Diabetes and your feetDiabetes, a disorder of high glucose levels, can harm various organs of the body if it is uncontrolled or there is a lack of proper care and management. Long duration of uncontrolled glucose levels in the blood stream damages the nerves. This is known as peripheral neuropathy. It may also affect the blood vessels resulting in decreased or complete obstruction of the blood flow towards the extremities (feet). This is called peripheral arterial disease. Neuropathy and peripheral arterial disease either individually or together result in serious problems like non-healing ulcer, infections and even amputation.People with Diabetes often don't realise or know that they have problem until it becomes apparent. There are many factors which contribute to the increasing incidence of severe Diabetes related foot problems. Primary cause is lack of proper foot assessment and foot examination. An insensate foot is more prone to repeated trauma, abnormal sheer forces and pressures. Wounds, injuries, burns, sprains and even fractures may be painless which is the reason why they are neglected. Motor neuropathy leads to limited joint mobility and structural deformities, leading to abnormal plantar pressure and skin breakdown. Autonomic neuropathy leads to excessive dryness and fissures.If proper care is not taken, it may lead to major complications such as ulcers, disability and lower limb amputation. Around 15 per cent of people with Diabetes are at risk of developing foot ulcers in their lifetime of which 14 to 24 per cent require amputation..Importance of protective footwearProtective footwear is necessary for all people with Diabetes irrespective of whether there are complications or not. Wrong footwear is often worn as it is readily available. Examples of faulty footwear include slippers, chappals, footwear with nails on the soles, footwear which is too narrow or high-heeled. Such footwear should be avoided.When the person has neuropathy or loss of protective sensations in the feet, then they are vulnerable to foot ulcerations. Such individuals should be advised that only appropriate footwear will protect their feet. Size of the foot should be measured on a foot scale and then footwear should be bought rather than what feels well or looks well. As the neuropathy advances, the feet become deformed. When the foot shape changes or there is recurrent ulcers, tailor- made shoes are recommended to accommodate the deformities...Qualities of ideal footwearFootwear should be in the form of sandals or shoes.Use footwear both indoors and outdoors.Shoes should have a wide toe area to allow the free movements. They should accommodate the toes without causing pressure or compression.Inner length of the footwear should be 1 to 2 centimetres longer than the foot length (as measured from heel to the longest toe when the person is standing).It should have a strong heel counter to give sufficient stability.Smooth inner lining and tough but lightweight outsole is recommended to absorb the sheer force while walking.Footwear with Velcro straps should be used to adjust the shape of the foot and deformity, if any.Footwear should be purchased in the evening time when the foot size is larger due to swelling in the feet.Cotton socks should always be used with the footwear to avoid friction between the skin and the footwear as this friction could lead to foot problems. Wearing socks inside the footwear prevents the possibility of injury by 30 per cent. People with Diabetes should wear light coloured cotton socks rather than dark coloured or synthetic socks. Light coloured socks help in identifying any injury or bleeding. Socks should be washed every day. The elastic in the sock's rim should not be tight as it could restrict blood circulation and could lead to swelling. Nowadays seamless socks and medicated socks are available for people with foot problems.Visually inspect and manually feel inside all shoes before putting them on, to ensure that there are no foreign objects within or penetrating the footwear. Also check your feet each time the footwear is removed.Obtain footwear from an appropriately trained professional in case of deformity. .Avoid:Footwear with toe gripHigh heeled shoes or sandalsToo tight or too loose footwearNarrow or pointed footwearDo not wear shoes that are too tight or have rough edges or uneven seams. Avoid wearing footwear with metal parts or buckles or nailsFootwear purchased onlineNew footwear or sandal should not be worn for long hoursFootwear with inside stitching, nails or any metallic objects.Open-heel footwear can result in direct trauma injury to the heel and increase the risk of ulceration. Adequate closure of the footwear is needed, to prevent the foot from sliding forwards and thus causing injury to the toes or plantar foot. RememberPeople with intact protective sensation or with normal blood flow in feet can select properly fitting off-the-shelf foot wear. Custom-made foot wear or insoles are required for feet with deformity like high arch, low arch, flat foot, newly healed ulcer or amputation. Plantar pressure measurement helps in designing the footwear to equalise the pressure distribution. Off-loading footwear is extremely important in preventing recurrence of ulcer.After diagnosis of Diabetes, feet should be checked by a podiatrist every year. This will ensure problems, if any, are diagnosed at early and complications are avoided. Correct footwear is part and parcel of Diabetes care and should not be neglected. It is like a tailor-made garment worn on the feet to protect them. It is recommended to take help of the advanced technologies and professionals in the field of Diabetic foot and save your feet! Dr Shubhangi Tathare is an Associate Podiatrist
