ALLAN DONNELLY
PODIATRIST and educator
Dip. Pod., Dip. Teach., B.Ed., M.Ed.
I marvel that society would pay a surgeon a large sum of money to
remove a patient's leg ..... but nothing to save it.
George Bernard Shaw 1906
This is the outcome for many Diabetic patients today with major foot issues
which are not adequately treated and managed by a qualified podiatrist.
This can occur through either a lack of knowledge or a lack of services.
So what does Podiatry have to do with diabetes? Simply this. 50% of every lower limb amputation in the world is due to diabetes (Diabetes Australia). One that in the indigenous population diabetes accounts for 98% of all lower limb amputations. If you are someone who likes figures, it is estimated that the hospital costs alone of a lower leg amputation is around $27,000.
Diabetes (both Type 1 and Type 2) affects the feet in two significant ways. First it affects the circulation. The feet, being the furthest from the heart are the first to suffer from a decrease in quality blood supply. Diabetes, if poorly managed, raises the level of glucose in the blood. This is the main trick of diabetes. It prevents sufferers from moving the glucose molecules out of the blood stream. This may not sound like much of a problem but our bodies work within certainly balances. Upset those balances and major things go wrong. An increase in the Blood Sugar Levels (BSLs) in our blood makes it more viscous. The heart now has to work harder to push the blood around our bodies. Let's reduce our vascular system to a simple plumbing system, a collection of pipes of different diameters. The thicker the liquid, the more pressure is required to push the liquid through the smaller pipes.
Diabetes, by increasing the amount of glucose in our blood, makes the blood thicker and at the same time makes the pipes narrower and harder.
Diabetes sufferers also tend to have high cholesterol levels and calcification of the artery walls. The kidneys, which filter our blood also struggle to filter this thicker fluid. All the tiny pipes such as those in the toes and in the eyes also struggle as this thicker fluid clogs up the system, denying a good circulation. This extra glucose and decrease in the quality of blood supply to the extremities also increases the risk of infection (the bacteria enjoy the extra nutrition provided by the glucose) and delays the dealing process. This is a very simplistic explanation but it does give you some idea of the process.
The second effect upon the foot by diabetes is the loss of sensation. The term for this is Peripheral (furthest away from the midpoint of the body) neuropathy (loss of sensation). This is a problem because if you lose your ability to feel, you will potentially not know when you have an injury to your foot. By the time you realise it, the injury will have become a wound which will turn into an ulcer because of the poor blood supply down to the foot. Hence the high percentage of diabetic feet which end up being amputated.
If the lack of quality blood supply and loss of circulation is not enough, diabetes just loves to have a few helping hands. Having diabetes and smoking is double jeopardy. Corns, calluses, foot deformities such as bunions and hammer toes all give diabetes the edge it needs to be truly disastrous.
Diabetes Australia has excellent information on diabetes which can be found here:
Type 1 diabetes
More information can be found on the Diabetes Australia website but also from Diabetes NSW and ACT and Diabetic Foot Australia.
