Clinical Specialities - Diabetes

Diabetic Foot

People with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead to serious complications.

Who is affected?

Diabetic foot problems are common throughout the world, resulting in major economic consequences for the patients, their families, and society1. If these problems are left untreated or not identified, they can result in a foot ulcer and potentially lead to an amputation (www.diabeticfoot.org.uk). Someone with diabetes is 15 times more likely to have an amputation than someone without diabetes. Diabetic foot problems are one of the commonest causes of admission to hospital for those with diabetes (www.diabeticfoot.org.uk). Health practitioners have a pivotal role in the prevention or early diagnosis of diabetic foot complications2.



How does it affect the foot?

Foot problems most often happen when there is nerve damage also called neuropathy, or poor blood flow to the legs and feet called Peripheral Arterial Disease or PAD.

Neuropathy (Nerve Damage)

Although in some cases it can hurt (cause tingling, pain (burning or stinging), or weakness in the foot), diabetic nerve damage can also lessen your ability to feel pain, heat, and cold. This usually happens on the bottom of the feet first but can affect the lower legs too. Loss of feeling often means that foot injuries are not felt. A stone in a shoe could be walked on all day without knowing. A foot injury may not be noticed until the skin breaks down and very quickly become infected resulting in a foot ulcer. Nerve damage can also lead to changes in the shape of your feet and toes. Shoes that may have fitted in the past might now cause injury to the feet for example rubbing more prominent joints which can also easily lead to foot ulcerations.

PAD (Poor Blood Flow)

Poor blood flow can make your foot less able to fight infection and to heal. Diabetes causes blood vessels of the foot and leg to narrow and harden. This can make the muscles in the calf hurt on exertion, walking up hill for example or even walking just a few 100 meters on the flat. Some of the things that cause poor blood flow can be controlled. Don't smoke; smoking makes arteries harden faster, eat a healthy diet; fatty deposits in the blood can stick to the blood vessel walls and make them narrower, increase the amount of physical activity you do to keep your heart healthy.

Diagnosis of Diabetic Foot Disease

Doctors, nurses or Podiatrists can assess the diabetic foot for neuropathy, changes in foot shape and PAD by asking questions about whether patients have been experiencing symptoms of the disease. They will also examine the legs and feet for signs of PAD (cold, weak or absent foot pulses, colour changes). They can also do a test called an Ankle Brachial Index (ABI) (link to Jane Davies’ page here?) and a Toe Brachial Index (TBI) to check the blood supply. This involves measuring blood pressure in the big toe and comparing to the blood pressure in the arms. They can also use a fine 10 gram weighted nylon filament (10g monofilament) and a Neuropen with sharp and blunt tips to check for neuropathy. The monofilament bends when it is pressed on the bottom of the foot to check if the patient can feel the light touch. The Neurotips allow the practitioner to see if the patient can distinguish between sharp and blunt feelings.

Diabetic Foot Assessment and related Huntleigh Products

An ABI and a TBI can be measured manually using a handheld Doppler in combination with an arm ankle cuff or an arm and toe blood pressure cuff (View our ATP Kit). An ABI <0.9 and a TBI <0.65 are considered diagnostic of PAD. The Doppler also allows the practitioner to listen to the nature of the blood at the foot and ankle. In addition, clinicians can visually assess Doppler waveforms which is a feature enabled on the Doppler DMX (View our Dopplex DMX or the ATP Kit).

The National Institute for Clinical Guidelines, NG19, for the diabetic foot recommends using the 10g monofilament together with the handheld Doppler to perform ABI and TBI. This combination allows the practitioner to perform a complete diabetic foot assessment for identifying and monitoring diabetic foot complications (ATP link).

For more information on identifying and managing the diabetic foot:

www.diabeticfoot.org.uk | www.diabetes.org.uk | www.nice.org.uk


 

View Vascular Assessment

 

Related Huntleigh Products:

 
References:
  1. Boulton AJ et al., 2005. The global burden of diabetic foot disease. Lancet, 366, 1719-24.
  2. Armstrong et al., 1998. Diabetic Foot Ulcers: Prevention, Diagnosis and Classification. Am Fam Physician, 15, 57, 1325-1332.