Feet at 'moderate risk'

[C6H12O6]

Possibly a 'how longbis a piece of string question' but has anyone ever had their foot tickled and the result be their feet are at 'moderate risk'? I had them tested before Christmas but the nurse didn't seem concerned and didn't make any comment: it was only when I was looking at my NHS online file that I noticed it. I did ask the GP I saw the other day but his opinion was 'some diabetics have to live with neuropathy even with good control'. The issues with my feet have never been officially diagnosed, just tagged on as part of diabetes. Should I get on and accept that this is a part of life and just keep my fingers crossed I stay at moderate?! Maybe this is an impossible question to answer, common sense says go back to the surgery and ask but that's a mammoth task in itself and I'm not sure they actually know! Feels a bit like a 'computer says' scenario 😳🙄

 

[Windy]

I googled and found a leaflet from one of the health authorities which covers the criteria for "moderate risk":
"Your podiatrist will tick which of the following risk factors you have.
 You have lost some feeling in your feet.
 The circulation in your feet is reduced.
 Hard skin / skin changes on your feet.
 The shape of your foot has changed.
 Your vision is impaired.
 You cannot look after your feet yourself."

and offers some advice on foot care. Did the nurse say she'd found any of these?

No personal experience of this, as I've only seen the tickler once as I'm recently diagnosed. Hopefully our more learned colleagues will know more.
Sarah

 

[everydayupsanddowns]

Sorry to hear about the way you had to find out about your foot increased risk.

It sounds like they aren’t too concerned about it, but it would have been nice to have been told! What is the phrase about including us in our care… ‘nothing about us without us’

I know that @Flower has a lot of experience of foot risk clinics, and I believe has experienced the results of pressure in the system recently

Hope you can find out exactly what factors were present that gained you that tick in the box, and which those factors can be modified

 

[C6H12O6]

Thank you both so much for your replies. It's a sign of how much this has rattled me that Googling simply didn't occur to me! That leaflet is really helpful: I do have a small patch of rough dry skin on one heel that she observed, but I'd be amazed if that was it - they might need some subcategories to their scale if it is! I'm concerned about the circulation as my ankles are swelling and my feet are now so cold having been able to fry eggs for most of my life.

Everydayupsanddowns, I might start quoting that with every consultation I have. Based on others' posts I think I've been pretty lucky with my care so far but oh, if only they would talk to me like an equal it would mean I could take more responsibility for my care and take pressures of the struggling system - it's false intellectual economy the way it is!

I will try to sort out the dry patch and see what happens but I feel much more informed so thank you again for your information and kind words, they were much needed tonight!

 

[KARNAK]

Hi @C6H12O6 I`ve suffered from severe Diabetic Peripheral Neuropathy (DPN) for many years,
mine was caused by reducing my HbA1c from 156 to 48 in 3 months no one told me I had to do
it slowly, I consequently learned about it on this forum. Its too late for me now I have to live with
it for life, I am considered at risk of Charcot foot especially the right foot. My feet are checked
every 6 weeks at the hospital by a Podiatrist and they are fully tested including temperature and
sometimes each individual toe temperature, all hard skin is removed, toenails cut too.

It also affects my lower legs which makes me walk unsteadily, I take 3300 mg of Gabapentin and
60 mg of Duloxetine each day to ease the 24/7 pain and that`s all it does ease it. Its not dry skin
that causes it its nerve damage which can be successfully treated for a lot of people with the right
medication and an understanding GP and Diabetic nurse. As Mike says @Flower who has Charcot
Foot is very knowledgeable about this condition and has a permanent cast on her foot to keep her
foot in shape and stop the bones collapsing, these two examples are more extreme and most people
are treated successfully.

From what you say you are probably in the latter and I`m sure you will be treated with success I know
of quite a few people who have been treated and cured strangely enough most of them are T2 but no
type are excluded. There are other reasons for nerve damage but I relate to Diabetics as I have done
a lot of research on the condition but have no medical knowledge other than what I have learned through
research, I would go back to the GP and ask for medication for Neuropathy and a referral to the Podiatry
department. They will also advise you how to look after your feet and which moisturiser to use and if your
lucky they can prescribe Flexitol which I am prescribed.

