What is it?

Diabetes Mellitus, commonly known as diabetes, is a metabolic disorder characterized by a high blood sugar levels over a prolonged period of time. If left untreated, diabetes can cause many acute and chronic complications. Podiatrists are interested in the changes it causes to the foot. Insulin is a hormone involved in the metabolism of sugar. All carbohydrate food substances such as bread, fruit and vegetables, pasta and sweet treats contain sugars both naturally and added. Once ingested the digestive system breaks down the food into its basic components. Diabetes can be caused either by the body not producing enough insulin, or the cells of the body not responding properly to the insulin produced. There are three main types of diabetes mellitus. Type 1 which is an auto immune disease, Type 2 generally brought on by obesity and inactivity and thirdly Gestational diabetes. Globally statistics tell us 8.8% of the adult population have diabetes with equal rates in both women and men. The World Health Organization believes that rates will continue to rise. Diabetes at least doubles a person’s risk of early death.

How does it affect my foot?

The major long-term complications relate to damage of the blood vessels and nerve endings. Diabetes doubles the risk of cardiovascular disease. Other macrovascular diseases include stroke, and peripheral artery disease. Gait can be heavily impacted in patients who suffer strokes and heart disease. Furthermore, increased convalescing from such events causes rapid depletion in a patient’s muscular strength, greatly impacting mobility.

Damage to the nerves of the body, known as diabetic neuropathy, is the most common complication of diabetes. A lack of or poorly performing insulin prevents sugars from being processed effectively. These sugars are deposited in and around nerve endings at different locations in the body. This results in the nerves becoming damaged. Nerves play a vital part in the body. They are the wiring of the body and delivery important information to and from the brain. They control organ function, blood flow, movement and balance, sensation and perspiration to name a few. The symptoms can include changes to gait, weakened muscles, impaired balance, numbness, tingling, pain, and altered pain sensation, which can lead to damage to the skin.

All forms of diabetes increase the risk of long-term complications. These typically develop after many years but may be the first symptom in those who have otherwise not received a diagnosis.

Diabetes-related foot problems such as diabetic foot ulcers may occur, and can be difficult to treat. These are caused by injury to the skin either from footwear or trauma. As many patients have no sensation due to neuropathy, they may be unaware of any problems. With diabetes, patients experience delayed healing and are more prone to infections. Diabetic foot ulcers often take months if not years of treatment and in many cases can lead to amputation.

How can a Podiatrist help?

Your podiatrist will assess your circulation, sensation, and other autonomic functions. They will assess the health of your skin and nails, muscle strength, gait, balance and coordination. They will review your activity levels, footwear and hosiery. They will offer chiropody treatments as required, give prescribed rehabilitative exercises, advice on personal hygiene and footwear. You may be prescribed prescriptive orthotics if your foot posture requires support. If you present with a foot ulcer you will be referred to your local HSE podiatry clinic. These clinics are highly specialized in the management of diabetic foot ulcer.

How you can look after your own feet?

Firstly, make the lifestyle choices your Doctors have recommended. Changes to diet and social habits are strongly recommended. Changes to your feet can be subtle. It is important that you look after them. A daily check is important. They should be washed and dried thoroughly every day paying attention in between the toes. The appropriate moisturizer should also be applied daily. Take note of changes to the skins colour and texture. Any cuts on the skin should be kept clean and covered with a dressing. You can expect delayed heeling with diabetes, however if you feel cuts are not making progress contact your HSE podiatrist promptly. Shoes should be sensible and fit appropriately. Nails should be trimmed regularly but never cut too short. If you have any corns or hard skin visit your podiatrist to have them removed safely, never remove them yourself. If you feel your gait has changed or your foot posture has deteriorated contact your podiatrist to get help and advice. You should visit your podiatrist regularly.

What is it?

