Diabetic Foot

What is it?

Diabetic foot disease covers the foot problems that develop when diabetes damages the nerves, blood vessels and immune response in the legs and feet. It includes numbness, ulcers, infection, poor circulation, Charcot foot (a weakening and collapse of the foot’s bones and joints), and, in advanced cases, gangrene and amputation. Diabetes-related foot disease is a leading cause of non-traumatic amputation in Australia, and up to one in three people with diabetes will develop a foot ulcer in their lifetime. The good news is that most serious outcomes are preventable with regular foot checks, early treatment, and prompt referral when something changes.

Why does it happen?

Three processes usually work together:

• Neuropathy: Loss of sensation means injuries such as blisters, cuts and pressure points go unnoticed. Nerve damage also changes foot shape and the way weight is carried, creating high-pressure areas.
• Peripheral arterial disease (PAD): Diabetes accelerates narrowing of the leg arteries, particularly the smaller vessels below the knee. Reduced blood flow slows healing and is present in a large proportion of people with foot ulcers.
• Infection: High glucose and poor circulation impair the body’s defences, so a small wound can become a deep infection, including bone infection (osteomyelitis), quickly.

For patients

Look after your feet every day

• Check both feet daily, including between the toes and the soles. Use a mirror or ask someone to help if you can’t see them easily.
• Wash and dry carefully, and moisturise dry skin (but not between the toes).
• Never walk barefoot, even at home, and check inside shoes before wearing them.
• Wear well-fitted footwear and seek advice from a podiatrist about nail and callus care, rather than cutting calluses yourself.
• Stop smoking and keep your blood glucose, blood pressure and cholesterol well controlled.
• Have your feet examined at least once a year, or more often if you are at higher risk.

For GPs

Screen at every review

• Examine both feet for deformity, callus, skin and nail changes, and pulses.
• Test protective sensation (10 g monofilament and one other test such as vibration).
• Stratify risk to set review frequency (low, moderate or high risk), in line with current Australian diabetes-related foot disease guidelines.
• Do not rely on the ABI alone. Arterial calcification in diabetes often falsely elevates it, so toe pressures or toe-brachial index and Doppler waveforms are more reliable.

When to refer to vascular surgery

• Any ulcer or gangrene in a patient with absent or weak pulses, abnormal toe pressures or abnormal waveforms
• Rest pain, or an ulcer that has not begun to heal after about two to four weeks of good care
• Suspected chronic limb-threatening ischaemia. This is urgent, and revascularisation is most effective when done early.
• Moderate to severe infection, an ulcer that probes to bone, or a hot swollen foot suggesting Charcot. These need urgent multidisciplinary review (podiatry, infectious diseases, and orthopaedics or the high-risk foot service).

Ongoing management: offloading of the ulcer is essential, along with early empirical antibiotics for clinically infected wounds, optimising glycaemic control, and treating cardiovascular risk (antiplatelet therapy, statin, blood pressure, smoking cessation).

Our approach

At Perth Vascular Clinic we assess the circulation of the affected limb with clinic-based non-invasive testing (toe pressures and duplex ultrasound) and, where needed, angiography. We aim to restore blood flow by the least invasive effective option, whether that is angioplasty, stenting, or bypass surgery when required. We work alongside your GP, podiatrist, endocrinologist and wound care team, because saving a limb is a team effort. Early referral gives the best chance of healing and limb preservation.

This page is general information and does not replace individual medical advice.