Diabetes UK, through there website, suggest that that there are 4.6 million people living with Diabetes in the UK today, and that by 2025, this will have risen to 5 million, despite advances in detection, medication, and a wider understanding about lifestyle and diet. 10% of this number have Type 1 diabetes, which is a lifelong condition that impacts upon the heart, eyes, kidneys and feet, and the remaining 90% have Type 2, which has very similar impact upon the body, but which more often occurs in later life.

Diabetes is a condition that exists because the levels of glucose in the bloodstream become dangerously high, all due to the bodies inability to create insulin, which assists in allowing this glucose to enter our bloodstream and be converted into energy. Type 2 Diabetes is often associated with poor diet or lifestyle, whereas there is little known about the causes of Type 1.

The reason Orthotists are interested in Diabetes, is that one of the key areas where the impact of the condition can be severe, is in the foot, and this is something that really should not be overlooked. A key feature of Diabetes is that cuts and wounds don’t heal as well or as quickly in a sufferer, and thus the foot, which is usually tucked away into socks and footwear, becomes increasingly vulnerable. Another symptom, for want of a better word, of diabetes, is that certain parts of the body, usually at the extremities such as the fingers or toes, begin to have reduced sensation or feeling, and this is called ‘Peripheral Neuropathy’. If you experience this, then it is easier to harm the foot, and not realise it quickly enough to prevent any damage. Ben Yates (2009) suggests that this peripheral neuropathy leaves diabetics at a greater risk of developing an ulcer, and sadly, he also argues that this increases the chances of reduced mobility, poor life quality and even amputation.

This is all quite scary, but I guess that this is where the Orthotist comes into the equation. The Orthotist will be able to identify risk at the earliest stages, will work with the patient to develop an appropriate prevention strategy, develop an integrated care plan if appropriate, and then refer to other clinicians if necessary, with the aim of maintaining foot health and reducing the risks that may ultimately cause problems into the future. Some of the challenges around a diabetic foot can be biomechanical, and as this is something I’ve discussed a great deal in this blog already, I won’t go on; but, it is important that the diabetic gets assessed by an Orthotist significantly early enough, in order that any issues with gait for example, are managed before they go on to be a bigger problem. The Orthotist is also the most appropriate clinician to advise on footwear, and whilst this may sound a little odd, they are in the best position to advise where an individual requires support, and as importantly, where pressure may become an issue. Appropriate footwear, including socks and hosiery for example, can make the difference between developing an ulcer or not, and where ulceration is already a factor, it is important to understand how to manage this for the best.

In truth, the diabetic patient will probably need the specialist intervention of several clinical experts, but the key message here, is that the Orthotist is an important part of this team, and should be one of the first people to intervene, if mobility is to be maintained, pain reduced, risk to the foot minimised, and a clear pathway established moving forwards, that will enable the diabetic patient to maintain quality of life, and reduce the chances of more severe treatments.

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