Athletes foot is a fungal infection of the skin. It usually is found in between the toes but can infect the whole foot and in some cases be found on the upper leg and groin. It looks like small brown blisters, can be itchy and if left untreated leaves the skin dry and cracked.

How can I treat it?

You can use a topical treatment, purchased from your local pharmacy. You should also change and wash your bedding and towels, and boil wash your socks. Sprays are also available for shoes

Prevention!

Hygiene is key. Wash your feet and socks daily. Avoid walking bare foot in swimming pools and changing rooms. Avoid sharing foot care implements.

What are they?

Fungal nail infections are common and mainly affection adults and more commonly toenails. It leaves nails discoloured, brittle and misshapen. People who are elderly, have underlying medical conditions, in particular, Diabetes, and circulatory conditions are more at risk. Also, those who play foot ball / rugby, runners and people wearing steel toe capped boots are prone due to repeated trauma.

How can your Podiatrist help?

Your podiatrist can assess and diagnose nail pathologies. We use the five-minute fugal test which is carried out in house and gives quick results. From there your podiatrist will reduce the nail back in length and thickness painlessly and leave it ready for topical treatments widely available from your local pharmacy. Occasionally the infection is so widespread that you may require oral medication. If this is the case, you will be referred to your gp or dermatologist.

Prevention!

Hygiene is key. Wash your feet and socks daily. Avoid walking bare foot in swimming pools and changing rooms. Avoid sharing foot care implements.

What are they?

Corns and callouses are thickened areas of your skin caused by friction or pressure usually caused by poorly fitting footwear or hosiery. They are usually irritating and painful.

How can your podiatrist help?

Your podiatrist is highly skilled in chiropody. They will painlessly remove these lesions leaving your feet feeling smooth and like new.

Prevention!

Corns and calluses can be removed by eliminating the circumstances that cause them. This is usually ill-fitting footwear and hosiery. Dry skin conditions and aging, poor circulation and conditions such as diabetes can lean to skin fragility leaving patients at greater risk.

If you have underlying medical conditions you should consult a podiatrist for foot care treatment and advice as if left untreated can lead to further complications.

Hygiene is key. Wash your feet and socks daily and wear appropriately fitting shoes.

What is it?

Plantar fasciitis is an injury to the plantar fascia which is a connective tissue which supports the arches in the sole of the foot. It becomes damaged by repeated micro traumas. The symptoms include pain on the heel of the foot on standing after getting out of bed or after rest. It affects men and women and can occur either in one or both feet.

Causes?

Risk factors include, inappropriate shoes, sudden increase in activity and weight gain. It is associated with an in rolling of the foot whilst you walk and tight calf muscles. Whilst heel spurs are common it is widely regarded that these are usually pain free and therefore is not the cause of heel pain. The structural damage of the plantar fascia is caused by persistent contributing forces.

Diagnosis?

Your podiatrist will assess your foot posture and function, take detailed history and carry out a gait analysis.

How can a podiatrist help?

In most cases heel pain can be resolved with conservative treatments. Your podiatrist will give you a prescribed rehabilitative exercise programme, modifications to your daily activities and footwear and pain management advice. In persistent cases prescribed insoles or orthotics will be recommended and night foot splints. Studies show a link to people who have a high body mass index score are more likely to experience heel pain. If this is the case your podiatrist will advise you on steps that can be taken to improve your body mass index score.

What are they?

Panful nails are common. A true ingrown nail is caused by a spike of nail growing into the skin at the side of the nail. They commonly become infected and are extremely painful. This is caused by a patient cutting their nails incorrectly or trauma. Other conditions to cause toenail pain include, involuted nails and corns under nail. Involution is a pinching of the nail caused by it curving inwards as opposed to it growing flat. Involution can be hereditary or caused by lifestyle choices such as dietary intake and smoking and elevated blood pressure. Corns can also be found under the nail due to tight shoes, occupational footwear and nail pressure. It is common for toes to become infected in the folds of the skin. This can add to discomfort.

