They move you from A to B. They let you know when the sand at the beach is blistering hot. They also take the painful hit when you connect with the edge of the coffee table. Feet rarely complain, they just get on with doing their job of supporting you. But outside of putting on your shoes and socks each day, how well do you know your feet?
For people with diabetes, feet are often over-looked as the management of other aspects of diabetes takes higher priority. However, foot problems are extremely common and often debilitating for people with diabetes. So slapping on a band-aid, ignoring foot changes, or saying 'She'll be right in a few weeks' could be putting your valuable feet at risk of diabetes-related foot problems.
The good news is that there are several preventative steps you can take yourself to help reduce the chances of developing diabetic foot disease. By following a daily foot care routine at home and having regular foot monitoring with your health professional, most foot problems are avoidable.
So, are you putting your healthiest foot forward?
Why is foot care so important?
A common symptom of diabetes is damage to the nerves in your feet. The damaged nerve function is called neuropathy, and about half of all people with diabetes have some form of nerve damage.
Neuropathy results in either pain, tingling, weakness or reduced sensation in the feet and lower limbs. A loss of sensitivity in the feet often leads to an abnormal walking pattern causing increased pressure in certain areas of the foot.
The development of callus can be an indication of abnormal pressure being applied and continuing to walk unnaturally on an ‘insensitive foot’ increases the likelihood of ulcers forming, and reduces the ability of the body to heal an existing ulcer.
Because of the loss of sensation in the foot, a person with diabetes is less likely to realise when they’ve injured their foot, as they may not feel the pain. This means they are less likely to notice and treat an injury, allowing it to progress to a more serious, advanced stage.
The most common of these problems is the Diabetic Foot Ulcer, which is a wound occurring on the foot, commonly caused by a lack of sensation and/or poor blood supply in a person with diabetes.
Simple steps you can take daily to significantly reduce your risk of foot problems
Check your feet daily
Look for Damage
Check for ulcers, cuts, sores, bruises, redness, new calluses and other signs of injury or damage, including between toes and on lower legs. A mirror may be helpful for examining the bottom of your feet.
Feel your Feet
Take note of changes in feeling which can include numbness, tingling or loss of feeling to touch. Be aware that you may not feel pain from visible injuries due to loss of sensation in your feet. These injuries still need attention even if they are not currently causing you pain.
Check foot temperature
Be aware of the temperature of your feet, and monitor for noticeable changes (hot or cold).
Wash your feet daily
Use soap/body wash and warm (not hot) water, including between toes and around toenails. Keeping your feet clean will help reduce the risk of infection.
Dry your feet
Dry your feet well, including between the toes.
Ask for help
If you have difficulty reaching your feet to clean and dry them, discuss options with your health professional and carer.
Care for your feet
Moisturise your feet and lower limbs
Apply moisturiser all over your feet to keep your skin supple. Don't moisturise between the toes or on broken skin as this may lead to infection.
Long or ingrown toenails can cut into the skin of your feet, potentially causing infections and ulcers. Toenails should be cut straight across. Seek assistance from a carer or health professional if you have difficulty maintaining your toenails..
Check for Corns or Calluses
Corns and Calluses are signs that your feet are getting too much pressure. In people with limited feeling, they are also a warning sign of ulcers forming. Don't use over-the-counter corn or callus removal methods as these can cause wounds. Consult with your health professional for treatment options.
Wear appropriate shoes
Protect your feet
Wear well-fitting footwear, both indoors and outdoors. This is important as you can easily injure yourself without realising (due to loss of sensation in the feet) by stepping on something hard or sharp. Wear clean socks to protect skin from chafing. Avoid sock seams where possible.
Check your shoes
Never store things in your shoes, as injuries can result. Check inside shoes before putting them on, for small pebbles, foreign objects or rough stitching.
Avoid ill-fitting shoes
When shoes don't fit well and are too tight, chafing and blisters may result. It's important for people with diabetes to wear footwear that fits, protects and accommodates their feet. Speak to a podiatrist to see if you require specialised insoles or custom-fitted footwear.
Care for your general health
Avoid heat and cold
As the nerves in your feet may be less efficient at communicating temperature and pain messages than before, it's important to take preventative measures: Avoid exposure to hot pavements, sunburn, heaters, and hot water. Avoid exposure to the cold and cold water. Wear warm socks and shoes in cooler months, and non-constrictive socks to bed if needed.
Manage blood flow
Keeping the blood flowing to your extremities can help reduce foot ulcers and improve healing. Avoid tight socks or stockings. Avoid sitting in the same position (especially with legs crossed) for extended periods. Exercise, especially walking, not only benefits your diabetes but can help with maintaining blood flow to your feet.