Long winded I know for a post but I feel if you know as much as you can learn about the condition you can
work at it to deal with it, don`t be fobbed off by a GP or nurse who hasn`t much knowledge or doesn`t think
its not a worry for you, one of the main things is keep control of your BGL`s if you start creeping up into the
mid to upper teens it will get more painful including cold feet. Don`t walk around indoors without something
on your feet if your feet are cold in bed wear bed socks and put extra covering over them, I could go on and
on but enough for today hope this helps.

Kindest regards Ted.

 

[C6H12O6]

Thank you so much for taking the time to share your experiences, so valuable to me as yes, I believe learning is central to being able to take responsibility for my own health.

I too dropped my HbA1c quickly although not as dramatically (mid 80s to mid 30) in just under 3 months. No mention that this wasn't a good idea and to take it steady! I am on 1500mg gabapentin a day which helps to control the burning, stabbing, walking on gravel/glass sensations but the numbness, cramping, swelling and coldness is getting worse and I know I'm rolling my feet out and walking on the outside edges. I keep my bloods under 9 which definitely helps - as soon as I get into the low 8s I can tell I'm on the way up- nothing serious but an uncomfortable feeling.

My main concern is that there has been no diagnostic process just you have diabetes and sore feet therefore it's diabetic neuropathy, accept it, live with it and that's that. I don't know whether I'm unreasonable to ask for nerve conduction tests, dopplers etc or whether this is unnecessary to secure effective treatment. I'll try for a podiatry referral and take it from there.

I really appreciate you sharing your experiences and validating my feelings. I like to think I'm pretty robust but this one is getting me down and I hate being powerless to help myself. I'll also make z request for Flexitol and have a good look at that website.

Best wishes and thanks to you all.

 

[Flower]

Hi @C6H12O6

I'm sorry you found out that your feet were at moderate risk from your health records and not in person with some guidance and advice Podiatry clinics have been badly affected by Covid although it seems to vary which services are available depending on which part of the country you're in.

Do ask for a podiatry referral - I think you can self refer in some areas - and keep ever vigilant for any changes in your feet sensation, temperature, wounds etc but if you want some peace of mind and if it is something you can afford to do book a private podiatry appointment - choose someone who has knowledge of diabetic feet.

I've had to go private for any podiatry for 2 years now with 2 high risk feet, one in a cast with broken bones. I can only get an in person appointment if I have a wound otherwise it's 4 monthly phone appointments and as I've been advised to have an amputation I'm trying my very best to avoid this and cannot afford to get a wound.

As @KARNAK says there are drugs that can limit the pain from neuropathy but I've found them difficult to get the combination and doses right for the best pain relief.

A podiatry appointment should test for circulation as well as sensation and advise on vulnerable areas with high pressure through them. You may also be referred to orthotics for some custom insoles/shoes to protect the vulnerable areas of your feet and offload some of the weight bearing going through areas at risk of damage. I hope you can get some more comprehensive advice and guidance but above all check your feet every day for any changes.

 

[Sharron1]

Possibly a 'how longbis a piece of string question' but has anyone ever had their foot tickled and the result be their feet are at 'moderate risk'? I had them tested before Christmas but the nurse didn't seem concerned and didn't make any comment: it was only when I was looking at my NHS online file that I noticed it. I did ask the GP I saw the other day but his opinion was 'some diabetics have to live with neuropathy even with good control'. The issues with my feet have never been officially diagnosed, just tagged on as part of diabetes. Should I get on and accept that this is a part of life and just keep my fingers crossed I stay at moderate?! Maybe this is an impossible question to answer, common sense says go back to the surgery and ask but that's a mammoth task in itself and I'm not sure they actually know! Feels a bit like a 'computer says' scenario 😳🙄

It is interesting that you were told that. I have had three foot checks. The first two I was told nothing and assumed it was ok. This time I was told my feet were considered low risk and see you next year. I didn't even know there was a risk scale.

 

[Eddy Edson]

Thank you so much for taking the time to share your experiences, so valuable to me as yes, I believe learning is central to being able to take responsibility for my own health.

I too dropped my HbA1c quickly although not as dramatically (mid 80s to mid 30) in just under 3 months. No mention that this wasn't a good idea and to take it steady! I am on 1500mg gabapentin a day which helps to control the burning, stabbing, walking on gravel/glass sensations but the numbness, cramping, swelling and coldness is getting worse and I know I'm rolling my feet out and walking on the outside edges. I keep my bloods under 9 which definitely helps - as soon as I get into the low 8s I can tell I'm on the way up- nothing serious but an uncomfortable feeling.