Diabetes and your feetDiabetes, a disorder of high glucose levels, can harm various organs of the body if it is uncontrolled or there is a lack of proper care and management. Long duration of uncontrolled glucose levels in the blood stream damages the nerves. This is known as peripheral neuropathy. It may also affect the blood vessels resulting in decreased or complete obstruction of the blood flow towards the extremities (feet). This is called peripheral arterial disease. Neuropathy and peripheral arterial disease either individually or together result in serious problems like non-healing ulcer, infections and even amputation.People with Diabetes often don't realise or know that they have problem until it becomes apparent. There are many factors which contribute to the increasing incidence of severe Diabetes related foot problems. Primary cause is lack of proper foot assessment and foot examination. An insensate foot is more prone to repeated trauma, abnormal sheer forces and pressures. Wounds, injuries, burns, sprains and even fractures may be painless which is the reason why they are neglected. Motor neuropathy leads to limited joint mobility and structural deformities, leading to abnormal plantar pressure and skin breakdown. Autonomic neuropathy leads to excessive dryness and fissures.If proper care is not taken, it may lead to major complications such as ulcers, disability and lower limb amputation. Around 15 per cent of people with Diabetes are at risk of developing foot ulcers in their lifetime of which 14 to 24 per cent require amputation..Importance of protective footwearProtective footwear is necessary for all people with Diabetes irrespective of whether there are complications or not. Wrong footwear is often worn as it is readily available. Examples of faulty footwear include slippers, chappals, footwear with nails on the soles, footwear which is too narrow or high-heeled. Such footwear should be avoided.When the person has neuropathy or loss of protective sensations in the feet, then they are vulnerable to foot ulcerations. Such individuals should be advised that only appropriate footwear will protect their feet. Size of the foot should be measured on a foot scale and then footwear should be bought rather than what feels well or looks well. As the neuropathy advances, the feet become deformed. When the foot shape changes or there is recurrent ulcers, tailor- made shoes are recommended to accommodate the deformities...Qualities of ideal footwearFootwear should be in the form of sandals or shoes.Use footwear both indoors and outdoors.Shoes should have a wide toe area to allow the free movements. They should accommodate the toes without causing pressure or compression.Inner length of the footwear should be 1 to 2 centimetres longer than the foot length (as measured from heel to the longest toe when the person is standing).It should have a strong heel counter to give sufficient stability.Smooth inner lining and tough but lightweight outsole is recommended to absorb the sheer force while walking.Footwear with Velcro straps should be used to adjust the shape of the foot and deformity, if any.Footwear should be purchased in the evening time when the foot size is larger due to swelling in the feet.Cotton socks should always be used with the footwear to avoid friction between the skin and the footwear as this friction could lead to foot problems. Wearing socks inside the footwear prevents the possibility of injury by 30 per cent. People with Diabetes should wear light coloured cotton socks rather than dark coloured or synthetic socks. Light coloured socks help in identifying any injury or bleeding. Socks should be washed every day. The elastic in the sock's rim should not be tight as it could restrict blood circulation and could lead to swelling. Nowadays seamless socks and medicated socks are available for people with foot problems.Visually inspect and manually feel inside all shoes before putting them on, to ensure that there are no foreign objects within or penetrating the footwear. Also check your feet each time the footwear is removed.Obtain footwear from an appropriately trained professional in case of deformity. .Avoid:Footwear with toe gripHigh heeled shoes or sandalsToo tight or too loose footwearNarrow or pointed footwearDo not wear shoes that are too tight or have rough edges or uneven seams. Avoid wearing footwear with metal parts or buckles or nailsFootwear purchased onlineNew footwear or sandal should not be worn for long hoursFootwear with inside stitching, nails or any metallic objects.Open-heel footwear can result in direct trauma injury to the heel and increase the risk of ulceration. Adequate closure of the footwear is needed, to prevent the foot from sliding forwards and thus causing injury to the toes or plantar foot. RememberPeople with intact protective sensation or with normal blood flow in feet can select properly fitting off-the-shelf foot wear. Custom-made foot wear or insoles are required for feet with deformity like high arch, low arch, flat foot, newly healed ulcer or amputation. Plantar pressure measurement helps in designing the footwear to equalise the pressure distribution. Off-loading footwear is extremely important in preventing recurrence of ulcer.After diagnosis of Diabetes, feet should be checked by a podiatrist every year. This will ensure problems, if any, are diagnosed at early and complications are avoided. Correct footwear is part and parcel of Diabetes care and should not be neglected. It is like a tailor-made garment worn on the feet to protect them. It is recommended to take help of the advanced technologies and professionals in the field of Diabetic foot and save your feet! Dr Shubhangi Tathare is an Associate Podiatrist
