What does a podiatrist do for diabetes?
That would start with a Diabetes Foot Risk Assessment. Let’s learn what the traffic lights mean.
At PridePlus Health we strive to offer the greatest, most comprehensive podiatry service around. When it comes to diabetes and its potential effects on feet, we’re firm believers in education, independence and self management where possible.
To aid this we use a traffic light system to help our clients understand how they need to manage their individual risks.
When you have diabetes and attend to a PridePlus Health podiatrist for an assessment, we undertake a comprehensive check and stratify the risk level as either at Low, Moderate or High risk of complications.
You are then provided verbal and written education on what you can do to manage your risk level and reduce the likelihood of complications.
The simple traffic light system with green/amber/red colouring helps you stay on top of things which are relevant to you.
The material has been produced by PridePlus Health and adapted from the very successful evidence-based program started in the NHS in the UK.
So, what tests are used to determine my foot risk?
Arterial Perfusion Testing (for circulation)
For many people, arterial disease is a considerable burden on daily life. With risk factors such as smoking, diabetes and obesity/sedentary lifestyle all linked with arterial disease, it’s no surprise we see it commonly in clinic.
For years, podiatrists have been involved in arterial perfusion testing with clinical tests such as capillary refill, palpation of pedal pulses and clinical signs/symptoms of arterial disease. In the past, a good podiatrist with time on their side will complete an ankle brachial index using an audible doppler, a sound clinical measure of arterial perfusion, but it can be unreliable in those with longstanding diabetes due to calcification of arteries.
At PridePlus Health, we use the latest technology to undertake Absolute Toe Pressures as a component in our vascular assessment. This test involves using a PPG probe, smart doppler and the smallest sphyg cuff available to measure the absolute pressure of a digit. We can then interpret that data as follows:
Absolute Toe Pressure:
- > 80mmHg = WNL
- < 80mmHg >30mmHg = reduced arterial perfusion
- < 30mmHg = critical ischaemia, inability to heal
Another handy tool is to combine this reading with a brachial systolic measure to give a TBI (toe brachial index). This has the advantage over an ABI (ankle brachial index) as it is unlikely to have an error due to calcification (digital vessels rarely calcify) as well as being simpler/faster to conduct for the patient and podiatrist.
All patients referred to PridePlus Health with arterial risk factors will be offered a thorough arterial test included in their assessment.
The ability to feel what is going on with our feet can be impacted with diabetes which can lead to all number of problems. The most obvious is if we cannot feel our feet, we don’t know if something is going wrong (the gift of pain!).
Other changes to sensation and nerves can increase the risk of falls as our feet can change shape, lose their proprioception (a big topic for a separate post – basically our feet can lose the ability to know if they’re going to walk over a step, or into the step and trip us up).
We test sensation by completing a variation of the following:
- Using a 10g monofilament
- Using a tuning fork
- Testing reflexes (plantar strike and achilles)
- Completing the Ipswich Touch Test
- And digit movement/discrimination for proprioception
These results combined with other clinical indicators will tell us if there’s any nerve changes and guide what we need to do next.
We combine the results of your arterial testing, your nerve testing, a thorough history, your ability to manage and positively influence your own changing foot care needs and a few other factors to work out if you are:
- Low risk of complications
- Moderate risk of complications
- High Risk of complications
Next we personalise your management and treatment plan to ensure we avoid any diabetes related pedal complications. This can include all sorts of changes. It might be exercises, footwear changes, socks, hosiery and orthotics. It might be changing how you manage your own skin care, your hygiene. Often it includes something called podiatry primary care, or even a medical pedicure.
Let’s learn a little more about that now.
Podiatry Treatment: What is Primary Care or a Medical Pedicure and why is it needed?
Podiatrists are able to assess, manage and treat almost any lower limb complication. Some of the more common presenting complaints we see are those grouped as “primary care” where the podiatrist attends to nail and skin pathologies that the patient no longer can, or never could address.
Gentle and professional care is a core skill of all PridePlus Health podiatrists.
One of the areas where our podiatrists do more than what podiatry was previously known for as a profession, is our education and prevention.
For those suffering with painful corns or callus, we take the time to explain the pathophysiology of the lesions, and, if they can/want to address their recurrence, how an individual might go about it.
To do this, we utilise our skills in footwear assessment, biomechanics and gait analysis to isolate the cause of lesion development. From here we can implement changes and get positive results.
If you have diabetes and unsure of your risk level book in with our podiatry team today here.