My main concern is that there has been no diagnostic process just you have diabetes and sore feet therefore it's diabetic neuropathy, accept it, live with it and that's that. I don't know whether I'm unreasonable to ask for nerve conduction tests, dopplers etc or whether this is unnecessary to secure effective treatment. I'll try for a podiatry referral and take it from there.

I really appreciate you sharing your experiences and validating my feelings. I like to think I'm pretty robust but this one is getting me down and I hate being powerless to help myself. I'll also make z request for Flexitol and have a good look at that website.

Best wishes and thanks to you all.

(EDITed some typing-too-fast glitches.)

Has anybody talked about the possibility of peripheral arterial disease (PAD), typically narrowing / blockage of femoral artery, which can lead to numbness, cramping, cold feet etc?

It's separate from neuropathy but often co-exists with it in evil alliance - eg I have both. It's also way under-diagnosed. The major classical symptom is "intermittent claudication" - cramping in the calves, typically, from exertion, which goes away when you rest briefly. But lots of PAD sufferers don't get IC, apparently, at least sometimes because they are too inactive to trigger it.

The main front-line therapy for PAD is to walk a lot, and via this I no longer have the cold foot thing.

Anyway, maybe worth talking to yr doc about it. It's a pretty simple diagnosis - just measuring blood pressure at ankle and at upper arm; if the former is a lot lower then its indicative of PAD.

Also: I find that improved blood flow from walking certainly improves neuropathy symptoms; nerves seem not to like being starved of blood.

 

[Flower]

It is interesting that you were told that. I have had three foot checks. The first two I was told nothing and assumed it was ok. This time I was told my feet were considered low risk and see you next year. I didn't even know there was a risk scale.

Here's what low, moderate and high risk mean to our feet - from Diabetes UK site

Know your risk of a foot problem​

Your healthcare team will tell you your results and how much you're at risk of a foot problem. These include:

• Low – no risk, or a callus without any other problem.
• Moderate – one sign of a foot problem, such as a loss of sensation or a change in foot shape.
• High – more than one sign of a foot problem, or a previous ulcer or amputation.

You might also hear your healthcare professional say your level of foot problem is active. This means you have highly serious foot complications, such as a spreading infection or ulcer and you should be having treatment for it already.

You’ll get information that explains what your level of risk means, and be told what you need to do next. If your feet are moderate or high, you’ll be referred to the foot protection team where you'll see a foot specialist.

Here's the whole page on diabetes foot checks

Your annual diabetes foot check

Everyone with diabetes should have an annual foot check. Your foot check is part of your annual review, which means you should have it as part of your diabetes care and it's free on the NHS. This is because you’re more likely to have serious foot problems and these can lead to amputations. If...

www.diabetes.org.uk

 

[Isabella66]

Has anybody talked about the possibility of peripheral arterial disease (PAS), typically narrowing / blockage of femoral artery, which can lead to numbness, cramping, cold feet etc?

It's separate from neuropathy but often co-exists with it in evil alliance - eg I have both. It's also way under-diagnosed. The major classical symptom is "intermittent claudication" - cramping in the calves, typically, from exertion, which goes away when you rest briefly. But lots of PAD sufferers don't get PAD, apparently, at least sometimes because they are too inactive to trigger it.

The main front-line therapy for PAD is to walk a lot, and via this I no longer have the cold foot thing.

Anyway, maybe worth talking to yr doc about it. It's a pretty simple diagnosis - just measuring blood pressure at ankle and at upper arm; if the former is a lot lower then its indicative of PAD.

I've just booked an appointment with Podiatry Clinic. I had an operation back in May last year to relieve PAD symptoms in my left leg (groin graft of femoral artery and stomach stent) which unfortunately did not fix the problem and it looks like I have to go through another more involved operation now so I was very interested to read this post. My symptoms have been a lot worse after this operation but because of my diabetes I wasn't sure whether the 'new' symptoms which include, numbness, tingling, sharp pains and severe foot cramps, were due to PAD or diabetic neuropathy. I find it's just too painful to walk any distance now so hence the reason for my podiatry appointment. Hopefully, they will be able to shed some light on all these different symptoms I'm having. I did read that if your symptoms are only in one of your feet then it would more likely be PAD rather than diabetic neuropathy as this normally affects both feet. Please feel free to correct me if I'm wrong. I will come back and update after my podiatry appointment

 

[Eddy Edson]

I did read that if your symptoms are only in one of your feet then it would more likely be PAD rather than diabetic neuropathy as this normally affects both feet.

