How do I do a Foot Check for people with Diabetes?

Okay, so my foot checks that I would do and things that I advise people with diabetes to do is a regular visual or feeling scan of their feet. So people know what their feet are like for them and I advise people not to kind of compare themselves to maybe images of feet that they see in magazines or books because you know what's normal for us is normal for us and so what's a normal colour for you, what's the normal sort of shape for you and anything that doesn't look normal is requiring some attention. So I ask people to take both shoes and socks off, check their feet visually every day, make sure that they look around their feet, underneath their feet, in between the toes, around the heels, around the nails and look for any discolouration, any signs of any injuries, any maybe bruising, any swelling, anything that as I say doesn't look normal for them. I would ask them to check their shoes to make sure that the shoes fit and that sounds really trite because you know we would assume that shoes fit but they don't always so sometimes people will wear shoes that are a size bigger because they get swelling through the day or they may wear shoes that are too tight because they can't do up laces so they wear a tight slip-on shoe and they have swelling that sort of stretches over the the edges of the shoes. So footwear is really important. I would make sure that they are checking that what they're doing is safe, so are they using safe treatments on their feet. There's lots of stuff that people can buy over the counter and I always tell people not to buy any over the counter things like corn preparations these corn plasters and corn pads because they contain an acid and the acid can burn the skin and it'll burn the healthy skin as well as the skin that you want to remove. Any emollients or any treatments that again people are applying topically that they that they're from a reputable source and they don't contain any added you know, chemicals or any added ingredients that might be harmful to the foot. I don't have a problem, particularly with some of the sort of cultural health beliefs that people want to do as a part of their, you know, maybe their sort of cultural health belief. belief. I do sometimes worry if people are using those instead of seeking advice, so I work in Birmingham, we have a big multicultural population, and the use of turmeric and turmeric paste on feet is quite common. That's okay if the skin is intact, but sometimes people will put it onto ulcerated or injured skin, and because the turmeric isn't a sort of clean product, sometimes they can introduce infection into a wound and also the yellow staining from things like turmeric can mask some of the clinical signs that we might want to see like redness or discoloration. The other thing that I'd ask people to do is to make sure that as part of their health check that they have a risk assessment done so that somebody assesses what they are feeling in terms of their nerve supply into their feet and what their circulation is like. And they don't have to do a big, sexy involved assessment. It's basically temperature of the feet, temperature gradient in the feet, whether their capillary refill, those small little blood vessels at the ends of the toes. If you squeeze them, does the blood come back quickly? And can you feel a pulse? And if people know where the pulse sites are on their feet, So if they're seeing a practice nurse or a healthcare professional, that they have a feel of the feet and they can feel if there's a pulse. And if there's a concern about the pulse being absent or some of the clinical signs sort of stacking up that there's a problem with the nerve supply or the circulation, that maybe an onward referral is considered just to investigate whether there's any intervention that's needed at that point. And then I would want people to know that what their risk status is. Are they low risk? Have they got no problems? And we're quite happy for them to carry on with some health advice and some signposting if they do develop a problem. Or are they at risk of problems developing? In which case they need to maybe have a bit of extra surveillance and maybe need to see a community podiatrist or another healthcare professional. Or are they at high risk of a problem? And do they need to be put into a sort of targeted individualized program of care? and also reinforcing that they need to do things like go for their regular eye screening and go for their annual diabetes checkups to make sure that their glucose treatments and interventions are optimized and that their blood sugars are within the range that we want them to be.