Time is tissue: the importance of foot care for those with diabetes

Posted on 2 December 2020

For people living with diabetes, what starts as a minor wound can soon turn into an urgent amputation – which is why podiatrists play a key role within a multidisciplinary diabetes treatment plan.

“We see patients with diabetes daily. In fact this is the majority of our patient base. Some of them have no complications, and are managing their condition well. Others have more serious concerns that need urgent intervention. But for all of them, and for anyone who has diabetes, it is essential to schedule regular sessions with a podiatrist.”

Anandi van Heerden, a podiatrist at Mediclinic Durbanville, explains that diabetes is a chronic disease that can affect the body’s vascular system, and cause major damage to nerves in extremities. In combination, these can cause major, life-limiting problems.

People living with diabetes have troubles with either producing enough insulin in the case of Type 1, or not using the insulin effectively as in Type 2. Insulin is required for the body to manage levels of glucose in the bloodstream. As blood glucose builds, uncontrolled, it weakens and affects structures all through the body. Over time, this build up can severely damage those nerves, causing a lack of sensation.

This is known as diabetic neuropathy, says Van Heerden, and it most commonly affects the feet. Over half of those who have been diagnosed with diabetes will develop this complication, and about 70% of those will develop peripheral neuropathy.

“The nerves in your feet actually originate all the way up in your lower back,” she explains, “as they branch off from the spinal cord and extend down your legs. The nerve damage can take place on different sections of the nerve. And this damage can ultimately lead to infections, ulcers, amputations – all kinds of complications.”

Nerve damage causes a loss of sensation, she says, which renders regular foot care an afterthought, while vascular damage causes disruption in the body’s natural infection-fighting processes. Put those together and it’s clear: people with diabetes require ongoing, expert care from a specialist podiatrist.

Usually, Van Heerden’s patients include adults in the range of 45-80 years old; who mostly present with poorly managed Type 2 diabetes. Younger patients are a growing issue, she says, as they struggle to manage the various complications that come with a Type 1 diabetes diagnosis.

For these patients, a simple ingrown toenail can lead to severe repercussions. “Most people don’t know how to cut their toenails properly,” she says, “but whereas for a healthy individual if nails are poorly cut the complications are usually less severe. For those with diabetes, it can easily and quickly become infected, then lead to an ulcer, and in no time at all, you are looking at the worst-case scenario: an amputation.”

Research shows up to 34% of people with diabetes will develop an ulcer, and half of them will see it becoming infected. This is frighteningly common, and the onset is alarmingly quick, she says. Your best weapon: regular interaction with an integrated multidisciplinary team of specialists.

As a podiatrist, Van Heerden’s focus is on the feet. But because diabetes is a disease that affects the whole body, throughout a patient’s life, regular check-ups are crucial to prevent the sudden onset of life- or limb-threatening complications, she explains.

“To manage diabetes well, you need constant input from doctors. If someone is not managing their diabetes well, and they come to me with a wound on their feet due to poor control, that’s a problem – it can take a long time to get their blood sugar back under control, leaving the wound vulnerable during that time to develop into a major infection and a potential non-healing wound. So, it is much better if that patient is carefully managed every step of the way, by a team, as we can then work together to help them live with this condition for a long time to come.”

When diabetic patients are referred to Van Heerden, they are usually being helped by a team of specialists including an endocrinologist, dietician and ophthalmologist, and they are comprehensively screened for a range of risk factors. This is to categorise the severity of their condition and to help the patient understand what is required to manage the disease well.

Patients who manage their blood glucose levels consistently well, see far better outcomes when treating wounds on their feet, says Van Heerden, while those who don’t, tend to experience recurrences of infections more often.

“For people with diabetes, what they are managing really is unhealthy tissue,” she explains. “When your limbs are prone to nerve and vascular damage, their natural defences are significantly weakened. So you have to help your body cope with that damage, and that means keeping a close, dedicated and expert eye on all these different parts of your body. That’s what we mean when we say, time is tissue: we don’t have time to wait for complications to develop, we must catch them and prevent them before they arise. Regular consultations are key and early treatment is everything.”

Published in Patients