Dr Arun Bal explains the importance of foot care and highlights why you should not dismiss caring for your feet.
Diabetes and your feet
Diabetes, a disorder of high blood sugar levels, can harm various organs of the body if it is uncontrolled or there is a lack of proper care management. A long duration of uncontrolled sugar levels in the bloodstream damages the nerves. This is known as peripheral neuropathy. It affects the blood vessels resulting in decreased or complete obstruction of the blood flow towards the extremities (feet). This is called peripheral arterial disease.
The foot is an often ignored organ in Diabetes management. Also generally, the foot does not have the care/attention as other organs like the heart, eyes and kidneys. Though feet are the second-most hard-working organ after the heart, they often do not get that required attention.
Diabetes and foot infections
The degree of neuropathy determines the severity of diabetic foot infections. Neuropathy causes numbness or weakness in the peripheral nerves. The reduced sensation in the feet may lead to lack of care. Injuries to the feet may be ignored thereby increasing the risk of infection.
The long duration of Diabetes and poor blood sugar control is a major risk factor for the development of diabetic peripheral neuropathy. Peripheral neuropathy results in weakness, structural changes in the foot also referred to as deformity, walking imbalance and autonomic nerve damage resulting in dryness, cracks, and decreased blood flow towards the foot resulting in major problems.
People with neuropathy either complain of pain or they stay non-responsive either due to complete loss of sensation or negligence. They have symptoms like numbness or cotton and wool sensation in the feet. Some individuals present painful symptoms like burning, pricking, discomfort evoked by a bedsheet and electric shock-like pain often with disturbed sleep.
Diabetic foot ulcer
A diabetic foot ulcer is a silent, innocuous onset disease due to diabetic neuropathy. There are many factors which contribute to its increasing incidence and severity. The primary cause is a lack of proper annual foot assessment and foot examination of people with Diabetes. The foot is still not a target organ in Diabetes organ management. Ulcers are detected late when they are infected.
The occurrence of a foot ulcer is an economic burden on the family as well as society. On average, people with a diabetic foot infection spend 50 per cent of their annual income on medical treatment. Mortality due to diabetic foot infection ranks third in the list of diseases of high mortality after lung and pancreatic cancer. So it is a serious problem and we need to tackle it on a war footing.
Take the pressure off, literally!
It is important – for any person with a foot wound – to follow good wound care practice like offloading (relieving weight from the wound site). Wound care with advanced dressing products is also helpful. It is well known that people with diabetic foot ulcers need to rest their feet. This is because putting pressure on the foot by walking can cause ulcers to deepen, be infected and further complicated.
The latest guideline from the Journal of the American Podiatric Association strongly emphasises the importance of offloading in healing diabetic foot ulcers. The guideline also suggests that for offloading, certain plaster-like casts of the foot called total contact casts, which can be removed only under medical supervision, are ideal. Taking the pressure away from the feet, using these offloading techniques, can lead to rapid healing of foot ulcers.
Management of diabetic foot
There are different components of diabetic foot management. The most important among these is improving circulation in the foot and the leg with the help of angioplasty, like that of heart. Now with modern technology, even the smallest vessel in the foot can be opened. This helps in preventing amputations.
Also, newer methods of wound healing like growth factor dressings, vacuum-assisted closure of the wounds, skin substitutes and hyperbaric oxygen therapy are useful. This can help to save the limbs by healing the most difficult wounds. Modern concepts of diabetic foot surgery involve the reconstruction of destroyed tissue. Similarly, peripheral vascular bypass using synthetic grafts to improve blood circulation is also possible.
Poor foot care results in nerve and blood vessel damage, foot deformity and non-healing of the wounds that may even lead to amputation. In case of infection, consult a doctor as treatment may require oral antibiotics or intravenous injections. People with Diabetes can have healthy feet with blood sugar control and by taking habitual good care of the feet.