How can my Podiatrist help?

Your podiatrist is highly skilled in the treatment of painful nails. They will assess your foot, take a detailed history and devise a plan to help with prevention including changes to self-nail care, footwear and lifestyle changes. Treatment usually entails intricate removal of offending piece. In persistent cases you will be recommended to have nail surgery where a section of nail is permanently removed.

Prevention!

Prevention is better than cure. Hygiene is key. Wash your feet and socks daily. Avoid sharing foot care implements. Always trim your nails regularly and never too short or into the corners. Never pick your nails. If you have a problem, contact your podiatrist for an appointment.

What are they?

A Bunion or Hallux Abductovalgus is a deformity of the big toe joint. It is characterised by the bulging outwards of the joint and an over or under riding of the lesser toes by the big toe. The joint becomes swollen and painful as it is not able to perform properly.

What causes them?

There are over 100 known causes of Hallux Abductovalgus. These include, poor foot alignment, occupation, pregnancy, underlying medical conditions, footwear, family history and trauma to the joint.

How can my podiatrist help?

Your podiatrist is highly skilled in lower limb biomechanical assessment. At your appointment they will assess your footwear, foot posture, gait and take an in-depth medical history. You will be then given a prescriptive rehabilitative exercise programme, footwear advice and possibly referred to your gp for pain management medication. In some case patients may be prescribed orthotics. If these conservative measures do not work, then you will be referred for orthopaedic surgery. We work with many orthopaedic surgeons who specialise in orthopaedic foot surgery.

Prevention!

Prevention is tricky. Patients usually have more than one causative factor and identifying causes is difficult. It is however important to get early intervention. If you feel you may have a bunion seek profession help in order to get the best outcome.

What are they?

A verruca is a wart caused by the human papillomavirus. When it grows on the sole of the foot it becomes ingrown and is referred to as a verruca. There are many different types and can appear singularly or in a large cluster. Close inspection of these lesions will show a disturbance in the skin, a milky coloured lesion which may or may not have black dots in it (ruptured blood vessels) and has the appearance of a cauliflower. They may or may not be painful. They can affect both adults and children with those who have underlying medical conditions being more susceptible.

How to prevent?

Avoid sharing foot care implements, avoid walking barefoot in heavily trafficked areas. Hygiene is key. Wash your feet and socks daily.

How can my Podiatrist help?

Your podiatrist will assess the lesion and determine which is the best way to treat it. Treatments range from at home treatments to specially prepared medicated dressings by your podiatrist. If the lesions prove to be stubborn, we will refer you to a dermatologist.

Shoes say a lot about person. They can be functional for work or hobbies, or stylish to finish off an outfit. Pregnancy, disease, trauma, and age can all impact the feet, changing their length, width and depth.

Often people continue to wear the same size shoes for many years without taking these changes into consideration. It is widely accepted by podiatrists that 7 out of 10 people wear shoes that are too small for them. It should come as no surprise that 70 % of the adult population suffer with foot complaints.

Since changes in foot alignment occur slowly over time, the nerves are slow to respond and become desensitised to the cramp conditions the foot is being subjected to. A tell-tale sign that your shoes are too small is persistent foot problems such as corns and calluses and foot pain.

Shoes should be roomy enough to spread your toes apart, flex up and down without restriction and have a thumbs width at the end of the toe box from your longest toe. Slip on shoes are always too tight and there for should be worn sparingly. Shoes should never need to be stretched or widened.

Practicalities and style apart, your shoes play an important role in aiding the function of walking. When choosing shoes, think are these correct for the task I want to wear them for? Are the supportive enough? Is the correct size? Do they suit my foot posture? Is the heel too high or too low? Are the soles too rigid or too soft? Are they secure on my foot? Are there any seams rubbing my skin?

To sum up, if you have persistent foot complaints then it is likely your shoes are the problem. If in doubt, ask your podiatrist for advice.