Hip 2 Toe Management plan covers:
- Foot management and Diabetes.
- Recommendations to pay serious attention to.
- Cholesterol levels.
- Your cognitive approach to managing Diabetes.
Some of the factors that you would have discussed with your doctor include the following:
A1c measurement: A1c measurement is a blood test done, to establish how well your diabetes is being managed, usually on a 3 monthly basis. So, what does A1c and the foot in diabetes mean? Very good question. A1c is a measurement concerning the amount of sugars that bind to haemoglobin, the protein in red blood cells containing iron and transporting oxygen around your body. The sticky nature of sugars allow this A1c to measure the excess sugar that was consumed over a given period. Sound boring? Don’t be bored. Excess in average blood sugar level increases the risk of developing vascular and neurological changes in the foot that can be permanent and irreversible.
The consequences can be enormous. When pathologies take place in the small capillaries of the foot, we call this microangiopathy. When changes take place in the lower limb, it is referred to as peripheral vascular disease. If damage takes place to the nerves in the feet, we refer to this as peripheral neuropathy. What the Hip2Toe Podiatry diabetes foot health program allows is monitoring of any vascular, neurological, dermatological or biomechanical changes or complications that can potentially take place in the feet. How important is this monitoring? Very, very important. There are many different aspects of foot care, foot inspection and foot treatment in the care of the foot in the presence of diabetes that require ongoing education. We are able to provide v podiatry foot education and diabetes programs, in order to allow you to learn the best evidence based strategies for managing the foot in the presence of Diabetes.
Foot care management and Diabetes
Let’s have a look at some of the more important things to consider about the feet. Some of these headings will allow us to think about the extra care needed for the foot, where Diabetes is present.
Nail care: Nail care and diabetes to be considered very carefully. Provided your nail plates are fairly normal, they should just be cut straight across. Sometimes there may be some conditions of the nail that stop you from being able to safely cut the nail at home. There is a Medicare program in place that allows up to 5 visits to a podiatrist for podiatry care, available to some patients with type 2 diabetes. If you have any questions about this program, contact our cairns podiatry surgery and we will assist you with the guidelines. The plan comes through under managed care for podiatry, otherwise previously known as EPC care program.
Foot Hygiene: It is important to wash your feet in warm soapy water every day, and to carefully dry your feet. I think using a white towel just for your feet is a good idea, as it will show blood or other discharges very easily, which guards against missing an area that you may not have inspected. Now this is the perfect time to do the Hip2Toe Podiatry foot inspection for the foot in diabetes.
This is how you do it:
- Check carefully between every toe, looking at the web space for any abnormalities, such as corns, callous, skin breaks, redness, swelling, maceration or excessive moisture and sogginess in the skin, rashes, blood or pus. This should be done every day, carefully and thoughtfully.
- Next, observe the bottoms of your feet. I you have difficulty reaching the bottoms of your feet, have a relative or friend check for you, or use a mirror. Check for all the things you checked for in between the toes, paying special attention to the possibility of cuts or puncture wounds that may have taken place. Check the heels for cracking, as the smallest cracks can be portals of entry for infection, which can take place quickly and have serious consequences. Remember this; any break in the skin can lead to infection, which can quickly lead to major systemic infection, risk of amputation and possible death. It really is this important.
- Next, check the tops of the feet and ankles, observing all areas of the foot for any redness, swelling or any of the above.
- Now, you have washed the feet and you must now moisturize the feet. Why? Put it quite simply, if the skin is sufficiently moisturized, the skin is less likely to crack or be torn if it undergoes abnormal load or trauma. Do not take this for granted. If there is callous or corns, they are potentially sites for ulceration of the skin, which is a serious medical condition if it takes place in the foot of a patient with Diabetes. What type of creams are the best? Sorbolene for every day general care of the feet is the minimum, but where corns and callous are present, something more is required. Consider balms like Eulactol and Dermal therapy for feet and for applying to the whole lower limb Calmurid will spread better and last longer. How do these work? Urea containing creams are hyperkeratolytic, and help to break down thickened callous in a controlled fashion. At Hip2Toe Podiatry, at our Cairns podiatry surgery, we are able to assist with this callous removal and educate you on the best ways to stop it from returning. Often Hip2Toe Podiatry prescription foot orthotics will decrease the callous and corn formation on your feet significantly, and decrease the frequency you need to return to us for callous care. In addition to this, our laboratory made orthotics can also help prevent further changes taking place in the structure of your foot, which may take place during the progression of Diabetes, where structural alteration or pathology has taken place.
