Did you know that the average person will walk up around 128,000 km over a lifetime? To put it into perspective, that is enough to go around the circumference of the earth three times. It goes to show how much we rely on our feet. As for diabetics, walking can be painful if you are not wearing the right shoes.

Diabetic shoes have certain functions that other footwear don’t have. They are designed to:

– Promote blood circulation.

– Prevent ulcers.

– Prevent blisters.

– Prevent calluses. 

– Provide pain relief.

Not all diabetic shoes are created equal and every foot is different so here are 9 tips from experts to help you find the right pair.

1. Generous Insole

Insoles sit directly on the sock liner to provide extra cushioning for comfort against blisters. They usually consist of a single layer of foam and can be ordered straight from the shelf or customised. If you purchase one from the shelf, look for an insole with a minimum of 3 layers. Customised insoles are known as orthotics which will require a podiatrist’s consultation.

2. Stiff Midsole

Midsoles are shock absorbers. The firmer the midsole, the stiffer and heavier the shoe will be. On the other hand, softer midsoles absorb more shock but have a shorter lifespan than the firmer counterpart.

Experts say to look for a midsole that is stiff through midfoot with toe flexibility. You can do a simple test by flexing the shoe with your hands. The breakpoint should be in the area where your toes would normally bend and not in the middle or rear of the shoe.

3. A Flared Or Wider Outsole

For stability, look for outsole that is flared or wide with non-slip pattern thick enough to provide maximum protection.

4. Rocker Sole

A rocker sole or rocker bottom is a shoe which has a thicker than a normal sole with a rounded heel. Experts suggest that a rocker sole can play an important role in offloading foot pressure and prevent ulcers from occurring. Speak to your podiatrist to see if this option is right for you.

5. Adjustable Fastenings

Diabetic feet often changes shape and size due to swelling so look for footwear with adjustable fastenings such as velcro straps or laces.

6. Wide Toe Box

A toe box is where your toes rest. There should be enough room to allow movement of your toes. Avoid shoes with a narrow toe which can make your toes feel cramped or confined. You also want to avoid a toe box with too much space otherwise your feet will slide around.

7. Padded Tongue

For shoes with laces, check for a tongue that provides enough padding so you still have room to tie up your laces, but not too much that it digs into your foot. Experts suggest that a tongue made from leather is preferable. Leathers are known for its hygienic properties.

8. Avoid Internal Seams

Seams can cause pressure and rubbing of the skin and toes so check the inside of the shoe for seams.

9. Heel Counter

A good heel counter controls ankle movement and aids in preventing ankle sprains. Look for a stiff and durable heel counter for support.

In short, diabetic shoes are worth the investment if you want to stay active by preventing complications and increasing blood circulation.

It’s time to put your feet first; invest in a pair today.

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Every year, there are 10,000 hospital admissions in Australia for diabetes-related foot ulcers in Australia – many of these end with people having a limb, or part of a limb amputated.

Good news is that we can avoid the risk of infection and maintain a mobile quality of life with these 7 tips for diabetic foot care.

1. Inspect Your Feet Daily

Nerve damage (neuropathy) is a complication caused by diabetes making it hard to feel sores or cracks in your feet. Check both the bottom and around your feet for anything that may lead to an infection. Place a mirror on the floor if you have a problem with flexibility. This will help you see your feet clearly.

2. Don’t Use Your Feet To Test Hot Water

Another problem with nerve damage makes it hard to test the water temperature. Stepping into a hot bath without checking the temperature can cause serious damage to your feet like burns. Burns and blisters often lead to an infection if not treated immediately so use your elbow to test the water temperature before taking a bath.

3. Don’t Go Barefoot Outside

We all know that enclosed shoes protect our feet from scrapes, cuts or splinters that causes infection. Sometimes it’s tempting to put out the trash or collect mail without wearing shoes because it’s quicker that way. Create good habits by wearing shoes at all times, even inside the house.

4. Keep Your Feet Dry

Athlete’s foot (tinea pedis) is a common fungal infection among diabetics. Reduce the risk of an infection by drying your feet properly after showering. The same applies to socks. Make sure you remove wet socks immediately, wash in-between your toes and dry thoroughly.