Manage your diabetes
Maintaining activity levels are also important, so talk to your health care professional about a gentle exercise program suitable for you. Monitor your blood sugar levels, take any prescribed medications and eat a healthy diabetes-friendly diet.
Talk to a health professional
Chat to your health care professional about your foot care management plan and ask for their support.
Maintain regular foot checks
Incorporate a foot check into your regular appointment. Ensure your GP, Podiatrist or other diabetes-advisor professional inspects your feet at least once every 12 months, or more regularly if you have a current (or history of) foot problems.
Report any foot changes
Report any signs and symptoms to your Health Care Professional as soon as possible for examination. By following your daily foot care checklist, any changes can be reported early.
Focus on your Footwear
Wearing the right footwear and introducing a footwear routine is one of the easiest ways to help take care of your valuable feet.
Protect your feet
Wear well-fitting footwear, both indoors and outdoors. This is important as you can easily injure your feet, by stepping on something hard or sharp, without realising (due to loss of sensation).
People with diabetes should always wear socks within their footwear to reduce rubbing. Socks should be made of mostly natural materials, should be seamless and shouldn't have elasticated cuffs.
Check your shoes
Never store things in your shoes, as injuries can result. Check inside shoes before putting them on, for small pebbles, foreign objects or rough stitching. Also check your feet when you take your shoes off.
Avoid ill-fitting shoes
When shoes don't fit well and are too tight, chafing and blisters may result. It's important for people with diabetes to wear footwear that fits and protects. Speak to a podiatrist to see if you require specialised insoles or custom-fitted footwear.
The serious impact of diabetic foot ulcers
Even minor injuries caused by a small cut, bruise or a blister can develop into a diabetic foot ulcer.
Diabetic foot ulcers can occur in people with both Type 1 and Type 2 diabetes. The term 'foot ulcer' refers to a break in the skin on the feet. For people with diabetes, high or fluctuating blood sugar levels, reduce blood flow to the extremities and nerve damage can inhibit the ability of the skin to repair itself. Because of this impaired rate of healing, even a minor injury can start a foot ulcer.
The occurrence of a foot ulcer is an unpleasant experience, causing pain and discomfort, the need for regular attention (eg. wound dressing), and often taking a lengthy time to heal. If you notice an injury or ulcer on your foot or lower leg, we recommend seeking advice from a health care professional (such as a GP or podiatrist) as soon as possible. Prompt attention will allow treatment to start as early as possible, giving you the best chance of faster and more successful healing.
Unfortunately, foot ulcers that progress to more advanced stages may become infected and can ultimately result in amputation. The personal impact of amputation is of course significant, resulting in reduced mobility, and often a sense of dependence and isolation. Don't wait for the problem to get worse as time is an important factor for foot changes. If you are experiencing any of the following foot problems make an appointment with your health care professional as soon as possible.
Acting on foot changes
Don't wait for the problem to get worse as time is an important factor for foot changes. If you are experiencing any of the following foot problems make an appointment with your health care professional as soon as possible.
You have a current, untreated ulcer or your feet show any sign of injury that becomes red or isn’t healing.
Your feet have noticeable changes in sensitivity (or loss of sensation) or appearance.
You notice pain, swelling, throbbing, temperature changes in the feet (especially heat) or changes to skin colouration.
Things to discuss with your Healthcare Professional
Ask your health care professional to check your feet at each diabetes check-up and mention any changes you have noticed in your feet or legs.
- Ask your doctor or health care professional to check your feet
- Mention any injuries, pain, wounds, ulcers
- Mention any changes in skin sensitivity / loss of sensation
- Discuss your Daily Foot Care routine
- If you experience issues adequately caring for your own feet at home (eg. due to mobility issues), please discuss options with your doctor
Where to get help
Diabetic Foot Australia advocates the involvement of your General Practitioner or Health Professional to support you in your Diabetic Foot Disease management journey. If you are unsure of who to talk to about your diabetes and the health of your feet, the following types of health care professionals can assist: General Practitioner (GP), Podiatrist, Diabetes Educator or Nurse, Local community health centre.
Find a clinic
The following clinics are well regarded and may be helpful to your General Practitioner or Health Professional in realising your rapid recovery.
Wound Innovations is Australia’s premier private facility dedicated to improving wound outcomes for all Australians through expert treatments, telehealth, education and translational research, including diabetic foot disease complications. We offer a telehealth service for patients who are not able to visit our clinic due to health, mobility or geographic reasons. We offer a multi-discliplinary, holistic and comprehensive service for patients, their carers and clinicians. Referrals to the service can be made through your health care practitioner or you are welcome to self-refer. Please call us to find out more or view our website for the referral form and further information, including referral eligibility.
