Abstract
This series on the foot care of patients with
diabetes focuses on the importance and assessment of foot structure. An
altered, ‘misshapen’ foot is an important risk factor for diabetic foot
ulceration, like vascular and neurological deficits.
Article Extract
The first article in this series addresses one of the basic
foot structure types, the flat foot, and its associated pressure
patterns and footwear needs. An appreciation of foot structure and the
pressure areas in stance and gait is important. A simple check of foot
structure and pressure areas can be included in the regular six-month
foot check of your patients with diabetes (Table).
Case history
Frank is 23 years old with an eight-year history of type 1 diabetes that
is well managed. His height is 1.84 m and weight 81 kg; thus his BMI is
23.92 kg/m2 (i.e. he is in the healthy weight range). His HbA1c is
6.5%, and he has had no hypoglycaemic episodes requiring external help.
Frank has normal foot pulses, healthy skin and no clinical evidence of
peripheral neuropathy. He is a good footballer, plays tennis and likes
to swim. His last football season was dogged by ‘shin splints’ (medial
tibial stress syndrome), and he also had problems with callus build up
(Figure 1) and sometimes blistering of the skin adjacent to the first
metatarsophalangeal joint and the big toe. The weight-bearing areas of
the feet show callus build up and his feet look quite flat when he
stands and walks.