5. Use Correct Footwear

Shoe shopping for diabetics requires more time in finding the right footwear. Diabetic footwear not only supports but also protects the feet. Look for a shoe with extra toe box depth, generous midsole, no seams on the inside and rocker bottom sole to reduce pressure on the feet. There is a velcro strap option for those with arthritic hands.

6. Low Impact Exercises

Exercise has many benefits, but for diabetics, especially those with neuropathy should be choosy when it comes to certain workouts such as aerobics or any high-intensity training. Sprinting,  jumping and leaping places pressure on your feet. Always choose low-impact exercises like walking, swimming or tai chi that doesn’t put too much pressure on your feet.

7. See A Podiatrist Regularly

It’s tempting to cut out corns or calluses or use over-the-counter pharmaceutical products to treat them. Do not attempt these strategies yourself. Always seek a podiatrist in any case and always book a yearly assessment. Your podiatrist will determine the frequency of each visit depending on the level of risk.

Let’s work at reducing the statistic of Aussie hospital admissions by making diabetic foot care part of your routine.

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In other words, Government assistance is available.

Chronic Disease Management (CDM) is a government initiative that enables General Practitioners (GPs), allied health providers and a multidisciplinary team to plan and coordinate health care needs of patients with chronic disease or terminal medical conditions.

While there are no list of eligible conditions, a chronic medical condition is one that has been (or is likely to be) present for six months or longer.

For patients with complex care needs, a multidisciplinary team consists of various different health professionals including:

– Medical practitioners.

– Home and community service providers.

– Allied health professionals.

– Care organisers.

There are 5 different Chronic Disease Management plans and each will be covered in detail further on.
Your GP and allied health providers conduct relevant plans to the service they provide.

Think of the plans by their item numbers.

1. Item 721 – General Practice Management Plan (GPMP)

2. Item 723 – Team Care Arrangements (TCA)

3. Item 729 – GP Contribution to or Contribution to a Review of a Multidisciplinary Care Plan for a Patient who is not a Resident of a Residential Aged Care Facility

4. Item 731 – Contribution to or Contribution to a Review of a Multidisciplinary Care Plan for a Patient who is a Resident of a Residential Aged Care Facility

5. Item 732 – Review of a GP Management Plan (GPMP) and/or Review of Team Care Arrangements (TCAs)

Let’s say that you have a chronic or terminal medical condition and have complex care needs that require care from a multidisciplinary team, then your GP will need to provide two plans – Item 721 and 723.

On the other hand, let’s say that you have a chronic or terminal medical condition (without a need of a multidisciplinary team), then your GP will only need to provide one plan – Item 721.

As with any Medicare rebate, the process must begin with an appointment with your GP.

Eligible patients will receive a Referral Form for Individual Allied Health Service under Medicare for patients with a chronic medical condition and complex care needs. 

Each patient is entitled to a maximum rebate of five individual allied health services. If your GP nominates multiple allied health providers, then the five will be divided.

Like most government rebates, they have an expiration date. Rebates must be used within each calendar year. A calendar year is defined as the period of time between January 1 and December 31.

If you are like most people then you are probably wondering at this point if there is an out-of-pocket expense associated with visiting a podiatrist. That’s a good question because it will depend on the podiatrist’s fees.

A podiatrist can choose to either bulk bill so that there’s no cost or charge an out-of-pocket amount. Good news is that in 2016-17, almost 8 in 10 Medicare services were bulk billed.

Below is an outline of each plan and its purpose.

You can always refer to The Department of Health for more information. A link provided on the bottom of this blog.

Item 721: General Practice Management Plan (GPMP)

Eligible patients will receive a comprehensive plan written by their GP.

Q: What is included in the plan?

A: The following will be documented:

1. Patient’s condition.

2. Healthcare needs.

3. Management goals (agreed by the patient).

4. Action to be taken by the patient.

5. List of treatments.

6. Review dates.

Item 723: Team Care Arrangements (TCA)

For patients that require ongoing care from a number of a multidisciplinary team.

Your GP will collaborate with other participating providers on the treatment/services required.

Q: What is involved in the plan?

A: Documentation of the arrangements of each health service provider and a review date.