- Shoe wear. Now here is a very important area of foot care in relation to your diabetes care. Why are shoes so important? Well firstly, shoes have a protective function. You should be wearing closed in shoes inside the house and whenever you go out. Feet can be injured just as easily around the house, as they can be outside. For instance, someone in the house breaks a glass and sweeps it up and misses a piece of glass. Even if you can feel the glass, you have still traumatized the foot. The above shoe recommendations may have prevented that from happening, but you must, under no circumstances, delay having a podiatrist of medical practitioner examine and manage the wound. In the presence of Diabetes, infection can take place easier, spread easier, and be harder to treat once it spreads. A small infection in the foot can spread to soft tissue and become cellulitis (with infection in surrounding tissues) and in a matter of days potentially become systemic. This may put one at risk of requiring amputation of part of the foot, the whole foot, or more of the limb. Can you see the importance of daily inspection? I hope so, as many patients make the mistake of thinking their Diabetes is only mild and that a lot of education does not concern them. An absolutely huge number of amputations are preventable, but take place due to poor management. If you have callous or corns or deformity in the foot(i.e. Clawed toes, bunions, mallet toes) or very high arched or flat feet, come and see us so we can assess your foot, to see if off-loading of your foot is required by Hip2Toe Podiatry foot orthotic in your shoe, from our Cairns podiatry surgery.
So in summary, some of the things you are recommended to pay serious attention to, when caring for the foot in Diabetes is as follows:
- Daily inspection of the feet.
- Special attention to washing and moisturizing the feet daily.
- Special attention to your foot wear and having a Hip2Toe Podiatry foot wear assessment for Diabetes at our Cairns Podiatry surgery.
- Regular assessment by a Podiatrist, at least 6 monthly, and at least 6 weekly in the presence of vascular, neurological, biomechanical or dermatological dysfunction or disease.
- Biomechanical assessment if there is any ankle, hip, lower back or foot pain, including lower limb pain. (i.e.: Achilles tendonitis, shin splints, knee pain, etc). You are recommended to have a Hip2Toe Podiatry Biomechanical examination for diabetes at our Cairns Podiatry surgery. You may require a Hip2Toe Podiatry orthotic to give you professional control and measurement of your ongoing foot position.
The importance of managing Diabetes cannot ignore the role of exercise in maintaining healthy blood sugar level control, especially where the feet are concerned. Put quite simply, if you can exercise you should be out there doing it. How much and how often? Well, daily is always best, and maintaining an exercise routine in Diabetes care is vital to achieve the best possible management outcomes over your lifetime. In the case of Type 2 Diabetes your doctor may even be able to reduce your medication, and in some cases allow you to be taken off your medication. Does that give you some idea about how important it is for you to maintain a strict self management plan? Remember, and again I underline this, all parts of yourself management that allow better daily blood sugar level readings help greatly. And better still, if your 3 monthly A1C’s indicate figures averaging 7, your risk of going on to develop vascular, neurological, or biomechanical complications can be greatly reduced. You can come in to see us for a Hip2Toe Podiatry exercise prescription for Diabetes assessment at our Cairns Podiatry surgery. This assessment is normally part of our ongoing foot management for Diabetes care. One of the best exercises in the world at any age is walking. Come and see us and we can do a biomechanical study of your foot and the type of footwear you require, and prescribe the right shoe and an exercise plan for you. Do approach large amounts of any exercise with care. As large amounts of exercise may lower your blood sugar level and lead to a hypoglycemic state, care needs to be taken. If you plan a change in your exercise level or extended exercise, you should carry a suitable portion to avoid hypoglycemia, and consult with your General practitioner or call us directly. And always remember to keep well hydrated when exercising, as rapid loss of fluid is also a health risk in Diabete
One of the most important things to acknowledge about you diet and diabetes and foot care, is that the way you are told to eat by your General practitioner, Dietician and endocrinologist, are very close to the way all people should be eating. Remember, alcohol is calories, make no mistake about that, and it can rapidly upset blood sugar levels. Alcohol can also affect your blood pressure, even after more than one standard glass. So please do not try to ignore this, as high blood pressure is definitely not good for your feet or any other part of your body. A note about being overweight or obese. Obesity can cause permanent damage to the foot. It is crucial for preventing all types of complications in the foot, to have a weight that can be considered average and healthy for your height, age and sex. Do not ignore lifestyle changes that you may have made, that have led to being overweight or obese.
