Diabetic foot checks

Most of what a podiatrist does is about comfort. This appointment is about margins. Diabetes narrows two of them at once, and the combination is what turns problems that would be trivial on any other foot into ones that are not.

Get seen now, not at the next available appointment

Some things on a diabetic foot do not wait for a booking:

A foot that is hot, red and swelling quickly
Redness spreading up the leg
A fever alongside a wound on the foot
A toe that has changed colour and gone cold

Those are infections and circulation problems, and they are measured in hours. A hospital is the right place for them, not a clinic appointment.

Short of that, a break in the skin — a blister, a crack, a small cut, a nail cut too short — needs looking at within days rather than weeks. Especially if it does not hurt. If you are not sure which category you are in, call Brunswick Health on (03) 9380 8099 and describe it; reception will get you an answer rather than a booking.

The two things diabetes changes

Sensation. Raised blood glucose over time damages the small nerves, and the feet are the furthest point from the heart, so they show it first. The loss is gradual and painless, and it usually begins as numbness or an odd burning at night rather than as anything obviously wrong. The practical effect is that the foot stops reporting: a stone in the shoe, a blister forming, a nail pressing into the skin. Damage that any other foot would announce immediately gets discovered days later.

Circulation. The same process narrows small blood vessels. Less blood arriving means less oxygen and fewer of the cells that repair tissue and fight infection, so a wound that would close in a week on a well-supplied foot takes considerably longer, and has more time to become infected while it does.

Either one alone is manageable. Together, they mean an injury that is not felt is also an injury that heals slowly — which is the whole reason this appointment exists.

What the assessment involves

It takes one appointment and produces a number you can act on.

Circulation. Pulses are located and assessed at the foot and ankle, along with skin temperature, colour and hair growth — all of which say something about how much blood is arriving.

Sensation. A monofilament is pressed against defined points on the sole until it buckles, applying a known force. Not feeling it at a given site is the standard measure of protective sensation being reduced. A tuning fork adds vibration sense, which often changes earlier.

Skin and nails. Callus over a pressure point, a nail cutting into a sulcus, dryness cracking at the heel margin, changes in shape that alter how the foot loads. On a foot with reduced sensation, a corn or callus is not a cosmetic issue — it is a pressure point with tissue underneath it.

Footwear. More foot wounds start inside a shoe than anywhere else. What you wear, how it fits across the front, and what has found its way inside it.

The result. A risk category and a review interval — annually where both circulation and sensation are intact, more often where either is reduced.

What you can do between appointments

Look at your feet daily, including between the toes and underneath. Use a mirror, or a phone camera, if bending is difficult
Check inside your shoes before putting them on
Moisturise dry skin, avoiding between the toes where damp skin breaks down
Cut nails straight across, not down the sides — or book it if that is difficult to do safely
Never use over-the-counter corn pads, acids or blades
Do not walk barefoot, indoors included

Where podiatry fits alongside the rest of your care

A foot assessment sits beside your diabetes management rather than replacing any part of it, and it does not change medication or glucose targets. What it does is catch pressure damage, circulation change and sensation loss early enough that they are still small problems.

Where something needs a specialist — a wound that is not progressing, or circulation findings that warrant vascular assessment — your podiatrist will provide a detailed letter setting out the findings and the recommendation, including who is best suited to see you, so the next step starts from an assessment rather than from the beginning.

Fees, health funds and Medicare care plan claiming covers the money side, and the podiatry page has booking.

Common questions

I have diabetes and my feet feel fine. Is a foot check still worth booking?

That is the point of it. A diabetic foot assessment is one of the few genuinely preventive appointments in podiatry — it establishes what your circulation and sensation are like now, so that any later change is measurable against something. Feeling fine is not evidence of intact sensation; reduced feeling is painless by definition, which is exactly why it goes unnoticed.

What happens during the assessment?

Pulses in the foot are checked and blood supply assessed, sensation is tested with a monofilament and a tuning fork, and the skin and nails are examined for early pressure damage, dryness and breaks. Footwear is looked at, because it is where a surprising share of damage begins. The result is a risk category and a review interval.

How often should I have one?

Annually where circulation and sensation are intact, and more often where either is reduced — the interval is set by the assessment rather than by a rule. If you have had an ulcer before, reviews are considerably more frequent, because a foot that has ulcerated once is the strongest predictor there is of one that will again.

Can I cut my own toenails if I have diabetes?

Many people can, carefully, cutting straight across and not down the sides. What changes the answer is reduced sensation, reduced circulation, eyesight, or nails too thick to cut safely — in any of those cases the risk of a small nick sits well above the inconvenience of booking. Over-the-counter corn pads and blades are off the table regardless.

Does Medicare cover this?

Podiatry is covered through a Chronic Condition Management plan arranged by a doctor, which allows up to five allied health visits per calendar year across all providers combined and still leaves a gap, since the rebate does not cover the full fee. Diabetes is one of the conditions those plans are commonly written for. Podiatry also claims on any extras policy that includes it.

What should I do if I find a break in the skin on my foot?

Have it looked at within days rather than weeks, even if it is small and especially if it does not hurt. Do not wait to see whether it settles. If the foot is hot, red and swelling quickly, if redness is spreading up the leg, if there is a fever alongside a wound, or if a toe has changed colour and gone cold, go to a hospital — those are measured in hours.