Diabetes

 

Diabetes is a very common disease. It develops from high blood glucose levels which can cause damage to the nerve systems in your body by stopping important messages getting to and from your brain. The nerves most likely to be affected are the longest ones – those that reach all the way down to your legs and feet. High blood glucose levels can also damage your blood vessels and thereby circulation to your feet and legs, due to less blood getting to your skin, muscles and tissues. 

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What are the symptoms? 
One of the early changes can be the loss of sensation in your feet, often starting at the toes. In fact, you may not be aware of any other diabetic symptoms at the beginning. Your chances of loosing feeling in your feet (neuropathy) will increase with the number of years that you have diabetes.  Very occasionally pain or a burning sensation may accompany the loss of feeling (painful neuropathy). When you loose feeling in your feet, you may not feel a splinter inside your sock or a blister on your foot, which can lead to cuts and sores. Cuts and sores can become infected causing serious infections which can spread throughout the body. Diabetes also can lower the amount of blood flow in your feet. Not having enough blood flowing to your legs and feet can make it hard for a sore or an infection to heal. This can sometimes lead to an ulcer forming beneath the hard skin. The first sign of this, if you have lost feeling to the feet may be fluid or coloured liquid coming either from your feet, or on your sock. There may be colour changes (red/purple/paler blacker than normal), the foot may become swollen or there may be an unusual odour. Part or all your foot may feel much hotter or colder than usual. If any of these symptoms are seen professional treatment must be sought urgently.

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Treatment
Diabetics are more at risk of developing a range of problems affecting their feet. For patients with this condition I recommend a full assessment of the circulation and nerves of the feet, to ensure that any potential foot related health issues are recognised and treated at an early stage. At the clinic I use a Doppler ultrasound to assess foot circulation and a range of sensory equipment to check the nerves. Appropriate advice will be provided on how best to minimise future problems, and to manage your condition. 

Once these observations are recorded, they can be monitored yearly. In many cases your GP practice may already be aware of your disease. However, if they are not; I will always make sure other medical professionals like your GP are made aware of your condition. Your GP practice may have many resources available to you for diabetes. Diabetes UK also has many more resources and advice.

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For more information on diabetes, please see the resources section for self care.

 

Arthritic Feet including Gout

Osteoarthritis is the most common form of joint disease. The surfaces within your joints become damaged so the joint doesn’t move as smoothly as it should. It causes joint pain and stiffness. In the foot, osteoarthritis most commonly affects the big toe, but it can also affect the midfoot.

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Rheumatoid arthritis is the second most common form of arthritis and mainly affects the body’s joints, causing inflammation, pain and swelling. Rheumatoid arthritis commonly affects the small joints of the feet, often causing symptoms in several joints of both feet. This can lead to the development of corns and bunions, and the curling and stiffening of the toes into positions such as claw toe or hammer toe. 

Gout is a form of arthritis that occurs when excess uric acid, is deposited as crystals in tissues of the body, including the joints. For many people, the first symptom of gout is excruciating pain and swelling in the big toe.

Treatment  

Sometimes your very first symptoms will appear in the feet first, so during the initial consultation I will closely assess your medical history, followed by a physical assessment of the area which may have pain stiffness and inflammation. Many arthritic patients find it difficult to manage their own feet, as bending down and using nail scissors becomes difficult. I can help you with all of this and recommend specialist equipment and shoewear to make life more comfortable.

 

One very important area I will be able to help you with to manage this condition is to provide insoles or orthotics to preserve the integrity of the foot structure. This is particularly important with early diagnosed Rheumatoid Arthritis as the latest research has shown that early intervention with orthotics can reduce joint destruction, deformity and immobility down the line. (See the Biomechanics MSK section).  If your GP is not already aware of the condition, he will be notified, so that you can access the best possible course of treatment.

For more information on how to care for your arthritic feet please see resources.

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