Podiatry

Also called Chiropody, Foot care

Foot care is not cosmetic. For somebody with diabetes it is the difference between a callus and an amputation.

What it is

Podiatrists assess and treat the foot and lower limb. Chiropody is the older name for the same profession.

For most people it is nails, corns, callus and painful walking. For people with type 1 or type 2 diabetes, peripheral arterial disease, rheumatoid arthritis or peripheral neuropathy, it is limb-saving work, and NHS podiatry is prioritised accordingly.

The mechanism is worth understanding because it explains the urgency. Neuropathy removes the pain that would make somebody stop walking on a sore spot. Poor circulation stops it healing. Together they turn a blister into an ulcer, an ulcer into an infection, and an infection into an amputation, often within weeks and often without the person ever feeling much.

Every person with diabetes is entitled to an annual foot check and a risk category. Knowing that category, low, moderate or high, tells you how urgently any change needs to be seen.

Signs you might notice

Anything on a diabetic foot is a reason to be seen: redness, swelling, a blister, a cut, a colour change, an unusual smell, warmth in one foot and not the other.

Callus building up on the sole, which is pressure that will eventually break down.

Nails a person can no longer cut safely, particularly when eyesight, reach or dementia is part of the picture.

Pain in the arch first thing in the morning, easing as the day goes on.

Same-day for anybody with diabetes: a break in the skin, spreading redness, or a foot that is hot and swollen with no obvious wound.

How it can affect day-to-day life

Feet are the part of the body people stop being able to see and reach, and the part nobody raises in an appointment. Somebody who cannot bend to their feet and lives alone may not have looked at them for a year.

NHS podiatry is rationed by risk in most areas, which means low-risk toenail cutting has largely gone. That leaves older people paying privately, going to unregulated providers, or cutting their own nails badly.

In residential care, feet are the classic gap between "personal care" and "clinical care", and the thing everyone assumes somebody else is checking.

Supporting someone well

Look at the feet. Every day for anybody with diabetes, weekly for everybody else at risk. Use a mirror on the floor if reaching is the problem.

Ask for the annual diabetic foot check by name, and ask what risk category the person was given.

Shoes that fit, checked inside with a hand before they go on. A stone, a fold or a drawing pin does not announce itself to a neuropathic foot.

Never use corn plasters or blades on somebody with diabetes or poor circulation.

Moisturise the feet, avoiding between the toes.

Check that any private practitioner is registered with the Health and Care Professions Council; podiatrist and chiropodist are protected titles.

Where to get help

A GP practice or the local NHS podiatry service, which in many areas accepts self-referral for people in a high-risk group.

The diabetes annual review, which must include a foot check.

Royal College of Podiatry hold a directory of registered private practitioners.

Diabetes UK have the clearest guidance on daily foot checks.