation (neuropathy) | 1x/ 6 months |
| 2a | Loss of protective sensation and deformities (Hammertoes, HAV: Bunions…) | 1x/ 3 months |
| 2b | Peripheral arterial disease (Vascular disease) | 1x/ 3 months |
| 3a | History of ulcers | 1x/ 2 months |
| 3b | History of amputations | 1x/ month |
In conclusion, consult your podiatrist for more preventive advice, to perform a complete examination, confirm the diagnosis and establish the right treatment plan for your diabetic foot. You don’t need a doctor’s bill or referral to see a podiatrist, just make an appointment today.
Article written by Dr. Olivier Daigneault, podiatrist
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Références : Bacarin, T.A., Sacco, I.C., Hennig, E.M., 2009. Plantar pressure distribution patterns during gait in diabetic neuropathy patients with a history of foot ulcers. Clinics (Sao Paulo) 64, 113–120. Blanchette V, Brousseau-Foley M, Cloutier L. Effect of contact with podiatry in a team approach context on diabetic foot ulcer and lower extremity amputation: systematic review and meta-analysis. Journal of Foot and Ankle Research (2020). Dumont IJ, Lepeut MS, Tsirsikolou DM, Popielarz SM, et al (2009) A proof-of-concept study of the effectiveness of a removable device for offloading in patients with neuropathic ulceration of the foot: the Ransart boot. Diabetic Medicine 26: 778-782 Fernando M, Crowther R, Lazzarini P, Sangla K, Cunningham M, et al. (2013) Biomechanical characteristics of peripheral diabetic neuropathy: A systematic review and meta-analysis of findings from the gait cycle, muscle activity and dynamic barefoot plantar pressure. Clinical Biomechanics 28: 831–45. Fernando M, Crowther RG, Pappas E, Lazzarini PA, Cunningham M, Sangla KS, Buttner P, Golledge J. Plantar Pressure in Diabetic Peripheral Neuropathy Patients with Active Foot Ulceration, Previous Ulceration and No History of Ulceration: A Meta-Analysis of Observational Studies. June 2014. Volume 9, Issue 6. Lazzarini, Peter A. & al. Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review. Diabetes Metab Res Rev. 2020;36(S1):e3275. Zubair, Mohammad. Prevalence and interrelationships of foot ulcer, risk-factors and antibiotic resistance in foot ulcers in diabetic populations: A systematic review and meta-analysis. World J Diabetes 2020 March 15; 11(3): 78-89
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Dr Olivier Daigneault
Podiatrist and owner
