People with diabetes face the possibility of developing a variety of diabetic complications, with the risk of each dependent on a number of factors including, first and foremost, blood glucose control. One area in which complications can occur is the feet. It is estimated that as many as 25% of people with diabetes develop a foot ulcer at some point in their lives, and ulcer risk tends to increase with age. The major contributing factor to this risk is loss of sensation in the feet, usually caused by peripheral neuropathy, or nerve damage in the feet and legs. This common complication can change or reduce the sensation of pain, heat, and cold in the feet. For example, if someone with neuropathy were to walk on hot pavement, he might not be able to feel the heat, so there would be an increased likelihood of burns or blisters — which, in turn, could easily go unnoticed and untreated due to the lack of sensation.
Add to the mix another common diabetic complication: reduced blood circulation in the limbs, or peripheral arterial disease. Blood is the main source of oxygen and other nutrients essential to healing, as well as immune defense, so when circulation is impaired, wounds tend to take longer to heal and are more likely to become infected.
Thus, for feet, the combination of reduced sensation and poor circulation can spell major trouble. While these two factors tend to play the largest role in the development of foot complications, other factors can also increase the level of risk, including foot deformities, loss of eyesight, kidney disease, chronic or frequent high blood glucose, previous ulcers or amputation, and cigarette smoking.
There is good news, however. Through early identification, diagnosis, and treatment of potential problems, the vast majority of foot-related complications can be avoided. The best way to accomplish this is through an annual comprehensive foot examination, as recommended by the American Diabetes Association. This article describes what to expect during such a foot exam, and what its results may indicate in terms of further examinations and treatments.
The foot exam
A diabetic foot exam should be conducted by someone experienced in the procedure, who may be either a doctor or another medical professional. The examiner should ask several questions on behalf of your feet; these questions guide the procedure, and are outlined below.
What have I been through?
Your medical history is important when it comes to evaluating your risk of foot complications. Any previous ailments or medical conditions should be discussed, both general and foot-specific. Key items to note include any previous ulcers or amputations and any abnormal feelings in the feet. More general risk factors such as circulation problems, impaired vision, kidney problems, previous surgeries, pain in the feet or legs, and smoking should also be discussed with the foot specialist. This information will help the examiner tailor a plan of care to your individual needs.
Am I in good shoes?
Once your socks and shoes are removed, the foot exam can begin — yet an important part of the exam involves inspecting your shoes and the effect they’re having on your feet. Your feet should be examined for any irritation that might result from a poor shoe fit, and the shape of your feet should be compared with that of your shoes. Improper shoes may be too constrictive, too small, too large, too rigid, or too worn, all of which can result in irritation that may lead to a blister and possibly an ulcer.