Podiatry for the diabetic foot in Barcelona

What warning signs does the diabetic foot have?

In the foot with diabetes, the skin is watched daily and local signs of infection and ulcer are looked for.

• Skin of the foot: Canal Salut says that in the daily check you should watch that the skin is not purple and that there is no hard skin, cracks, blisters or wounds.³
• Local signs of infection: the Ministerio de Sanidad lists swelling or induration, redness, increased tenderness or pain, increased temperature and purulent discharge (pus).²
• Ulcer: the IWGDF guideline asks you to contact a trained healthcare professional as soon as possible if you have or suspect a lesion or ulcer.¹

If you have diabetes, these are the criteria for seeking advice:

• Wound or ulcer on the foot: MedlinePlus says to contact the healthcare professional if there is an open ulcer or sore on the foot.⁴
• Active problem in the foot with diabetes: MedlinePlus asks you to seek advice immediately if you notice a cut, blister or bruise that does not start to heal within a few days, red, warm or sore skin on the feet, or a callus with dried blood inside.⁵
• Foot with diabetes and serious risk: a foot infection that turns black and smells bad could be gangrene, and MedlinePlus asks you to seek advice immediately.⁵

Loss of protective sensation is not treated as an isolated symptom: it appears as a finding looked for in screening that defines the level of risk.² That is why having no symptoms is not the same as having no risk: the guideline recommends a check every year even for a person at very low risk, to detect signs or symptoms of peripheral neuropathy and peripheral arterial disease.¹

If you fear not noticing a problem because you do not feel your foot well, the guideline says the person at risk should examine their feet every day.¹

What does the diabetic foot check involve and how often is it done?

The diabetic foot check combines the daily inspection that you do and the periodic examination by a professional, with a frequency that rises when the risk is higher.¹²

The general content of care is this. For moderate or high risk, the IWGDF guideline includes integrated foot care with, at least, professional foot care, suitable footwear and structured education.¹ That same guideline indicates daily examination of the feet by the person at risk.¹

There are different risk scales and it is best not to mix them.

• IWGDF guideline scale: in people with loss of protective sensation or peripheral arterial disease, extended screening is repeated every 6 to 12 months at risk 1, every 3 to 6 months at risk 2 and every 1 to 3 months at risk 3.¹ For integrated care, the repeat interval is every 1 to 3 months at high risk and every 3 to 6 at moderate risk.¹
• Ministerio de Sanidad scale: it classifies risk from 0 to 3, with annual inspection at risk 0, half-yearly at 1, every 3 to 6 months at 2 and every 1 to 3 months at 3.²
• Canal Salut groups: it is its own classification, of groups 1 to 6, with 0, 2, 3, 4, 4 and 9 podiatrist visits a year, respectively, and the level of risk can change during follow-up.³

Who does what: screening is done by primary care professionals, and the podiatrist sees the person when they are referred according to their risk group.³ The sources cited do not detail the step-by-step of the visit or its drawbacks.

When should you seek urgent care?

Contact a trained healthcare professional as soon as possible if you have or suspect a lesion or an ulcer on the foot with diabetes.¹

1. Wound, ulcer or suspected lesion: the IWGDF guideline says to contact a trained healthcare professional as soon as possible.¹
2. What to watch for in the daily check: purple colour, cracks, blisters, hard skin or wounds.³
3. Signs of infection: swelling or induration, redness, increased pain or tenderness, increased temperature or purulent discharge.²

If you have the signs that MedlinePlus lists for the diabetic foot, seek advice immediately.⁵ This information does not replace a consultation with a healthcare professional, who is the one who assesses your case. The sources cited do not set a time limit or distinguish between emergencies and appointments.

If you have none of these signs, the periodic checks follow their schedule according to your level of risk.¹