There were 415 million diabetics worldwide last year and the number is expected to touch 642 million by the year 2040 according to the International Diabetes Federation. The estimated life-time risk of a person with diabetes developing a foot ulcer is 25 per cent. Every 30 seconds, a leg is lost to diabetes somewhere in the world.
Every diabetic patient should have his/her feet examined for risk assessment and adequate steps should be taken to prevent them from developing a foot ulcer. In a good number of cases with foot ulcers, a scientific approach to healing can prevent amputations. The social, psychological and financial consequences of diabetic foot are immense. Remember, prevention is always better than cure.
How do the Feet get affected in diabetes?
Diabetes affects the nerves of the leg. Initially the patient experiences pricking pain but with time the pain disappears and the feet becomes insensate. If there is a minor trauma the patient may not realise it until it’s too late.
The skin gets dry, dark, hard and is accompanied by itching. The nails of a diabetic also get brittle and often has fungal infection which can take months to treat.
The excess glucose in the body of a diabetic combines with certain proteins and gets deposited on the tendons and ligaments of the foot which leads to structural changes to the foot. The feet change their shape leading to abnormal looking toes leading to high pressure points which leads to a callus and can breakdown to form an ulcer. The bones of the feet become weak and lead to fractures which are called Charcot’s Foot. Here, the bones lose their strength and gets fractured. With time, the foot turns into nothing more than a bag of bones.
The blood supply to the legs are decreased in most diabetic patients, particularly in smokers, non-exercisers, hypertensive and those with high cholesterol levels it can cause pain to the legs while walking. As the disease progresses, pain is there even at rest. Such patients are at high risk for gangrene and major amputations.
How can we prevent foot problems?
The at-risk foot can be detected years before the actual ulcer occurs. Tests like ABI (Ankle brachial index) shows the amount of blood supply to the leg. Biothesiometry (VPT) can quantify neuropathy (damage to nerves). Pedopodogram is an instrument that shows the high pressure points and abnormal plantar pressures of the feet. At the earliest stage, the risk can be reduced by good metabolic control and appropriately designed footwear which helps decrease and re-distribute abnormal plantar pressures. The insole (inside of the footwear) and outsole (the external part on the base) have to be designed with certain properties. Sometimes the footwear has to be customised to the patient. Certain drugs help decrease the neuropathic pain and improve nerve function and blood supply.
Evolution has taken the feet farther away from the eyes. Take care of your feet as carefully as you take care of your face. Ten important care tips are given below. One needs to maintain excellent blood sugar, BP and cholesterol control. Quit smoking. Get your feet checked every time you see your doctor. Proper tests can quantify your risk. The footwear of a diabetic patient needs to do what the feet fails to do.
• Check your feet every night before going to bed. Look for cuts, red spots, swelling or blisters. Inspect between the toes for whitish areas. If you have trouble inspecting the feet, use a mirror. Consult your doctor if you find anything abnormal.
• Wash your feet every day with lukewarm water. Check the heat of the water with your elbow and not your feet. Keep the area between the toes dry.
• Apply moisturising lotion on your legs and feet but not between the toes.
• Wear appropriate footwear at all times. Do not walk barefoot even indoors. Use white cotton socks (not tight).
• Always inspect your footwear before wearing it. Make sure there are no pebbles or sharp particles in it.
• Do not keep your feet close to hot objects (radiator, fire, hot water).
•Avoid vigorous massage of the legs with pain balms or oils. Avoid hot fomentation.
• Do not sit cross legged for lengthy periods of time.
• Don’t wear tight footwear or those with narrow toe boxes or high heels. It’s preferable to purchase your footwear in the evening when the feet is slightly larger.
• If you have neuropathy and are planning an exercise programme you need to do your exercise (walking) with frequent short breaks. Always wear good protective athletic shoes that fit well. Wiggle your toes for five minutes two to three times a day.
• Move your ankles up, down, in and out to improve blood flow to your legs.
Dr. Praveen Jeyapathy M.D(Rom), M.Sc (DDFS), PGDFM International Medical Centre – Apollo Sugar Clinic