Managing foot problems

Getting a Foot Check

People with diabetes are at risk of developing foot problems because diabetes can damage the nerve (feeling or sensation) and blood vessels in your feet. In most cases, you can avoid these problems by checking your feet daily and having a foot check at least every year by your GP practice.

Diabetes leads to approx. 28 hospitalisations and 12 amputations per day! That is one amputation every second hour. Doing your own checks and attending your annual foot check with your GP helps with early preventions. Know the signs and talk to your GP or healthcare professional.

Every person with diabetes should have their feet checked every year by their GP practice even if they see a podiatrist regularly or a specialist high-risk foot clinic.

Your healthcare team will discuss your results and your risk of developing a foot problem.

What to expect at your annual diabetes foot check

A diabetes foot check is usually undertaken at your GP practice by your healthcare team and is part of your annual diabetes cycle of care.

You will need to take off your shoes, socks or stockings so that they can:

Check your whole foot. They will be looking for ulcers, hard skin, changes in foot shape, dry skin or cracks.
Test for the sensation and blood flow to your feet.
Check your footwear. Ill-fitting footwear can cause wounds to your feet, so it is important to make sure your shoes fit properly, are protecting your feet and not causing any problems.

You will be asked lots of questions about your feet and how you manage your diabetes:

Have you had an ulcer or amputation due to your diabetes?
Are you taking medications or are on dialysis for chronic kidney disease?
Have you had any operations to your legs or feet to improve the blood flow?
Do you get any discomfort in your feet or legs during the day or night?
Do your feet feel very cold and are hard to warm up?
Do you experience unusual sensations in your feet and legs? Pins and Needles, numbness, or shooting pains?
Do you or does someone else check your feet every day?
How has your Diabetes been recently?

A change in nerve function, known as loss of protective sensation (or diabetic peripheral neuropathy) may be caused by persistently high blood glucose levels. If you have had diabetes for a long time, it can cause abnormal sensations in the feet and sometimes hands. People report feelings of numbness, tingling, pins and needles, and sometimes pain, especially at night.

Most people who develop loss of protective sensation lose feeling in their feet, which means that they do not feel cuts, wounds or burns. Injuries like these can develop into an ulcer which can lead to an amputation if it is not picked up quickly.

During a diabetes foot check your healthcare team will test the feeling in your feet using a monofilament (thin plastic strand), tuning fork or the touch test, which you can do yourself.

A change in circulation (or peripheral artery disease) affects the blood flow to your feet and legs.

Diabetes can cause deposits called plaque to build up inside the artery wall, reducing the amount of blood that reaches the feet and legs. Arteries carry blood away from your heart and supply oxygen and nutrients to every part of your body. Without an adequate blood supply, nutrients and oxygen, people can experience cold feet, pain in their calf muscles while walking, pain in their feet at night or wounds do not health properly.

During a diabetes foot check your healthcare team will test for the blood flow by feeling for the pulses in your feet and legs.

Foot health check takes approx 2 mins

Know your risk of getting diabetes foot problems

At your annual diabetes foot check, your healthcare team will assess your risk of developing a foot problem

Your healthcare team will be looking for certain risk factors that can increase you likelihood of wounds that won’t heal:

Previous foot ulcer or lower-leg amputation caused by diabetes
Losing feeling (numbness) in your feet
Circulation in your feet is reduced
Chronic kidney disease (on medication or dialysis)

Generally, your risk is catagorised as Very low risk, Low risk, Moderate risk or High risk.

Very Low Risk

No risk factors for foot disease

Foot check every
12 months

Low Risk

One risk factor (either loss of protective sensation – changes in feeling or blood flow)

Foot check every
6 – 12 months

Moderate Risk

Two risk factors including foot deformity (change in foot shape)

Foot check every
3 – 6 months

High Risk

Two or more risk factors

Foot check every
1 – 3 months

What to expect:

Your healthcare team will provide:

Your healthcare team will provide information that explains what your level of risk means, what you need to do next and how to look after your feet at home.
If your feet are assessed as being at moderate or high risk, you may be referred to a podiatrist or vascular specialist.
Depending on your risk level, you may need to have more regular foot checks to help you get on top of any changes to your feet quickly. It is important that you make your appointments and stick to them.
It’s important to develop a foot action plan with your healthcare team to help you prevent foot problems from happening. If you don’t get one, ask for it!
Ask for your emergency contacts in case you find a foot problem. It’s always good to ask a healthcare professional if you’re worried.

Seek medical treatment if you see any of the following:

Immediately

Ulcers or wounds that won’t heal
Swelling, heat, or changes in skin colour – signs of infection
Pus or a bad smell coming from a wound
Bruising
Blisters or cuts
Infected ingrown nails
Pain

Within 7 days

Broken skin between toes
Callus (hard skin)
Changes to foot shape
Changes to nail colour
Painful toenails
Corns
Cracked skin