The Diabetic Foot & Podiatry


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Many people are surprised to find that one of the major concerns and complications of diabetes is a condition called ‘diabetic foot’. This is a particular disorder that can be effectively treated by a trained podiatrist, and in this article we look at what the condition actually is and how it affects the foot.

A brief introduction to diabetes

Diabetes (or diabetes mellitus) itself is a condition that doesn’t particularly affect the foot.  It is a condition affecting a completely separate organ with vital functions. There are in fact a number of subtypes of diabetes, and these will be discussed in a moment.

Diabetes  around a disruption in the body’s production of a key hormone called insulin. Insulin is an important regulator of blood sugar, which is effectively the amount of glucose in circulation. Insufficient insulin causes an increase in blood sugar which can have a number of negative effects on the body, and over time, these can turn into major health risks.

Diabetes is classified according to the reasons behind the disruption of insulin production. Type 1 diabetes (also referred to as type 1 diabetes mellitus or type 1 DM) is where the body can no longer effectively produce insulin. Type 2 on the other hand has a different basis, in type 2 the body can produce insulin, however through an improper use of the hormone the body develops a resistance to it which means that insulin doesn’t work as it should. There are other subtypes of diabetes brought about by different conditions like pregnancy and cystic fibrosis, however type 1 and type 2 remain the key subtypes of the disease.

The archetypal symptoms of high blood sugar are elevated thirst and hunger (polydipsia and polyphagia respectively) and polyuria (unusually frequent urination). High blood sugar for prolonged periods of time can cause very serious complications like kidney failure, heart problems, and damage to the retinas (an important component of the eye).

Managing diabetes is a stepwise process which first involves providing insulin when necessary (usually through injection) or other medication if type 2 diabetes is present. Lifestyle changes are considered a vital part of the first line management of the condition, and careful weight management through diet and exercise can vastly improve diabetics’ quality of life and general health. If lifestyle changes are not effectively implemented then there are subsequent stages of treatment through medication.

Fortunately diabetic care has evolved hugely in recent years, and our current understanding of the disease and its treatment are better than ever. An important aspect of care for the condition is ensuring that the complications of diabetic foot don’t arise, the consequences of which can be as severe as amputation in some cases.

What is diabetic foot?

Diabetic foot is one of the potential complications of diabetes that affects the lower limb. This condition usually arises if the appropriate lifestyle changes needed to manage diabetes are not needed. These changes include diet and exercise plans that aim to maintain relatively constant blood sugar levels. Medications, particularly insulin, are used to manage the condition as well, but it is important to point out that lifestyle factors are absolutely critical to managing diabetes and preventing complications like diabetic foot.

Diabetic foot is an umbrella term referring to 3 key foot-centric  complications that can occur as a consequence of diabetes. These are:

Diabetic foot ulceration: Affects a large number of diabetic patients and responsible for a vast number of diabetic foot amputations. Ulcers form as a consequence of disruptions in the body’s wound healing systems because of the effect of diabetes on blood flow to the foot and lower limb as a whole. There is a significant neurological complication of diabetes with many signs and symptoms. Ultimately neuropathic osteoarthropathy results in an eventual decline in the foot’s ability to support you whilst mobile.

Neuropathic osteoarthropathy: Is a gradual wearing down of heel bone and joint. This is an extremely debilitating part of diabetic foot which seriously impedes a person’s ability to walk properly and without pain.

Diabetic foot infections: The poor circulation and susceptibility to injury caused by diabetes can render the foot vulnerable to a range of different infections which can be painful and unpleasant.

Podiatric care of diabetic foot

The care of diabetic feet is an important part of modern podiatric care. As the previous section has illustrated, diabetic foot can severely impact mobility and cause chronic pain problems, on top of these complications are the many other problems posed by diabetes, and as such having a dedicated foot care specialist involved in the care of a diabetic can help secure long term quality of life.

Podiatric care of diabetic feet involves both regular assessments of the foot’s health and condition and treatment of live injuries or complaints. Diabetic foot does not usually set in without prior warning signs which can be picked up by a trained podiatrist at review sessions. At these appointments your podiatrists will also be able to give you valuable advice on how to avoid injury and preserve the health of your foot.

A podiatrist can help prevent diabetic ulceration by making adjustments to your shoes. Ill-fitting footwear is one of the major causes of ulceration and foot pain, which is further complicated by neuropathy which means that you won’t be able to feel a wound form and develop. These events can lead to infections, and in extreme cases, amputation.

It is recommended that diabetics attend at least one annual session with a podiatrist, regardless of whether or not they are currently experiencing foot problems. Prevention of diabetic foot is definitely a priority, and if other aspects of managing the diabetes as a whole are proving less effective, more regular sessions can be arranged. These appointments will usually be arranged through the NHS, however you can arrange further private podiatry sessions if you so wish.


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