Diabetic and High-Risk Foot

Diabetes is a major public health concern, in Singapore, and around the world. In Singapore, an estimated one in three will develop diabetes in their lifetime. If this trend continues, approximately 1 million Singaporeans will be living with diabetes by 2050.

In particular, diabetes affects the eyes, kidneys, and also, your feet. Diabetic foot complications contribute to both mortality and morbidity, leading to substantial physical, psychological and financial burden.

One significant consequence of diabetes is foot ulceration and subsequent amputation. Individuals with diabetes are at 2 to 4 times the risk of a foot ulceration and possible amputation. The lifetime ulceration risk is approximately 25% in diabetics.

What this all means, is that just by having diabetes, risk of lower limb complications is elevated.

However, foot ulceration is very preventable by regular preventative measures as well as adequate and appropriate education of risk factors.

What is a diabetic wound, and how does it form?

In individuals with diabetes, wounds can take longer to heal, which increases the risk of infection and further lower limb complications.
Cuts and wounds are unfortunately a part of life. However, these simple injuries may eventually lead to serious issues in individuals with diabetes.

Diabetes causes damage to nerves and affects blood circulation in the lower limbs. These directly lead to formation of foot deformities, skin and nail changes, potential ulcerations, and an increased risk of infection.

Pathological calluses on the foot could form as a result of physical deformity of the foot. Further, loss of sensation to the feet due to peripheral neuropathy could lead to increased risk of trauma to the foot. Repeated trauma then results in the erosion of healthy tissue which becomes an ulcer.

Diabetic wounds often happen at parts of the foot where there is repeated trauma, stress or friction. There are several underlying reasons why diabetic wounds form:

• Poor blood glucose (glycaemic) control
• Presence of pathological foot calluses
• Presence of foot deformities
• Inappropriate self-care of the feet
• In growing nails
• Poorly fitting shoes
• Nerve damage to the feet (neuropathy)
• Poor blood flow to the feet
• Smoking
• Neglect to self-care for the feet

Proper patient education about diabetes and its consequences, as well as professional medical care to the feet will significantly reduce the development of wounds, and their associated complications.

How can we help you?

A consultation and assessment by our Podiatrist will involve neurological and vascular tests, as well as an assessment of your feet to determine your risk of developing lower limb complications.
Management of the diabetic foot would require a holistic approach. This includes ensuring good glycaemic control, ensuring adequate blood flow to your legs, and ensuring that your legs are free of any trauma and are healthy.

Your Podiatrist will be able to help you with your routine diabetic foot management needs and address any foot problems early and promptly.

We would recommend a diabetic routine assessment at least once every 6 months so that any issues can be detected early and serious complications can be prevented.

Should you have a wound, our Podiatrist is proficient in helping you with its management and treatment. This includes:

• Wound cleansing and professional debridement of the wound to keep it clean
• Application of specialised dressings
• Advanced wound management such as Negative Pressure Wound Therapy (NPWT) dressing changes
• Customised accommodative foot orthotics to offload high pressure areas, to help healing of the wound, and prevent recurrence of wounds

If you need additional management, our Podiatrist will be able to refer you onto different medical specialists so that you can get the treatment that you require.