Not looking after your feet if you have diabetes is the cause of foot disease, which can have complications including amputation. It’s why it is especially important that people with diabetes look after their feet. Check your feet every day, look for changes in shape, cover any cuts, or scratches. Wear shoes that fit properly, make sure you know how to look after your feet, and get them checked at least twice a year by a podiatrist. Each visit can be viewed as an opportunity to assess and improve your understanding of your illness, and your ability to control the disease.

Every  year, persons with diabetes should attend a foot examination. This should involve:

• Testing the sensation and pulses in your feet
• Examining your feet for any deformity, signs of infection or ulceration, and checking if your footwear is suitable
• Asking you about any pain or previous ulceration.
• And remember, if you are not being asked to remove your shoes and socks, then it doesn’t count as a proper foot review!
• If there are no problems, then your risk status will be recorded as low. You will be given general advice, and then you would need to have your feet reviewed again in another 12 months.
• If your foot does not have full sensation or pulses, there is deformity or infection, you are at increased risk of foot problems. This means you should have your feet reviewed much more regularly in the future.
• If your foot has a severe deformity or other serious complication, then you’re at high risk of increasing foot problems, and in most cases, should be referred to the relevant specialist. Once the problem has been addressed, you need to focus on preventing future foot disease. This is likely to include regular inspections of your feet; management of your diabetes; and making healthy lifestyle changes such as quitting smoking, and becoming more physically active.

 Further reasons for review

• To educate the patient, and enable them to monitor and manage their diabetes as effectively as possible.
• To assess and address any problems in glycaemic control, to improve it.
• To detect and treat any complications of diabetes as appropriate.
• To educate and reinforce healthy lifestyle advice.
• To assess the patient’s overall health, treating with any associated or coincidental illness, physical or mental.
• To provide support and advice to the patient on how to cope with living with a chronic illness, and how they can best alter their lifestyle to maintain their health.

Patient’s History

There is much to cover if all the information below is to be discussed at the review:

• Education and self-management:
  • How is the patient coping with self-care and self-management of their diabetes?
  • Is the patient a smoker? If so, what help would they like to become a non-smoker, and are they aware of the importance of quitting smoking?
• Complications:
  • Has the patient had any treatment or hospital admissions for complications of their diabetes in the year before? For example, angina/myocardial infarction, cerebrovascular event/transient ischaemic attack (TIA), diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, or diabetes foot problems.
  • Has the patient had any symptoms of cardiovascular, cerebrovascular, renal, ophthalmological, or neurological complications of diabetes?
• Treatment:
  • How is the patient coping and complying with their medication regimen for diabetes? Are injections or medication regularly missed?
• Monitoring:
  • Are there any problems with the equipment that they have to monitor their glucose levels?
  • Do they have their records of their blood glucose monitoring?

Examination

• Neuropathy:
  • Examine the legs for evidence of diabetic muscular atrophy.
  • Check peripheral limb sensation.
  • Inspect footwear (for suitability), and the feet carefully, for any evidence of peripheral neuropathy causing deformity and ulceration, or decreased blood flow due to peripheral vascular disease.

Diet, physical activity and education

• What is the patient’s current level of physical activity, and can this be improved if thought necessary?

Assessing and addressing modifiable risk factors

• Glycaemic control and how to improve it.
• Smoking status and how to stop smoking if needed.
• Dietary patterns and how to modify them (can help with improving glycaemic control).
• Exercise and how to incorporate regular physical exertion into one’s life.
• Blood pressure, and how to improve its control with medication and lifestyle modification.
• Avoiding weight gain or loss.

 Discussing results and agreeing a treatment plan with the patient

• Any change in management that is needed should be outlined and agreed; it should be clear to the patient what the ‘medical’ and ‘self-managed’ changes need to be.
• Where patients are seen by other health professionals, a further appointment should be offered, to discuss what the ongoing treatment plan is, and ensure that the patient is clear about it, and knows how to proceed.
• Arrange referrals to other practitioners as appropriate.

Your feet mirror your general health . . . cherish them!