Therapeutic pedicure in Coimbra
Diabetic foot and at-risk foot in Coimbra
Diabetic foot and at-risk foot
With diabetes, and other conditions that affect circulation or sensation, the feet need monitoring even without complaints — because the problem is often that you stop feeling. The appointment is there to see what you cannot feel and to treat safely what would be a risk at home.
What it is
An at-risk foot is one that, because of a disease, is more likely to develop wounds, infections and complications. The best-known example is the diabetic foot: over the years, diabetes can damage the nerves of the feet (neuropathy) and the arteries of the legs (peripheral arterial disease), and weaken the response to infection.
With neuropathy, protective sensation is lost: a tight shoe, a stone, a burn or a corn injuring the skin no longer hurt, and the injury is only discovered late. With poor circulation, wounds heal badly. Together they explain why a small wound on the foot of a person with diabetes can become an ulcer and, in severe cases, lead to amputation — and why most of these situations can be prevented with monitoring and regular care.
People with peripheral arterial disease without diabetes, kidney failure, rheumatoid arthritis, neurological disease, older age with difficulty seeing or reaching the feet, and anyone who has had an ulcer or amputation also have at-risk feet.
Signs and symptoms
- Tingling, numbness, a “cotton-wool feet” or pins-and-needles feeling, especially at night.
- Loss of the sensation of pain, temperature or touch in the feet.
- Dry, thin, shiny, hairless or cold skin; thick nails.
- Leg pain when walking that eases on stopping (claudication), or foot pain at rest.
- Corns, blisters or small wounds that do not hurt and that you find by chance.
- Foot deformities (claw toes, bony prominences) and redness over pressure areas.
Most common causes
- Diabetes that is poorly controlled or of many years’ duration: neuropathy and poor circulation.
- Smoking, high blood pressure and high cholesterol, which worsen arterial disease.
- Unsuitable footwear on a foot that no longer feels.
- Poorly managed calluses and nails, which injure the skin underneath.
- Cuts, burns (hot-water bottles, heaters) and walking barefoot.
- Difficulty seeing or reaching the feet to inspect them.
How it is treated
The diabetic foot appointment begins with a risk assessment: testing sensation with a monofilament and tuning fork, feeling the pulses and examining circulation, skin, nails, deformities and footwear. This gives a risk classification that sets how often the feet should be checked — from once a year for a foot with no changes to every 1 to 3 months for a high-risk foot — in line with the guidance of Portugal’s Directorate-General of Health and the International Working Group on the Diabetic Foot (IWGDF).
Then whatever is needed is treated: safe nail cutting, callus debridement (on an insensitive foot, calluses are frequently where ulcers start), moisturising, treatment of small lesions and protection of pressure areas. All with technique and materials suited to a foot that must not be injured.
The most important part is education: learning to inspect the feet every day, choosing shoes and socks, knowing what never to do and recognising the warning signs. This care complements — it does not replace — follow-up by your GP, endocrinologist or hospital diabetic-foot clinic, with whom we liaise whenever there is a wound or signs of infection.
What happens at the appointment
- 1Risk assessment: sensation (monofilament), circulation (pulses), skin, nails, deformities and footwear.
- 2Safe technical nail cutting and callus debridement.
- 3Treatment of small lesions and protection of pressure areas; dressing when needed.
- 4Teaching of daily care and what to avoid; footwear and sock advice.
- 5Monitoring plan according to risk (yearly to monthly) and liaison with your doctor when necessary.
What you can do at home
- Check your feet every day — soles, toes and between the toes — for wounds, blisters, redness or colour changes; use a mirror or ask for help if you cannot.
- Wash with warm water (test the temperature with your elbow or a thermometer) and dry well, especially between the toes; moisturise, but not between the toes.
- Never walk barefoot, not even at home; always wear socks with shoes and check inside your shoes before putting them on.
- Do not use hot-water bottles, heaters or electric blankets on your feet.
- Do not cut corns or use corn plasters; cut nails straight across or leave cutting for the appointment.
- Closed, wide, soft shoes with no inner seams; buy shoes at the end of the day and break them in a little at a time.
- Control of blood sugar, blood pressure and cholesterol, and not smoking, are the measures that protect the feet most.
When not to wait
Book without delay — or see a doctor — if you notice any of these signs:
- Any wound, blister or crack on the foot — even painless — that does not close within a few days.
- Redness, warmth, swelling, pus or an unpleasant smell; dark or black skin anywhere on the foot.
- New pain in a usually insensitive foot, or a foot that becomes cold, pale or bluish.
- Fever or feeling unwell together with a foot lesion. In these cases, see a doctor or go to the emergency department the same day.
Frequently asked questions
I have no complaints. Do I really need an appointment?+
Yes. The danger of the diabetic foot is precisely that it does not hurt. A yearly risk assessment is recommended for everyone with diabetes, and it is what tells you whether once a year is enough or whether your feet need checking more often.
How often should I come?+
It depends on the risk found at the assessment: once a year if there is no loss of sensation or circulation change; every 3 to 6 months if there is neuropathy; every 1 to 3 months if there is neuropathy with deformities, poor circulation or a history of ulcer.
Can I have a normal pedicure?+
On an at-risk foot, care should be given by a health professional trained in diabetic foot, with sterilised instruments and a technique that does not injure the skin. Avoid cosmetic pedicures with blades, aggressive cuticle work and very hot foot baths.
Does this appointment replace my doctor?+
No: it complements it. Your GP or endocrinologist manages the diabetes; here the feet are cared for and the warning signs monitored. If a wound or infection appears, we liaise with your doctor or direct you to the hospital diabetic-foot clinic.
This information is general and meant to help you understand the problem. It does not replace an individual assessment or medical follow-up. If in doubt, book an appointment. Content reviewed by Priscila Arantes, registered nurse (Ordem dos Enfermeiros no. 117508).
Other problems we treat
Wounds and dressings
A wound on the foot has body weight, shoes and, often, circulation that is no longer at its best working against it. Healing well depends on cleaning, protecting and relieving pressure — and on seeing the wound at the right intervals.
Learn more →Corns and calluses
Debridement takes the pain away the same day. What stops the corn coming back is understanding where the pressure comes from — and that is what the appointment assesses.
Learn more →Cracked heels and fissures
Cracks start as dry skin and end up as splits that hurt and bleed. The skin is treated and, more importantly, whatever is drying it out and splitting it is corrected.
Learn more →Ingrown toenail · Nail fungus · Plantar wart · Thick or deformed nails