I think that's correct, from what I've read, and it's certainly true for me.

Good luck getting it sorted! Do you have a good vascular specialist? Mine's only interested in surgery, really, so as I haven't needed any of that so far he hasn't been very useful.

 

[C6H12O6]

Do ask for a podiatry referral - I think you can self refer in some areas - and keep ever vigilant for any changes in your feet sensation, temperature, wounds etc but if you want some peace of mind and if it is something you can afford to do book a private podiatry appointment - choose someone who has knowledge of diabetic feet.

I'm so sorry to hear you're in such a horrible position, you're very kind to give me advice now. I've looked into podiatry referrals and it does look like I can refer myself so will do exactly that! If there really is nothing to be done but watch and wait then so be it but I do want a professional opinion beyond a shrug🙄 I did have pulses checked on the most recent appt but only on one foot (which hurt like hell!) so that also didn't fill me with confidence. Normally I would have queried this but by this point my confidence had nose dived so I accepted a blood test for something else, and skedaddled!

Has anybody talked about the possibility of peripheral arterial disease (PAD), typically narrowing / blockage of femoral artery, which can lead to numbness, cramping, cold feet etc?

No but those symptoms do sound familiar and I do get some cramping in my calves especially after prolonged (not as far as it used to be!), brisk walking. I'll get the blood pressure metre out and have a play but will definitely mention it at any future appointments.

I find it's just too painful to walk any distance now so hence the reason for my podiatry appointment. Hopefully, they will be able to shed some light on all these different symptoms

I do wish you all the best with the appointment. It's horrible isn't it, not being able to get around. I look drunk some of the time because either I can't feel my feet at all, or I can feel them too well, or my brain and my toes don't talk to each other and I just fall over myself😳

Thank you again to all of you who have taken the time to reply. As always on these forums it is a mixed feeling of being sorry others are suffering and relief that people do understand sometimes!

 

[C6H12O6]

Thank you all for your advice on here. I've now had a very thorough appointment with my GP who is taking me seriously. I now have clear 'stocking and glove' neuropathy - my hands have started to tingle and go numb to add to the fun. My GP is contacting a neurologist and we'll see what comes back from that but at least she agrees it's worthy of investigation. The good news is that she was impressed with how the skin on my feet was looking so that was worth the effort

 

[WendyB61]

I have not had any foot checks and they haven’t been mentioned by my doctor, I have very dry skin on the top of all my toes does anyone use the cream you can buy from diabetes uk shop ?

 

[ColinUK]

I have not had any foot checks and they haven’t been mentioned by my doctor, I have very dry skin on the top of all my toes does anyone use the cream you can buy from diabetes uk shop ?

Your feet should be checked every year by the nurse as part of your regular diabetes checkup.
If they’re not then speak to the surgery and ask them why not.

 

[EmmaL76]

I was diagnosed sept 20’ never had my feet checked or even mentioned . The cream I use is called pedisalve and it’s available from Amazon. It’s really good and my feet are really soft now

 

[ColinUK]

I was diagnosed sept 20’ never had my feet checked or even mentioned . The cream I use is called pedisalve and it’s available from Amazon. It’s really good and my feet are really soft now

Are you getting annual retinopathy checks?

I’m just curious what other routine things are being skipped if your feet aren’t being checked.

It’s the nurse who checks my feet when she takes blood for the HbA1C. It’s not a big long process or anything but it happens every single time.

 

[EmmaL76]

Since diagnosis I’ve had one hba1c and kidney function blood test. Nothing else has ever been offered by my surgery. I have had 2 retinopathy eyes test so can’t grumble about that.

 

[ColinUK]

Since diagnosis I’ve had one hba1c and kidney function blood test. Nothing else has ever been offered by my surgery. I have had 2 retinopathy eyes test so can’t grumble about that.

HbA1C should be checked annually so maybe ask them to do it.