What is the diabetic foot?

The diabetic foot is a set of chronic damage caused by hyperglycemia (too high blood sugar level over a prolonged period) which leads to dysfunctions of the blood circulation, alteration of the immune system, musculoskeletal deformations, loss of sensitivity (neuropathy ) and potential infections.

What are the risks, symptoms and complications?

Just because you have diabetes doesn’t automatically mean you have a diabetic foot at risk. It is by carrying out your vascular, neurological and dermatological examination that the podiatrist will be able to establish your risk. When sugar levels are well controlled, the risk of developing a long-term diabetic foot is minimized.

The sugar level can therefore cause, among other things, a loss of sensation in the feet, an alteration in the flexibility of the skin, drying of the feet, muscle/joint deformities which increase pressure points and a decrease in blood circulation. All of these symptoms are gradual and they will not necessarily create pain. It is for this reason that it is important to be evaluated a few times a year in order to ensure that an injury is not amplified without realizing it. The podiatrist is therefore your ally to ensure that your feet remain healthy.

Here are some important statistics to consider in support of diabetic foot prevention:

• 25% of diabetic patients will have a diabetic foot ulcer in their lifetime.
• 85% of lower limb amputations are preceded by a diabetic foot ulcer.
• The mortality rate within 5 years following a diabetic foot ulcer is over 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 the homemade tricks to prevent diabetic foot?

• Good blood sugar control
• Avoid walking barefoot
• Examine your feet and shoes daily
• Wear good sneaker type shoes with good support
• Apply moisturizer on your feet; Avoid creams between the toes (unless prescribed by a medical professional)
• Dry well between the toes when getting out of the bath or shower
• Wear protective dressings for corns in moderation (Avoid drugstore products with salicylic acid or other Dr. Scholls type medication)
• Good diet and avoid tobacco

How does the podiatrist assess your feet and what is their role?

An analysis of the plantar pressure of the feet is very important and thanks to the static and dynamic analysis with a pressure plate, we make sure to evaluate and quantify the pressure of each of your feet to limit possible tissue damage. When a region of the foot is recorded at more than 20 N/cm2 in static and above 50 N/cm2 in dynamic, the risk is higher of developing a diabetic foot ulcer.

The podiatrist performs an analysis of the VIP, the dermatological status (general condition of your skin and nails) as well as a follow-up of blood sugar control. He works closely with an interdisciplinary team including, among others, the family doctor, vascular surgeon, infectiologist, microbiologist, nurse, etc., with the aim of offering the best care to the patient.

1-V: Vascularization

• Assessing Foot Circulation Using Doppler

2-I: Infectious status

• Treat and prevent infection with oral/topical antibiotics as needed
• Ensure good asepsis in the treatment of the foot

3-P: Pressure Distribution (Assessment of Footwear and Insoles)

• Relieve pressure areas using relief boots, specialized shoes, orthotics and insoles adapted as needed

4- Dermatological evaluation and treatment

• Remove calluses/corns, reduce nail thickness and moisturize the skin

5- Change and evaluation of dressings

6- Treatment and evaluation of wounds

The pressure is the most important point to make sure to prevent the appearance of an ulcer and to prevent recurrence when there is a history of diabetic foot ulcer.

How often should I come to the podiatric clinic?

The patient can also come for a dermatological treatment of his nails and his hyperkeratosis (Horn) every three months and the evaluation of his feet will also be completed by the same fact in prevention.

Consult your podiatrist for more prevention tips, perform a complete examination, confirm the diagnosis and establish the right treatment plan. You don’t need a doctor’s note or a referral to see a podiatrist, make an appointment now.

Article written by Dr Olivier Daigneault, podiatrist