July's Minutes 2016

July’s Minutes

July’s meeting saw us welcome Julie Lee from Podiatry Services, she is a Specialist Podiatrist and Diabetic Foot Care Podiatrist.

Julie highlighted the Putting Feet First campaign by Diabetes UK and confirmed that this is a huge focus of Public Health Wales and England. Diabetes UK are holding a number of campaigns relating to foot issues, one of which was a recent “thunderclap” event where Diabetes UK staged a demonstration of odd shoes with individual stories on a lawn outside the Houses of Parliament, to highlight the number of amputations due to complications of diabetes. They also opened a “pop up” shop that only stocked odd shoes again to highlight the number of amputations due to diabetes complications every year. Huge visual demonstrations that bought these issues to the fore, as they should.

Julie concentrates on wound healing but some wounds can be avoided but early detection of foot issues is vital.

It’s important to have your annual foot check with your dedicated diabetes team. So what constitutes your foot check, and what do these procedures do.

So firstly, your foot check has to be done on bare feet, you really have to take your shoes and socks/tights off so you can accurately feel the filaments, if your diabetes team are not doing this, you need to ask why!

The first test is normally a visual check to make sure your nails are looked after and there are no obvious sores on your feet. Then a thin filament, a little thicker than a hair, is used to test the feeling in your feet, so your healthcare professional will touch the filament to the bottom of your feet when you can’t see, to test the feelings, you should be able to feel the touch. The next part of the test is to have your pulses tested, your healthcare professional will test the pulses in the top of your foot and in the ankle, this is done to check your arterial circulation. Bad circulation found at this stage can help prevent neuropathy developing. The next test is a vibration test which is to test your feeling and sensations in your feet and is tested with, of all things, a tuning fork, so not looking for an A# but to make sure you can feel the vibrations of the fork through the top of your foot.

All of these check your circulation and sensations in your feet which can help detect early risks of neuropathy. Don’t forget the Ipswich test Professor Evans told us about where you can check sensations in your feet by having someone touch the bottom of toes 1, 3 and 5. If for any reason you can’t feel it, it’s time for a visit to the GP.

Julie told us that of all the people who are invited for their annual foot check only 67% of us actually attend, so 33% of people with diabetes are not having their feet checked at all which is where some of the people who ultimately end up at the amputation stage slip through the net.

The healthcare professional can spot things like neuropathy or peripheral vascular disease and can then refer you straight into podiatry services.

The assessment of foot problems is listed in a traffic light system.

 

 

Green – Low Category

This shows there are no risk factors, no loss of sensation, no signs of peripheral vascular disease. And no other risk factors.

The recommendation is to wash and dry for feet carefully and to moisturise your feet regularly.

You can care for your feet yourself but if problems arise you can go back to the GP/Nurse when you find them. Problems like blisters, in-growing toe nails, dry skin or cracked heels.

Amber – Moderate Risk Category.

This is if there are one risk factor present. Loss of sensation, signs of peripheral vascular disease, but without callus or deformity.

You should be offered an appointment to visit a podiatrist for a one off consultation on foot care advice.

Red – High Risk Category.

This is when there is more than one risk factor. Pathological callus and deformity, previous ulceration, previous amputation, loss of sensation and signs of peripheral vascular disease.

You will be offered an appointment to see a podiatrist.

The risk categories are active if the following are present. Ulceration, spreading infection, critical blood flow loss, gangrene, unexplained hot, red, swollen with/without the presence of pain.

Some appointments are offered at local health care clinics or one that specialises in the care of foot wounds.

The structure of podiatry services is that there are 45 community specialist podiatrists who deal with all aspects of foot care.

5 diabetes and tissue viability podiatrists who specialise in treating ulcers especially those in diabetic feet.

5 podiatry assistants who run nail cutting clinics.

It’s important to not walk around barefoot as a diabetic, this is because, with neuropathy, loss of feeling, it cannot always be felt if you stand on things which could cause injury.

Things to watch out for:

Ulcers – loss of surface tissue area under a blister, where it hasn’t been able to scab over. Can be caused by rubbing shoes or following a burn such as dropping boiling water on your feet. These are treated with dressings and antibiotics and at this stage you should be referred to a podiatrist. The podiatrist will remove the dead skin which will show the infected/ulcerated skin and dress it to promote healing.

Under extreme circumstances ulceration can lead to amputation, this is where an ulcer reaches the boney part and can be resultant of issues that have not been picked up previously.

Please remember that as a diabetic we are more susceptible to problems with our feet and as such it is vitally important that you check your feet regularly.

Footwear is another vitally important aspect of footcare. Good feet mean that normal everyday shoes are fine providing there is enough depth and room in the toe box of the shoe. It’s important to have them well fitted because if they are too loose it can cause rubs and blisters which slowly heal or can be a forerunner to ulcers.

If you have clawed toes and bunions it is important to have your feet measured regularly to make sure they have good fitting shoes, this can prevent corns and callus’s. you may even be recommended to have insoles which can redistribute pressure.

Ulcerations of the feet should be referred to the orthotics department at the hospital for shoes to be made for you.

As an aside, diabetics should not use salicylic acid for the removal of verrucae’s – the normal removal method.

See you at the next meeting – 15th September.