Diabetes affects the foot by reducing the blood supply (ischaemia) so healing is impaired, and impairing nerve function (neuropathy) so that you cannot feel damage to the skin.
Diabetic foot care involves a podiatrist identifying what areas of the foot may ulcerate in the future, and advising what could be done to prevent this. Diabetic patients unable to feel a device used by chiropodists and podiatrists known as the 10-gramme Mono-filament are what is known as neuropathic, and have a 7.7
fold risk of ulceration.
The presence of callous (which is hard skin) with neuropathy increases the risk of ulceration 77 fold.
The loss of feeling in the foot (neuropathy), with a deformity, and trauma (damage to skin), collectively may also cause an ulcer
For diabetics, I am able to reduce thickened nails, reduce hard skin, treat corns, and treat heels, as well as carry out a check on the blood and nerve supply, and also give advice, which is equally as important for the prevention of major problems
A diabetic foot ulcer should heal if:
1. There is adequate arterial blood-flow.
2. Any infection is appropriately managed.
3. Pressure is removed from the wound.
If arterial blood flow is a big issue, then a vascular surgeon may be able to operate to improve the blood supply to the area.
Infection can be managed by antibiotics.
Pressure may be removed by using a blade to remove any hard skin from around the ulcer, or using an orthotic, or a cast, or
by simply changing the footwear.
Amputations are preceded by ulcers in 85% of cases. Amputation rate is 15 fold higher for patients with diabetes.
Improved footcare programmes may prevent 50% of amputations by identification, education, and intervention.
Indications for the high-risk (of losing a leg) foot:
“Charles is extremely knowledgeable about his profession and gives good accurate advice without any charge... having used his services over the last few years I would not go to back
to my previous chiropodist or any other chiropodist because I think Charles is treats me fairly and effectively”
“When we came to Werrington, we initially had Charles for a home visit. During that visit, he said to us that he could do a far better service at his surgery, and were we absolutely sure that we couldn't get to his surgery. We have been attending his surgery ever since, and find him to be more thorough than the last person that we had, particularly with regards to my heels”
“I have thickened nails. I used to go to someone to have them treated. The person that I went to, encouraged me to return after 6 weeks to have them reduced again. I have been going to see Charles for several years now. I find him much more thorough in his approach”
“I used to have someone else but they were on holiday once and I couldn't get an appointment when I wanted one . I went to see Charles. At the first appointment, the first thing that Charles noticed was the fact that I had athletes foot. I have never ever been told this in several appointments over a time frame by the
other chiropodist. He said that the length of time that I had had the athletes foot untreated explained why I had developed fungal nails. He also gave me both short term, and long term advice on how to deal with this / the prognosis. I also have hard skin. He told me how to prevent this / delay it from returning.
And I am not talking about me using a foot file. either! The other person never once told me this. Although the cost of the appointment itself is more expensive than the other person, I find Charles far better value for money”
“I used to have someone attend once every 6 weeks. Charles came at the end of May, did far more for my nails in 1 visit and I didn't need him until early November”
“Charles was concerned that something on my leg was taking a long time to heal (over 1 year). A nurse had been dealing with dressing the "ulcer". Although I attend his clinic for nail cutting, he was concerned at this and wrote to the GP so that a further investigation along separate lines could be carried out
(this was as a result of a lecture he had attended). As a result, the GP's surgery have taken a completely different approach to treating the problem and have referred me to the hospital. All thanks to Charles's intervention”