There is only one approach to this subject. Do not smoke. Before you stop reading this, please read on for a little longer. Every time you take nicotine into your blood stream with all that other chemicals (about 1000 identified chemicals) you perform an instant major assault on your arteries. For anything up to 40 minutes your blood supply to your feet can be nearly totally shut down, due to vasoconstriction of the arteries. From an endocrinology point of view, the hormonal upset is significant and undesirable. Now just think what that does if similar assault takes place to the blood vessels in the eyes, kidneys and heart? Smoking should never take place for any person, but to smoke and have Diabetes is totally out. Whatever it takes to give up smoking is an enormous investment. There are many paths open for you to consider, and at Hip2Toe Podiatry at our Cairns podiatry surgery, we are always happy to discuss this. Remember, we have a pair of feet that we want to last for our whole life time. Every single factor is manageable, and no matter how strong an addiction to smoking is, continuous and absolute dedication to abstaining from all types of smoking is essential. Seek whatever method of quitting that works for you, and inform your General practitioner what management you will be choosing, as soon as possible. We will stand by you and support your new direction of not smoking, as there are very few changes that can have such an enormous affect and improvement to your overall health.
You must regularly have your cholesterol levels checked to ensure good long term function of the blood vessels in the feet. Blood vessels in the feet are very prone to what is called microangiopathic changes, and high cholesterol levels are part of the potential for atherosclerotic changes to the microcirculation or capillary beds. In order to discourage nerve damage in the lower limbs, good blood vessel health and good blood flow to the feet is absolutely essential.
Why you should get in touch with Hip 2 Toe
We live in a wonderful world, and with all the challenges that Diabetes management has, it is important to embrace Diabetes management and move with your foot care management with a positive attitude. Being optimistic about your long term foot management should be a part of your daily life. We used to think that we had to wait for years to get the benefits from changes to our health management. Wrong. Lowering your blood pressure has immediate effects on your survival rate. So does lowering cholesterol, so does exercise. And so do all the other recommendations we have made here. Convinced? I hope so. Primary health care and foot care in the presence of Diabetes is largely about prevention. And you are your own personal manager. Your general practitioner will manage your overall Diabetes care, but so much is really up to you. You must believe change is necessary, and then you must reap the rewards of your lifestyle changes, and applaud yourself for these changes. As we are part of our family and part of our community, we have responsibilities to the people we love too. Your own personal management needs to include looking for ways to keep with your good routines. If finance is an issue, be aware of the Management plans that can be set up by your Cairns General practitioners, to allow you access to 5 allied health visits per year. You may decide one of those will be with a podiatrist, one with a Diabetes educator and two with a Physiotherapist, or maybe all with one of the many allied health professionals that are available. But what if you have developed some complications already? In that case, you must quickly make sure you are in a management routine that lowers the risk of any further complications, and prevent the many dangers that you must avoid. This is done by our Hip2Toe Podiatry foot care for Diabetes ongoing education, at our Cairns Podiatry surgery. Ring us and we will arrange for you to come in for a full assessment of your foot management requirements, and we can arrange vascular, neurological, dermatological, biomechanical and muscle assessment and examination. We look forward to being lifetime partners in you and your family’s foot health.