Royal Brisbane and Women's Hospital is Queensland’s largest hospital and provides a wide range of clinical services in the heart of Brisbane. RBWH employs more than 6,000 multidisciplinary staff that together provides life-saving treatment to over half a million people each year. GP or Health Care Professional referral required.
The Prince Charles Hospital is the leading cardiothoracic hospital in Australia with a reputation for delivering excellence in healthcare. They employ around 3200 staff who together provide specialised care for over 420,000 people a year. Podiatry led Multidisciplinary High Risk Foot services. GP or Health Care Professional referral required.
NEW SOUTH WALES
The HRFS uses a multi-disciplinary team approach to manage patients with complex foot pathologies due to medical disorders such as Diabetes Mellitus. The main aim of the HRFS is to provide the best care possible for patients with high risk feet in order to reduce and prevent foot ulceration, infection, hospital admissions and lower extremity amputations. The HRFS liaises closely with other medical departments such as Endocrinology, Vascular, Infectious Disease, Orthotics / Prosthetics, Wound Care Nurses and Community Nurses to achieve the best possible of care for our patients. We are continuing to build on our strong clinical reputation for offering the most up-to-date evidence based medicine for treating high risk feet. We continue to invest in new technology and staff to help us achieve our goal of being one of Australia’s leading High Risk Foot Services.
The Royal Prince Alfred Hospital, High Risk Foot Service (RPA HRFS) is a specialised multi-disciplinary service, established 25 years ago, dedicated to the management of patients with diabetes-related foot ulceration, infection and acute / severe Charcot’s Neuroarthropathy. This service is an endorsed “International Diabetes Federation Centre of Excellence in Education and Foot Care”. Comprehensive and well co-ordinated services are provided on-site to prevent avoidable hospitalisation and amputation. Inpatient care and ambulatory clinic services are provided by the team. Patients residing within the Sydney Local Health District catchment area, or rural/regional patients without access to a comparable service, are encouraged to contact the RPA HRFS with any new foot ulceration, infection and acute / severe Charcot’s Neuroarthropathy. New patients are provided urgent access to treatment as required.
The Diabetic Foot Unit offers specialised inter-disciplinary care for people with active wound complications as a result of advanced diabetes within an acute setting.
The team work with people who have a diabetes-related foot problems such as:
- Foot ulceration
- Charcot foot
- Acute lower limb ischaemia
We accept referrals for this service. The Direct Access Unit also welcomes phone enquiries to discuss potential referrals or an existing referral.
The Chronic Wound Service provides treatment to patients in the community with chronic or complex wounds. We aim to provide treatment the way the person needing the service wants. We work as a team and use the most current research to guide our service. A chronic wound is persistent broken skin present for more than four weeks.The Chronic Wound Service team can help patients, their families and health care professionals. GP or medical specialist referral required (medical referral letter).
The diabetes service provides education and support for people with diabetes and their carers regarding self-management, lifestyle modification, equipment supply and maintenance. The diabetes service liaises with the individual’s general practitioner (GP) and other health professionals regarding patient care. GP or Health Care Professional referral required
The Barwon Health Diabetes Referral Centre specialises in acute and chronic care for diabetes. Our multidisciplinary team consists of Diabetes/Endocrinology Consultants, Advanced Trainee Endocrine Registrars, Endocrine Fellow, Credentialled Diabetes Educators, Division 2 Medication Endorsed, Dietitian and Podiatrist. A Diabetes Foot Service is also available for the acute management of foot disease in diabetes including vascular, neuropathic, acute infections and ulceration. GP or Health Care Professional referral required.
Lyell McEwin Hospital Diabetes Multi-Disciplinary Foot Clinic
Lyell McEwin Hospital, Haydown Rod
Elizabeth Vale, SA, 5112 (08) 8182 9288
Opening as a small country hospital in 1959, Lyell McEwin Hospital (LMH) is today the premier hospital of the northern metropolitan area and is recognised as a leading teaching institution for health care professionals. Dedicated to providing equitable and accessible health care to all members of the community, LMH also works closely with Muna Paiendi Aboriginal Community Health Centre, located on-site.
The Central Adelaide Diabetes Service provides inpatient and outpatient services for patients living in the Central Adelaide Local Area Health Network with diabetes. GP or Health Care Professional referral required.
