Foot complications in diabetes are common yet the link between the two is not very well-known. Here to tell us more about it ahead of World Diabetes Day on 14 November is specialist and author for Journal of Foot and Ankle Research Trevor Prior, with colleague Debbie Coleman.
Diabetes is a lifelong health condition in which the bodys levels of blood glucose and the hormone insulin are out of balance. Symptoms include increased thirst, increased frequency of passing urine and fatigue. There are two main forms;
- Type 1 in which the body doesn’t produce enough insulin
- Type 2 where either the body doesn’t produce enough insulin or the body’s cell no longer react to the insulin produced
An inability to produce insulin or use it effectively results in raised levels of blood sugar (hyperglycemia). If present over a prolonged period, hyperglycemia is associated with damage to organs and tissue within the body including the heart, blood vessels, nerves, kidney and eyes.
The risk factors for type 1 diabetes are still being researched but several have been identified for the commonest form, Type 2. These include a family history of the disease, being overweight, physical inactivity and unhealthy eating.
How does diabetes link to podiatry?
Foot complications in diabetes are common and account for more hospital admissions than any other diabetic complication. Foot ulcers present as one of the most significant pathologies and are associated with neuropathy (nerve damage) and/or peripheral arterial disease (poor circulation). These greatly increase the risk of amputation with up to 80% of amputations attributed to foot ulceration.
The prognosis for individuals with ulceration and amputation is poor with a five year mortality rate of 43-55% and up to 74% respectively. Podiatrists play a leading role in the management of ulceration providing treatments including wound debridement, dressing and pressure relief and it has been suggested 80% of amputations are potentially preventable through the provision of well structured, quality care.
Why is awareness important?
Optimizing blood glucose control is key and by providing regular foot checks.
The consequences of diabetes manifest slowly over a period of time. As a result, by the time they occur, it is too late and the focus of treatment is the prevention of ulceration and the subsequent consequences.
That is why patient education is so important from the outset and should be an ongoing process. Optimizing blood glucose control is key and by providing regular foot checks, this can be reinforced as well as warning those who are developing the complications.
What recent advances have you seen in the field?
One of the most recent advances has been in the prevention of foot ulceration. A multicentre study looking at how to prevent ulcers reoccurring, evaluated a new type of shoe.
The TrueContour insole is made from a combination of analysis of the plantar pressures beneath the foot and an impression of the patient’s foot. By combining the two, a specialized insole can be produced and the study demonstrated that it reduced the re-ulceration rate by three times.
Another advance is in measuring skin temperature. Ulcers are preceded by an increase in skin temperature and studies have shown that by measuring this and seeking help when there is a differential of four degrees can help to reduce the re-ulceration rate.
What are the challenges for the future and what findings do you hope we will see in the next 10 years?
Advances in predicting ulceration could lead to greater prevention and improving vascular surgery techniques would allow limb salvage.
There are so many challenges, it is difficult to know where to start. Identifying the causes and potentially preventing Type 1 diabetes would be a major breakthrough. Developing techniques that allowed autoregulation of blood sugar control would provide a more stable disease state and prevent many of the complications.
The Southern Arizona Limb Salvage Centre (SALSA) have an extremely good blog which outlines many of the advances and future developments.
I asked David Armstrong DPM, Professor of Surgery and Director of SALSA what he felt would be the biggest development.
“As the line between medical devices and consumer electronics become more and more blurred, we will become more and more able to help our patients manage themselves. We have always been activity doctors – helping people move through their world as best they can- but we now have the means to dose that activity in a meaningful way.”