The foot clinic

The foot clinic is staffed by two podiatrists and an orthopaedic surgeon with experience in blood vessel surgery, who has a weekly consultation. The surgeon examines and treats people with special diabetes-related foot problems.

Diabetes and the feet
People with diabetes may experience complications in the form of nerve damage (neuropathy), reduced circulation to the feet or a combination of both. Changes in the skin’s elasticity and moisture content may occur as well as changes in the muscular function. These conditions require preventive footcare and regular examination of both feet and footwear to avoid problems. Proper guidance and education in footcare is therefore crucial to understanding and preventing complications.

Aims
In addition to improving the overall quality of life of people with diabetes, the foot clinic aims:

- to detect neuropathy and changes in the blood vessels sufficiently early to prevent foot ulcers
- to reduce the number of major amputations by 30% by the year 2010
- to reduce the number of new amputations by 50% in those patients who have already had an amputation

Check-ups in the foot clinic
All patients with current or potential foot problems and/or symptoms of complications such as neuropathy or circulatory problems are referred to the foot clinic.
Patients are examined to assess the extent of the problem: blood samples, x-rays of the feet and swabs of wounds are taken, and the blood flow in the legs and feet is checked. Those who are not at risk of developing complications are referred to a local podiatrist.

What the podiatrist looks for
The podiatrist examines the condition of the feet. This includes an examination of the blood flow to the feet, the sense of feeling in the feet and whether the patient has any skin problems. Based on these observations, the podiatrist advises on prevention, relief and treatment.

In a typical examination:
• the feet are examined for pressure sores, hard skin and cracks
• the shape and appearance of the toenails are examined
• the feet and toes are examined for incorrect positioning
• foot pulses are checked
• the sensitivity of the feet is checked
• the patient’s gait is observed
• the patient’s footwear is checked

Teaching at Steno Diabetes Center and other establishments
The podiatrists teach at the type 2 clinic and are also available to teach other groups of staff. They participate in the multidisciplinary teaching days held at the Steno Education Centre.