The Importance of Diabetic Foot Exams
Each human foot contains approximately 7,000 nerve endings — making the area quite sensitive to the touch. The feeling of touch on the skin comes from a series of nerve endings and touch receptors which are responsible for detecting incoming stimuli. When a stimulus is received, the touch receptors become activated, in turn sending nerve impulses to the brain. Finally, within the brain, the information that is transmitted and decoded allows one to feel responses such as pain, pressure, temperature, and vibrations.
Types of Receptors
Starting with proprioceptors, these play a key role in maintaining equilibrium between the surrounding environment and position of body parts in relation to each other. Next, thermoreceptors aid in detecting temperature, whereas, mechanoreceptors detect sensations consisting of pressure, texture, or vibrations. Most importantly, pain receptors are responsible for detecting anything with the potential to cause damage to the skin; however conditions such as Diabetic Neuropathy may impede one’s ability to feel changes as this condition is responsible for damage to the nerves within the legs and feet.
While the main cause of Diabetic Neuropathy is due to sustained high blood glucose levels over an extended period, symptoms can range from mild to severe: such as numbness and pain in the legs and feet which can lead to debilitating or even fatal results. There are approximately 200,000 cases of Diabetic Neuropathy in the United States per year; however, treatment includes controlling blood glucose levels and taking medications such as Gabapentin or Pregabalin to help ease uncontrolled pain.
As Diabetic Neuropathy is a chronic condition that is lifelong due to its inability to be cured, there are serious consequences for Diabetic patients who do not care for their feet. While managing blood glucose levels and taking medications to ease nerve pain are feasible treatment options to manage the condition, regularly checking the bottom of the feet daily for cuts, bumps, and bruises should not be ignored.
An annual Diabetic Foot Exam most oftentimes will be conducted by a podiatrist; however, pharmacists who are certified in Diabetes care and management are also knowledgeable on how to conduct such a test. Typically, a monofilament is held perpendicular to the bottom of the foot and pressed against the skin for about 2 seconds and this process is repeated for a total of 10 times at different sites on the bottom of each foot. While a positive monofilament test is indicative of a patient having peripheral neuropathy, it is important to discuss the meaning of these results and what can be done to assist the patient going forward.
Signs of the most serious medical problems can be detected within the feet as conditions such as Diabetes, nerve and circulatory disorders, and Arthritis begin to showcase their initial presentation within this area of the body. Diabetic Neuropathy is the most concerning as nearly 60–70% of Diabetics will develop a form of nerve damage with severe cases leading to lower limb amputation. Approximately, 56,000 Diabetics will either lose a foot or leg annually due to this condition, and it is imperative that the proper education to patients must be given to prevent further consequences.
In addition to an annual Diabetic Foot Exam performed by a healthcare provider, it is important to educate Diabetic patients to wear proper foot wear that is not tight, wear socks to help prevent cuts and scrapes, and check their feet daily for signs of bruises or infection that may go unnoticed due to existing nerve damage. A family member or caregiver may also be educated on what signs of a Diabetic foot infection may present in the case that a patient is unable to view the soles of their own feet. A plan to manage glucose levels and when to contact a doctor with signs of concern should also be generated to optimize patient care.
Overall, within the United States, Diabetes and its existing comorbidities are on the rise, and improper patient education and lack of daily care associated with Diabetic Neuropathy can lead to lower limb amputations and even complications that can lead to death. It is imperative for healthcare providers to perform annual monofilament exams and for patients to examine their feet daily to prevent negative outcomes.
References
Diabetic neuropathy. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580. Published March 3, 2020. Accessed May 27, 2020.
Foot Care When You Have Diabetic Peripheral Neuropathy. EndocrineWeb. https://www.endocrineweb.com/guides/diabetic-neuropathy/foot-care-when-you-have-diabetic-peripheral-neuropathy. Accessed May 27, 2020.
