Foot Health

Is it time for your diabetic foot exam?

Most diabetics are seen regularly by their doctor, so some may be tired of seeing doctors or health care professionals, but don’t skip the foot doctor, it can save your life! Every diabetic should have their feet examined at least once per year to find out if there are any problems with the feet that can lead to ulcers and amputations.

What is a diabetic foot exam?

People with diabetes are at higher risk for a variety of foot health problems. A diabetic foot exam is a special foot test that checks people with diabetes for these problems, which may include infection, injury, and bone abnormalities. Nerve damage, known as neuropathy, and poor circulation (blood flow) are the most common causes of diabetic foot problems.

Neuropathy can make your feet feel numb or tingly. It can also cause a loss of feeling in your feet. So if you get a foot injury, like a callus or blister, or even a deep sore known as an ulcer, you may not even know it.

Poor circulation in the foot can make it harder for you to fight foot infections and heal from injuries. If you have diabetes and get a foot ulcer or other injury, your body may not be able to heal it fast enough. This can lead to an infection, which can quickly become serious. If a foot infection is not treated right away, it can become so dangerous that your foot may need to be amputated to save your life. Fortunately, regular diabetic foot exams, as well as home care, can help prevent serious foot health problems.

What is it used for?

A diabetic foot exam is used to check for foot health problems in people with diabetes. When ulcers or other foot problems are found and treated early, it can prevent serious complications such as amputations.

Why do I need a diabetic foot exam?

People with diabetes should get a diabetic foot exam at least once a year. You may need an exam more often if your feet have any of the following symptoms:

• Tingling;

• Numbness;

• Pain;

• Burning sensation;

• Swelling;

• Pain and difficulty when walking.

You should call your health care provider right away if you have any of the following symptoms, which are signs of a serious infection:

• A blister, cut, or other foot injury that doesn’t start to heal after a few days;

• A foot injury that feels warm when you touch it;

• Redness around a foot injury;

• A callus with dried blood inside it;

• An injury that is black and smelly. This is a sign of gangrene, the death of body tissue. If not treated promptly, gangrene can lead to amputation of the foot, or even death.

How often should I have a diabetic foot exam?

It is recommended that every diabetic have a diabetic foot exam at least once per year, but based on the results, more frequent testing may be required.

What happens during a diabetic foot exam?

A diabetic foot exam may be done by your primary care provider and/or a foot doctor, known as a podiatrist. A foot doctor specializes in keeping feet healthy and treating diseases of the feet. The exam usually includes the following.

General assessment. Your podiatrist will:

• Ask questions about your health history and any previous problems you’ve had with your feet.

• Check your shoes for proper fit and ask questions about your other footwear. Shoes that don’t fit well or are otherwise uncomfortable can lead to blisters, calluses, and ulcers.

Dermatological (skin and nails) testing. Your podiatrist will:

• Look for various skin problems, including dryness, cracking, calluses, blisters, and ulcers.

• Check the toenails for cracks or fungal infection.

• Check between the toes for signs of a fungal infection.

Neurologic (nerve) testing. Your podiatrist will do a series of tests that may include:

• Monofilament test. Your provider will brush a soft nylon fiber called a monofilament over your foot and toes to test how well you feel on your feet.

• Tuning fork and vibration perception tests (VPT). Your provider will place a tuning fork or other device against your foot and toes to see if you can feel the vibration it produces.

• Pinprick test. Your provider will gently poke the bottom of your foot with a small pointy object to see if you can feel it.

• Ankle reflexes. Your provider will check your ankle reflexes by tapping on your foot with a small mallet. This is similar to a test you may get at an annual physical, in which your provider taps just below your knee to check your reflexes.

Musculoskeletal (bones and muscles) testing. Your podiatrist will:

• Look for abnormalities in the shape, structure and movement of your foot.

Vascular (blood flow) testing. Your podiatrist will:

• Check the blood flow to the feet by looking at the feet for signs of poor circulation, feel the feet and check the pulses. After the age of 50, an in-office doppler is also used to check the feet.

If you have symptoms of poor circulation, a more extensive tests called a Doppler ultrasound will be ordered to see how well blood is flowing in your foot. Based on these results you may also be sent to the vascular specialist.

Will I need to do anything to prepare for the test?

No, you don’t need any special preparations for a diabetic foot exam.

Are there any risks to the test?

There are no known risks to having a diabetic foot exam.

What do the results mean?

The podiatrist will explain the results and give you handouts. You should also get a copy of your results to take back to your primary doctor. If a problem is found, your foot doctor will likely recommend more frequent testing. Based on what is found during the testing, other treatments may include:

• Antibiotics to treat foot infections;

• Surgery to help with bone deformities;

• Change in footwear style or size to protect the feet;

Treatment for nerve damage to the foot, to relieve pain and improve function. These may include:

• Medicine;

• Skin creams;

• Physical therapy to help with balance and strength.

Is there anything else I need to know about a diabetic foot exam?

Foot problems are a serious in people with diabetes. But you can help keep your feet healthy if you:

• Take control of your diabetes. Work with your health care provider to keep your blood sugar at a healthy level and HbA1c below seven.

• Get regular diabetic foot exams. You should get your feet checked at least once a year, and more often if you or your provider finds a problem.

• Check your feet every day. This can help you find problems early before they get worse. Look for sores, ulcers, toenail cracks, and other changes in your feet.

• Wash your feet every day. Use warm water and mild soap. Dry thoroughly.

• Wear shoes and socks that fit properly at all times. Make sure your shoes are comfortable and fit well.

• Trim your toenails regularly. Cut the nails straight at the tip of the toe and gently smooth edges with a nail file.

• Protect your feet from injury, excess heat and cold. Wear shoes on hot surfaces. Don’t use heating pads or hot bottles on your feet. Do not soak your feet in hot water. Before putting your feet in water, test the temperature with your elbow. Because of reduced sensation, you can burn your feet without even knowing it. To protect your feet from cold, wear socks in bed, never go barefoot, not even in the house. Pay attention to your environment to prevent injuring your feet.

• Keep blood flowing to your feet. Put your feet up when sitting. Wiggle your toes for a few minutes two or three times a day. Stay active, but choose activities that are easy on the feet, such swimming or biking. Talk to your health care provider before starting an exercise program.

• Don’t smoke. Smoking reduces blood flow to the feet and can make wounds heal slowly, if at all. Many diabetics who smoke may end up getting an amputation, because ulcers don’t heal if there is no blood flow.

• Learn more about how to care for your feet.

• For more information, email us at foothealth242@gmail.com or visit www.medlineplus.gov/lab-tests/diabetic-foot-exam/ or www.foothealthfacts.org. To see a podiatrist, call 325-2996 for an appointment or visit Bahamas Foot Centre on Rosetta Street, or call 603-1814/15/16 for an appointment or visit Bahamas Surgical Associates Centre at Hilltop Medical Centre, off 4th Terrace Collins Avenue. In Grand Bahama, call Lucayan Medical Centre at 373-7400 for an appointment today.

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