Expert talks
Cindy Bouché has been a practicing podiatrist for 20 years. Outside her practice, she also teaches at university and for continuing education. She describes the importance of being aware of diabetic foot problems and how to approach them.
Diabetes occurs when there is too much glucose, or sugar, in the blood, called hyperglycaemia. There are two main types. Type 1 is called juvenile diabetes as it mainly develops in children. Their pancreas doesn’t regulate the sugar in the blood. "Type 2 diabetes is far more prevalent," Cindy Bouché continues. "Often brought on by an unbalanced diet and sedentary lifestyle, among other factors, it mainly appears in adults over 40. 92% of diabetic people in France have Type 2, and there are more people every year."
The sugar in the bloodstream creates complications throughout the body. With skin being the body’s largest organ, "high sugar levels create stress in the skin’s layers. The sugar creates chemical reactions in nerve endings, which no longer fulfil their role of distributing information."
Patients can develop dry skin, hyperkeratosis (thick skin) and also artery problems, all associated to high blood sugar levels. "Often, patients aren’t even aware that these problems are a result of their diabetes.".
When these problems move to feet, a number of complications can occur. "Diabetic foot problems are a medical syndrome all on their own, that affect a quarter of all diabetics," Cindy Bouché notifies." They start when there is either a nerve and/or arterial problem that already exists, plus a triggering factor. A cascade of events can occur which, if not quickly cared for, can have dramatic consequences."
Diabetes creates stress in the skin’s layers
Dr Cindy Bouché, Podiatrist and teacher
"Nerve damage leads to a loss of sensitivity in a patient’s foot," Ms. Bouché explains.
"Patients can’t feel when there is a pebble in their shoe or rubbing in one spot. This can lead to a deformity, which causes more friction as the patient walks. Callouses and corns can appear, and with the friction, an ulcer can develop underneath." Combined with artery problems, blood doesn’t circulate through the wound, so that it doesn’t receive oxygen and heals poorly, or not at all, leading to amputation.
"Happily, when diabetics are aware of the problem, they consult early enough to ensure proper healing."
The team of healthcare professionals that diabetics consult share the responsibility of providing their patients with all the information about what can happen to their feet, and why caring for and inspecting them is so important.
Cindy Bouché is uncompromising. "Daily hygiene is essential. Patients must wear comfortable shoes with no stitching inside. They should wash their feet with warm, not hot, water, use a gentle cleanser and dry their feet well."
"Applying cream on a daily basis is also important" she continues.
"A protective and moisturising one, with glycerine, and with low dose of urea to help it penetrate. Don’t apply between toes, where it can macerate and cause problems. Diabetics must play an active role in scrutinising their feet, and applying cream is a good opportunity to examine feet and check for any loss of sensitivity, callouses or corns, and keep an eye on them. Problems can develop quickly."
Diabetics must play an active role in scrutinising their feet.
Dr Cindy Bouché, Podiatrist and teacher
A diabetic with a balanced treatment has a lower risk of developing damage, and a yearly visit to the podiatrist is all that is required.
A change in sensitivity is a flashing red light. "It’s the first thing to check. Sometimes feet become hypersensitive. More often they lose feeling, maybe in just one part, which can lead to more serious problems."
"Second, check for deformities: a flatter foot, a misshapen toe."
"Third, check the colour: red feet or blue toes can indicate an artery problem. Finally, check wounds."
If a diabetic experiences any of these symptoms, they should consult their podiatrist and their doctor without hesitation to seek appropriate care. In general, establishing a foolproof routine in foot care, including regular check-ups with healthcare professionals, goes a long way to ensuring lasting health.
Discover our article : "Diabetes and how it affects skin and feet"
