The number of people with diabetes continues to grow at alarming rates locally and internationally. In 2003, the global prevalence of diabetes was estimated at 194 million. This figure is predicted to reach 380 million by 2025 due to people living longer, lack of physical activity and changes in the way we eat. While it is estimated that about nine to 10 percent of the Bahamian population is diabetic, that number is also increasing every year. This means that there are potentially many more persons out there with diabetes or pre-diabetes. It is anticipated that this rise will also bring an increase in the numbers of people with diabetes complications, including those in the feet. Having a quick look or screening of the foot in people with diabetes can save lives.
It is determined that between 40 to 80 percent of all lower extremity amputations occur in people with diabetes. The overwhelming majority, 85 percent of them are preceded by foot ulcers. Every 20 seconds a leg is lost to diabetes somewhere in the world and there are over one million lower extremity amputations every year. Researchers have established that between 49 percent and 85 percent of all amputations can be prevented. Lower extremity complications are expensive for the health care system and for the individual and their family. For the person who receives an amputation, life is forever changed, often leading to increased pain, depression, sickness, and an early death. More people die after having an amputation than those who had breast cancer or prostate cancer.
To significantly reduce amputations, well-organized and skilled multidisciplinary diabetic foot care teams, good diabetes control and well-informed self-care, are all needed. Diabetic foot screening is the cornerstone of good diabetic foot care. The purpose of foot screening is to identity people “at risk” for foot complications early and prevent it. It allows us to see early signs of ulcers or changes in the foot that can lead to amputations before they become a problem. It leads to prevention, early diagnosis, treatment or even referral to another health professional who can fix the problem. The risk level is identified, and this tells us how often the feet need to be screened.
It is simple, screening saves legs and lives.
All diabetics should have their feet screened when they attend the clinic or doctor’s office for treatment of their diabetes. People with type 2 diabetes should have their feet screened at the time of their diagnosis or at a first-time consultation. People with type 1 diabetes should start having their feet screened five years after they were diagnosed with diabetes. Based on the first screening results, additional foot screenings are scheduled. It could be within one month, three months, six months or even a year. Diabetic foot screening can be done by the nurse, doctor or other trained health professional who can identify possible concerns and get the patient in to see their primary doctor. All diabetics should also receive a comprehensive foot exam at least once per year which is done by the podiatrist. This annual review allows for the podiatrist to identify any changes in the foot and start early treatment like ordering diabetic shoes, surgery to prevent ulcers, or referral to the vascular specialist.
There are a number of diabetic foot screening tools available. It is most important that the tool that is used can identify the “at-risk” foot because it is looking at all parts of the foot – skin and nails, blood flow, shape of the foot, sensation or feeling in the foot and even footwear. Second, the tool must identify the person’s risk level and guide when more screening should take place or if a referral is needed. Diabetic foot screening is quick, simple and can be carried out by any trained healthcare professional. The diabetic has to take off their shoes and socks/stockings during their doctor’s visit and the nurse or doctor takes some time to look at and screen the feet. Simple tools and forms are used, and it can take as little as one to three minutes.
Screening also provides opportunity for education on diabetic foot care as well and reinforces importance of diabetics examining their feet every day. Diabetics have an important role to play in the screening process as well. They need to remove footwear and socks to be ready for when the nurse/doctor enters the room. This helps to remind the health professionals to look at the feet. You can also ask them about checking your feet, your risk level and when you need to have your feet checked again. If you have any concern or see any changes in the look, shape or feel of your feet, see the podiatrist right away. Schedule an appointment with your podiatrist to have your feet screened as soon as possible.
Foot screening should be performed as early as possible in diabetics to detect “at-risk” feet and prevent the development of diabetic foot complications. In this way, the risk of major amputations could be reduced.