Relevant copies will be provided to the collaborating allied health providers.

Item 729: GP Contribution To Or Contribution To A Review Of A Multidisciplinary Care Plan For A Patient Who Is Not A Resident Of A Residential Aged Care Facility

Patients with a chronic or terminal medical condition and complex care needs can have a health care provider other than their usual GP to review their care plan under this item.

As the title states, this is not available to patients of residential aged care facilities.

Q: What is involved in this plan?

A: A review of your GP and other allied health providers’ contribution to the patient’s treatment.

Item 731: Contribution To Or Contribution To A Review Of A Multidisciplinary Care Plan For A Patient Who Is A Resident Of A Residential Aged Care Facility

This is good to know if you have an elderly family member and are considering care at an aged care facility.

This item was introduced to cover the resident’s behavioural or lifestyle needs. This is in addition to a care plan prepared for the resident by the aged care facility.

Item 732: Review Of A GP Management Plan (GPMP) And/Or Review Of Team Care Arrangements (TCA)

GPs use this item to review patients who have a current GP Management Plan and Team Care Arrangement plan and require a review of one or both.

Q: What is involved in the review?

A: Documentation of any changes and setting the next review date.

All in all, looking after your health is one thing. Expenses associated with treatment is another. Visit your GP to assess your eligibility for this rebate.

For a comprehensive look into Chronic Disease Management, refer to The Department of Health Question and Answers on the topic at http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-chronicdiseasemanagement-qanda#or

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Please note: All care into researching and writing of this blog has been checked both verbally and in a written statement provided by the relevant department as of 21 September 2018.

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Suffer from diabetes? Learn about the 10 conditions of diabetic neuropathy and peripheral vascular disease of the legs and feet and how to prevent severe complications from reoccurring. 

Believe it or not, around 1.7 million Australians have diabetes.

Diabetics are prone to having problems with their legs and feet due to the following two conditions caused by diabetes:

– Neuropathy (loss of normal nerve function) and

– Peripheral vascular disease (loss of normal circulation).

Living with diabetes means that it is important to take care of your feet because neuropathy and peripheral vascular disease can cause serious lower limb problems if left untreated.

The risk of amputation from severe complications is higher than you think.

There are more than 4,400 amputations every year in Australia as a result of diabetes.

Checking your feet daily for changes in skin condition or possible infections can prevent serious complications. This should be done in addition to regular assessments carried out by a podiatrist. If you haven’t had an assessment, it is important to have one booked.

During the initial assessment, a podiatrist will document the level of risk in order to determine the frequency of each visit. Recommended visits of a high-risk patient are usually every 3-6 months whereas low-risk patients are at least once a year.

Seek medical treatment as soon as possible if you notice the following signs:

– Ulcer.

– Wound not healing.

– Unusual swelling.

– Redness.

– Blisters.

– Ingrown nail.

– Bruising or cuts.

The following are 10 conditions of the legs and feet that are not specific to diabetics; however, they occur more commonly to diabetics due to nerve and vascular damage.

1. Athlete’s Foot (Tinea Pedis)

Athlete’s foot is a common fungal infection that affects the skin on the feet and causes itching, redness and cracking. For most people, it often appears on the webbed skin between the toes.

Like all fungal infections, they thrive in a warm and moist environment so make sure your feet are completely dry after showering and wear clean socks at all times.

Footwear can promote the growth of bacteria so it is recommended that you clean, dry and change shoes regularly to prevent the opportunity for bacteria to manifest.

Common symptoms of Athlete’s foot are:

– Intense itching of the foot.

– Redness and scaling on the soles.

– Flaky skin.

– Burning or stinging sensation.

Athlete’s foot can lead to foot or leg infections (cellulitis) if not treated properly. Cellulitis is covered in number 3.

2. Bunion 

A bunion develops when the bone at the bottom of the big toe moves out of place causing the big toe to point inward (toward the other toes). Bunions can form on one or both feet.

Bunions can be either hereditary or it can be caused by wearing inappropriate shoes over time. For diabetics, the nerve damage can cause muscle weakness and loss of tone in the feet.

Bunions can be painful so it is important to avoid shoes with a narrow toe.

