Podiatrists are pivotal in the prevention and early diagnosis of diabetic foot complications. Management of the diabetic foot requires a thorough knowledge of the major risk factors for amputation, frequent scrupulous evaluation, and regular preventative maintenance. Patients at most risk for foot ulceration are those with diabetic neuropathy, structural foot deformity and peripheral arterial occlusive disease (PVD/PAD).
Avoiding amputation requires regular inspection of the diabetic foot by the patient and by a podiatrist. This is the easiest, least expensive and most effective measure for preventing foot complications; it can reduce a person’s amputation rate by up to 85%. Diabetic foot management requires practitioners to recognise the risk factors for limb loss, which usually span across multiple medical disciplines.
Diabetic foot ulcers typically form due to overloading of a particular area of the foot. It can also start as a small abrasion or blister where footwear is rubbing the foot. Diabetic ulcers describe wounds which do not heal normally and is at high risk of deterioration and infection, due to a multitude of interrelated diabetic complications. It is estimated that 15-25% of the adult diabetic Singaporean population experience a foot ulcer in their lifetime. 84% of all non-traumatic lower leg amputations started with a foot ulcer. Statistics show that functional decline often occurs quickly in patients with leg amputation, resulting in early death.
Blindness, foot ulceration leading onto amputation and kidney failure are the most well-known and dreaded complications of diabetes. People often worry about “leg gangrene” and pair it with diabetes; this is actually the end-stage consequence of a foot ulcer as tissue death sets in.
What can my podiatrist do for me?
Podiatrists at East Coast Podiatry Centre have a reputation for high-intensity wound treatments. Our achieved average healing time for even chronic complex wounds is less than 3 months. Your podiatrist will likely:
- Run though a thorough examination and extensive medical history-taking.
- Full diabetic foot examination to classify your diabetic foot status.
- Test for neuropathy and vascular insufficiency (doppler/ ABPI/ TPBI).
- Judicious wound debridement, cleansing and care using specialised dressings.
- In-clinic wound treatment to promote healing through increasing localised circulation and influx of regenerative cells.
- Casting of the lower limb depending on the need (soft, compressive, fixed, removable, fibreglass, plaster of Paris).
- Long-term offloading, footwear modification and customised orthotics to prevent recurrence of wound.
- Regular foot care when needed to ensure the wound site becomes as normal as possible, reducing the need for follow-up visits. Stabilise the foot condition.
- Yearly diabetic foot examination to track foot condition and overall risks.
- Onward to surgical referral if required.
Our podiatrists aim to keep diabetic patients ambulating and living an active lifestyle with minimized risk of wounds and infections. Everything your podiatrist does for you is to avoid amputation and a worsening foot condition. If your foot condition worsens and requires surgical intervention, your podiatrist will determine the severity and act accordingly and swiftly to ensure you receive prompt referral to the correct specialist (endocrinology, orthopaedic, or vascular).
Risk Factors for Lower Extremity Amputation
- Peripheral neuropathy
- Structural foot deformity (bunions, toe deformities, collapsed foot, Charcot foot)
- Peripheral Vascular Disease (PVD) / Peripheral arterial disease (PAD)
- Ulceration or non-healing wounds
- Lack of compliance to recommended treatments
- Uncontrolled blood sugar levels
- Trauma to the feet and lower limbs
- Not inspecting the feet regularly for wounds, skin changes and infection
- Cigarrette smoking
Patient education regarding foot hygiene, nail care and proper footwear is crucial to reducing the risk of an injury that can lead to ulcer formation. Adherence to a systematic regimen of diagnosis and classification can improve communication between podiatrist and diabetes specialists, and facilitate appropriate treatment of complications. This team approach can ultimately lead to a reduction in lower extremity amputations related to diabetes.