If you have diabetes or another condition affecting your foot sensation or circulation, you will benefit from this programme. The programme uses the foot assessments recommended expert guidelines and adds additional assessments based on up to date research and the latest technology. At Footmotion, your programme includes:

  • Neurological assessment
  • Vascular (circulation) assessment
  • Assessment of foot shape and deformity using physical examination and 3D laser scanning
  • Computerised plantar pressure assessment
  • Footwear assessment and advice
  • Foot care education

Neurological Assessment

People with intermediate or high risk feet in diabetes usually have decreased sensation due to peripheral neuropathy (nerve damage). Peripheral neuropathy can be of two main types- sensory and motor [2]. Sensory neuropathy affects the sensory nerves (those responsible for feeling) and can produce numbness, tingling or even increased sensitivity and pain in your feet. Motor neuropathy affects the nerves that control the muscles and can lead to muscle weakness, which in turn can produce deformity of your toes and feet. The neurological assessment includes a range of clinical tests.

monofilament_web At Footmotion, we use one of the most widely recommended tests for neuropathy – the monofilament test. If you can’t feel the monofilament you will not be able to detect a foot injury in that area of your foot and will need to take special precautions to protect that area.

 

 

Vascular (Circulation) assessment

Diabetes can also cause peripheral arterial disease (PAD), previously referred to as peripheral vascular disease (PVD) [2] . Peripheral arterial disease  can result in reduced blood flow to your feet and legs which can cause pain in the feet or legs with walking or even when at rest. People without diabetes can also develop PAD, particularly when there is a history of smoking.

VASCULAR At Footmotion the podiatrist will check your circulation beginning with feeling the pulses in the feet and ankles. Often the Doppler ultrasound is used to measure the blood pressure at the ankle and the arm. The guidelines recommend an ankle-brachial index or ABI to be calculated. The ideal ABI is 1.0, which means there’s no drop in blood pressure at the ankle compared to the arm and hence minimal/no damage to the large arteries in the leg/ankle.

 

PPG_web If the podiatrist requires more information about your blood flow below the ankle they may use another test called photoplethysmography or PPG. This test can detect the blood flow through the smaller arteries to the skin, by placing a sensor on your toes. A Toe-Brachial Index can be determined-TBI, similar to the ABI. Another acceptable PPG test we use is an Absolute Toe Pressure (ATP).

Assessment of foot shape and deformity

Diabetes can cause a number of changes in foot shape, structure and movement including collapse of the arch, development of toe deformities and stiffening of the joints in the foot due to changes in the ligaments.  Wasting of the soft tissues and padding beneath the foot can make the metatarsal heads and heel bones more prominent and susceptible to injury. Muscle weakness can also change the shape of the foot. FootMotion podiatrists conduct a visual and physical examination of your foot to identify the onset of these problems.

3D_Scan_Report At Footmotion, we have a state-of-the-art 3D laser scanner which is able to measure the shape and dimensions of your feet with the highest levels of accuracy. This is allows FootMotion podiatrists to identify subtle differences between your feet and to monitor your foot structure over time – providing early warning of changes.  Patients receive a copy of the scanner results.

 

Computerised Plantar (Sole) Pressure Assessment

Foot deformities and changes in the soft tissues of the feet can lead to high pressure areas under the sole of your foot during walking. Often this can lead to callous formation and once callouses develop, they can increase the stress under the foot even further [4] which can lead to ulceration.

footprints Footmotion podiatrists perform a computerised plantar pressure assessment to measure high pressure areas under your foot as you take a step. Once these areas are identified, the podiatrists can prescribe changes to footwear and shoe insoles or foot orthoses to reduce these pressures.

It is essential that everyone at risk of foot ulcers has their feet and shoes checked for signs of high plantar pressures.

 

Footwear Assessment and advice

Foot deformities such as bunions and hammer toes can affect shoe fitting and many people wear shoes that are the wrong size for their feet. Foot deformity and footwear are key contributors to ulceration risk and 35-50% of foot ulcers may have been caused by inappropriate footwear according to some studies [3].  Shoes with extra depth, good cushioning and support are important for protecting feet in diabetes. It is essential that everyone at risk of foot ulcers has correctly fitting footwear. Once the podiatrists have conducted the assessments of your foot shape and looked at the plantar pressures they can provide individualised footwear recommendations for you.

Some of the latest research suggests it is important to keep the plantar pressures below 200 kPa to prevent foot ulcers [5]. We know that shoes with a rocker sole, custom moulded insoles, metatarsal pads or arch support orthoses can help to reduce plantar pressures [6]. One study found that custom shoes with different combinations of metatarsal pads, localised cushioning under problem areas of the foot and extra cushioned insoles could further reduce plantar pressures by as much as 24% [5].  So we can see that there are many ways that the podiatrist can reduce the pressures under your feet and bring them to a safe level.

Foot Care Education

Once your foot assessments and footwear evaluation are completed, the podiatrist will talk with you about the most important findings. They will discuss with you how diabetes can affect the feet, highlight any current problems and discuss appropriate treatment options. They will also talk with you about a home foot care routine you can use to keep your feet healthy.

If you have diabetes or you are concerned about the circulation or sensation in your feet the Comprehensive Diabetes Foot Protection Program is designed for you. Our expert staff will use the latest technology and evidence-based techniques to assess your feet and give you the best advice we can on preventing foot problems in the future.

Call the Clinic and start protecting your feet TODAY.

References

  1. Diabetes Australia. About Diabetes. [cited 2016 9th September]; Available from: https://www.diabetesaustralia.com.au/about-diabetes.
  2. Australian Institute of Health and Welfare, Diabetes Australian Facts, 2008, Australian Government: Canberra.
  3. National Health & Medical Research Council, National Evidence-Based Guideline on Prevention, Identification and Management of Foot Complications in Diabetes (Part of the Guidelines on Management of Type 2 Diabetes), 2011, Baker IDI Heart & Diabetes Institute: Melbourne.
  4. Hamatani, M., et al., Factors Associated With Callus in Diabetic Patients, Focused on Plantar Shear Stress During Gait. Journal Of Diabetes Science And Technology, 2016.
  5. Arts, M.L.J., et al., Data-driven directions for effective footwear provision for the high-risk diabetic foot. Diabetic Medicine: A Journal Of The British Diabetic Association, 2015. 32(6): p. 790-797.
  6. Bus, S.A., et al., Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review. Diabetes/Metabolism Research And Reviews, 2016. 32 Suppl 1: p. 99-118.