Nick Howsam, Podiatrist and Chiropodist, 23rd April

Nick Howsam, Podiatrist and Chiropodist, 23rd April


Nicolas J. Howsam MChS
BSc (Hons) Pod, BSc (Hons), PG Dip
Podiatrist & Chiropodist
HCPC Registered


Because of his extensive knowledge and understanding of the needs of foot care for diabetics Nick has become a regular and much appreciated speaker to the Group, and though a fully qualified podiatrist with many years of NHS practise Nick now works as an independent providing his services as home visits.

For this talk Nick focussed on the reasons why diabetics have foot problems and their treatment and prevention. Starting with the structure of the foot he illustrated its complexity by noting it has 26 bones, 33 joints (20 actively articulating) and over 100 muscles, tendons and ligaments, and since a good blood supply is critical to their function this is easily compromised in diabetics. Considering also the pressures on the foot (the ‘average’ human takes 3 to 3.5 million steps each year) it is vitally important for diabetics to be regularly checked for vascular disease, peripheral neuropathy (loss of feeling) and infections to reduce their risk of serious damage.

Vascular disease can be caused by high blood pressure, high blood sugar and high LDL cholesterol levels, with excess sugar causing a stiffening of the arteries and fatty plaque build up. The podiatrist will thus check the main artery (dorsalis pedis) on top of the foot with ultrasound and also look at the integrity of the skin (symptoms of the disease showing as pale or purple colouration), the condition of nails (nails will become thicker) and temperature gradient (cool to cold if diseased), whether or not all hairs are absent from the toes and another clue is cramping in the calves.

Peripheral neuropathy (damage to nerves) is looked for by sensation testing and shows as reduced or loss of sensation, or neuropathic pain, which may be expressed as numbness, tingling, pins and needles or a burning sensation. Damage to the autonomic nervous system affects the sweat glands causing dry skin – and a dry skin is a weak skin causing reduced protection. Hence the need to use urea-based creams that prevent water loss and promote rehydration.

Motor neuropathy causes changes to the bone architecture and nerve supply to the muscles resulting in limited joint motion or even joint deformity.

Infections mostly occur through the loss of feeling allowing callus to form or other damage that causes ulcers. Also of course with high sugar levels infections are more likely as bacteria thrive on sugar. Points to look out for are redness of the skin, swelling, heat, pain and loss of function. Thus wearing good foot-ware is essential to good care but feet are very individual thus shoes should not be a tight fit, but be supportive, have a good fastening (to stop chaffing) and a good heel cup. They should also be long enough and deep enough to cover any deformities.

General recommendations:

            Check feet daily and look for: colour changes to the skin; any breaks in the skin; discharges of blood or pus; soreness or redness.

            Protect and prevent problems by: using an aqueous cream (or a cream containing at least 10% urea); managing blood sugars (remembering that exercise increases the body’s sensitivity to insulin) and wear good supportive foot-ware.

Nick Howsam can be contacted via his mobile ‘phone on 07717 124 907