It is recommended that you book an appointment with a podiatrist to discuss the option of surgery or footwear.

3. Cellulitis

Cellulitis is a bacterial infection of the skin and tissue. This infection occurs from a wound or sore and the result can be life-threatening if left untreated.

Cellulitis can appear anywhere on the body; however, the legs are a common area.

Common symptoms of cellulitis are:

– Redness.

– Pain.

– Tenderness.

– Swelling.

– Warmth of the affected area.

If you experience any of the above symptoms, seek medical assistance immediately.

4. Charcot Arthropathy (Charcot’s Foot)

The bones in the foot become weakened causing fractures and dislocations. The patient will feel little pain due to neuropathy. The result often leads to severe deformities of the foot.

Common Charcot’s foot symptoms are:

– Warmth to the touch (the affected foot feels warmer than the other).

– Redness in the foot.

– Swelling in the area.

Such a condition may require surgery or it can be simple as finding the right footwear. In either case, see a podiatrist for their recommendation.

5. Corn And Calluses

A callus is a build-up of hard skin, usually on the bottom of the foot caused by the uneven distribution of weight.

Corn is a build-up of hard skin near a bony area of a toe or between toes.

Corn and calluses are not normally harmful, but for a diabetic, the result can lead to an infection if left untreated. Do not attempt to remove them yourself. Always book an appointment with a podiatrist to carry out the treatment.

Shoes are often the factor behind the condition. If the shoe is too tight, it creates pressure on the skin. If the shoe is too loose, they can cause friction. When possible, wear socks to prevent corn or callus from occurring.

6. Dry Skin 

Dry skin is common among diabetics due to neuropathy that prevents sweating. Sweat is important to control the moisture balance of the skin.

Dry skin on the legs and feet can cause cracks which allow bacteria (cellulitis) to enter.

Maintain a daily routine of moisturizing with non-fragrant soaps and moisturisers to help keep your skin moist and soft in order to prevent bacteria from entering the skin.

7. Fungal Infection Of Nails

Fungal nail infection is caused by fungus spreading under the nail. In some cases, it may separate from the bed of the nail.

The nail becomes discoloured (yellowish-brown or opaque) and quite often produces an odour.

Certain shoes can promote fungal growth because of the dark, moist and warm environment of which they thrive in.

If left untreated, the likelihood is high for developing other infections such as cellulitis, ulcers and even gangrene (see below).

8. Gangrene

Gangrene is a condition that occurs when body tissue dies due to loss of blood supply.

There are two types of gangrene: dry and wet.

Dry gangrene is common in people with diabetes. It develops when blood flow to the affected area (feet in this case) is impaired as a result of poor circulation. The tissue dries up and may be brown, purplish-blue or black in colour.

Wet gangrene is caused by an injury so severe that it cuts off blood supply to the affected area, causing tissue decay and increased risk of infection. The term ‘wet’ comes from tissue swelling and blisters due to pus.

Once gangrene is present, amputation is often the remedy.

9. Hammertoes

A hammertoe is a condition where a toe is bent due to weakened muscle. The weakened muscle makes the tendons shorter causing the toe to curl under the feet.

Hammertoe can be caused by arthritis, wearing inappropriate shoes or hereditary.

For diabetics, the result often leads to an infection or an ulcer due to irritation caused by excessive rubbing.

Hammertoes may require surgery or it can be simple as finding the right footwear. In either case, see a podiatrist for their recommendation.

10. Ulcers

A foot ulcer is a break in the skin or a deep sore which can become infected.

Poor fitted or poor quality shoes can cause rubbing of the skin or cuts which heal slowly. This is the reason why booking a footwear assessment with your podiatrist is important.

Early signs of an infection are unusual swelling, redness, irritation or odour.

If you have an elderly family member, it is recommended that you check for stains on socks or around the shoe itself for any leaks from the wound.

Sometimes, symptoms of an ulcer are not obvious so it’s best to see a podiatrist as soon as you notice a slight discolouration on the skin or pain around the areas that appear callused or irritated.

By monitoring your feet on a daily basis for changes in skin condition and booking regular assessments with your podiatrist will help prevent serious complications and undue stress on yourself and family members.

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