Fremantle Hospital Multidisciplinary Foot Ulcer Clinic
Level 2, B Block, Fremantle Hospital
Alma Street, Fremantle, WA, 6160
(08) 9431 2330
Fremantle Hospital provide a range of services for both inpatients and outpatients, including podiatry, footwear prescription and foot health education. We cater for complex cases including patients at risk of amputation or the development of foot wounds due to diabetes, peripheral vascular disease, renal disease and/or related neuropathic conditions. Direct referrals from allied health within Fremantle Hospital and from outside are welcome, provided the referral is for a current patient of the hospital and the GP is aware of the referral. Direct GP referrals are accepted.
Fiona Stanley Hospital Multidisciplinary High Risk Foot Clinic integrates multidisciplinary high risk foot inpatient and outpatient teams, working with Vascular Surgeons, Infectious Diseases Physicians, Endocrinologists, Podiatrists and other Allied Health professionals in the management of complex foot ulceration, infection and Charcot Arthropathy.
SJOG Midland Public and Private Hospital Multidisciplinary Complex Foot Service provides assessment, management and coordination of care for acute or chronic foot problems. The service combines diabetes physicians, infection specialists, podiatry and wound management. External referrals must be from a relevant health professional (Ie not self referral) EG: GP, Specialists, Podiatrist, Nurse practitioner. Patients must have an active foot ulceration (with or without infection, with or without PAD.) We do have a defined postcode catchment which is East Metropolitan Health Service catchment or WACHS Wheatbelt. Referrals are via email: [email protected] or Fax 9462 4085 (NOT via WA Health central referrals service). Contact for advice, to discuss referrals or notify of urgent incoming referrals: [email protected], Tel: 9462 4325, Mon to Fri 8-4.
The Royal Perth Hospital Multidisciplinary Foot Ulcer Clinic (MDFUC) was established in 2004 to provide comprehensive, co-ordinated care to outpatients with complex foot ulcers. In 2014 a dedicated inpatient Multidisciplinary Foot Unit (MDFU) was also established to ensure patients receive the same multidisciplinary care when admitted to hospital. Our comprehensive team includes Vascular Surgeons, Endocrinologists, Infectious Diseases Physicians, Podiatrists, Wound Care Nurses, Pedorthists and other surgical and allied health professionals. Royal Perth Hospital services patients living in the East Metropolitan Health Service. We also provide services to patients in rural and remote WA, often via Video Conferencing. Referrals can be faxed directly to the Podiatry Department: 6477 5188 or sent via Central Referrals ( Fax: 1300 365 056 Email:[email protected]).
Launceston General Hospital Multidisciplinary Diabetes Clinic based in the Northern Integrated Care Service. Referral to the center is not required if you seek education, support or resources from a Diabetes Education, Dietitian or Social Worker. You will however need an appointment. A referral from your treating doctor is required when seeking an appointment with a Diabetes Medical Specialist or the Podiatrist.
A referral from your treating doctor is required when seeking an appointment with a Diabetes Medical Specialist or the Podiatrist. Referral to the Diabetes Centre is not required if you seek education, support or resources from a Diabetes Educator, Dietitian or Social Worker. You will however need an appointment.
Helping your foot ulcer at home
Your Diabetic Foot Team can only do so much. Between visits it's important to be proactive in monitoring your ulcer and feet at home by following some simple steps.
Infection significantly increases the risk of hospitalisation and amputation. When changing your dressing at home, check if your foot feels hot, is red, swollen or has any pus.
Once you've checked your ulcer, inspect your feet for other lesions (calluses, corns or blisters) that can develop into new ulcers without prompt treatment.
Wear your prescribed offloading device
Offloading devices such as Moonboots are prescribed to reduce as much pressure as possible under your ulcer to promote faster healing. So it's extremely important to wear them both inside and outside the house.
Act on any foot
Remember time is key, when treatment commences as soon as possible. Make sure you urgently act on any new infections, ulcers or pre-ucler lesions when you are checking your feet at home.
diabetic foot team
Over the last 30 years, expert multidisciplinary diabetic foot teams have been shown to be more effective in managing diabetic foot ulcers compared to solo expert health practitioners. So what should you expect when checking in with your own Diabetic Foot Team?
Your current medication should be checked for both your foot health and general health.
Your ulcer should be properly assessed to see if it's improving or needs different treatment.
Any unhealthy skin on and around your ulcer should be removed if possible.
If your ulcer has become infected, new antibiotics should be prescribed.
The correct dressing should be applied that properly absorbs the ulcer fluid.
The right offloading device should be prescribed to remove the most pressure on the ulcer.
If the ulcer needs more specialised treatment, your team should refer you to the specialist you need.
Advise you on how you can help your ulcer at home and what to look out for between visits.