Why is foot screening important?

Each year there are a number of tests that your GP or practice nurse will undertake to monitor your diabetes. You will probably be familiar with the importance of measuring your blood pressure and blood glucose levels, but why is it important to have a foot screening examination?

Over a long period of time high blood glucose levels can cause damage to different areas of your body and this includes your feet and legs.

The nerves in your body that are most likely to be affected are the longest ones – those that have to reach all the way to your feet and legs. Damage to your nerves is the thing most likely to affect your feet if you have diabetes.

Nerve damage is also sometimes called neuropathy. When it affects your feet it can lead to the following:

• Damage to sensory nerves, which means that you start to lose sensation in your feet and are less able to feel pain, temperatures and vibrations.
• Damage to motor nerves, which can affect the muscles in your feet causing toe joints and bones to change shape.
• Damage to autonomic nerves which can reduce the amount of sweat that your feet produce, which will make your skin very dry.

The other important reason why some people with diabetes develop foot problems is because high blood glucose levels can also damage your blood vessels. This can affect the blood supply (circulation) to your feet and legs and may mean that less blood gets to your skin, muscles and tissues.

Because of these changes your healthcare professional should check your feet each year. This test is free of charge so if you’ve not had your feet examined recently please contact your GP.  As well as checking for changes to your nerves, blood supply and the shape and condition of your feet, your healthcare professional should also talk to you about how you can look after your feet yourself and what changes you need to look out for.

During your foot screening examination your bare feet should be checked, this should include your heels, the underneath of your feet, your toenails and between your toes. Dryness, scarring, callus, corns, athlete’s foot and breaks in your skin are all risk factors. Your footwear should also be examined to make sure there are no seams or stitches that may rub.

Why is this important?

Damage to your skin, like a cut, blister, burn and scald can take a long time to heal if you have diabetes and sometimes these wounds can become infected.

Hard skin can build on the parts of your feet where there is a lot of pressure or repeated pressure, for example where your shoes or socks rub on your skin. If an area of hard skin builds up then the pressure on the skin under it starts to increase. This can cause damage to the tissues underneath. Eventually this pressure can cause a wound to form under the hard skin.

Any area of skin on your feet and toes could potentially become damaged but there are some places where your skin is more at risk. These are areas to keep a close eye on when you check your feet:

• The ball of your foot (underneath of your foot just below your toes) is an area where your skin is under a lot of pressure because when you walk much of your weight is on the ball of your foot.
• Any areas where your bones might stick out – for example if you have a bunion or hammer toes. Your skin can become damaged on the areas that stick out if your shoes don’t fit well.
• Places on your feet where shoes or socks might rub. When you walk, your shoes and socks can rub backwards and forwards over your skin which creates friction. This can cause your skin to become pulled and stretched.

Testing for nerve damage

The nerve function in your feet should be checked with a fine plastic strand called a monofilament, this instrument tests your large nerve fibres or sensory nerves and determines your level of protective sensation (or how well you can feel the pressure on your skin). Before conducting this test, you should be shown how this feels on your forearm. With your eyes then closed the monofilament is placed at 90 degrees and slowly pushed until it bends by 1 cm. It is then held against your skin for 1-2 seconds and you will be asked to say yes if you can feel the filament.

Why is this important?

Damage to your sensory nerves can mean that you start to lose sensation in your feet, so you are less able to feel pain, changes in temperature, pressure and touch. The longer you have had diabetes the more likely you are to develop nerve damage. It often comes on gradually so you may not even be aware of it. You might think that if you injured yourself, for example if you got a blister or cut, that it will hurt. If you have nerve damage then the chances are that it won’t, because the pain is dulled or because you don’t feel it at all – which is why it’s so important to look after your feet and check them every day.

Testing your circulation

Your foot pulses should be checked. There are two main sites; on the top of your foot and behind the inside of your ankle.

Why is this important?

Large blood vessels called arteries, supply your legs and feet with the blood, nutrients and oxygen they need to work well and to stay healthy. Your arteries can become furred up over time, which narrows them and reduces the supply of blood going to your tissues. This problem can affect your legs and feet more than other parts of the body because they are furthest away from your heart, where the blood is pumped from. A poor blood supply to your feet means that any injuries won’t heal as quickly and could become infected.

The test results will show how likely you are to develop a foot problem

At the end of your appointment the results should be explained to you, so you understand how to take care of your feet and what you can do to prevent problems from occurring. This should include foot care advice and who to contact if you notice something you are worried about.

If all the tests aren’t undertaken or you are not given guidance about how to look after your feet, make sure you ask why this hasn’t been done

For more information on how you can look after your feet if you have diabetes please click • here.•

 

 

 

 

 

 

 

 

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