The Diabetic Foot Epidemic

Dr David G. Armstrong discusses with Dr Anjali Bhatt ways to nip foot related problems in the bud!
woman massaging her foot
woman massaging her foot

Dr David G. Armstrong is renowned worldwide for his work in wound healing, amputation prevention, and the diabetic foot. Throughout his distinguished career, Dr Armstrong has contributed to most foundational works in the taxonomy, classification, and treatment of the diabetic foot. He helped launch the Diabetic Foot Global Conference (DFCon), which is the largest annual diabetic foot gathering in the world, hosting delegates from 50 countries. Dr Armstrong serves as Professor of Surgery and Director of the Southern Arizona Limb Salvage Alliance (SALSA) at the University of Arizona.

Diabetes in India

India has the dubious distinction of being labelled the 'Diabetes Capital of the World'. There are currently about 68 million people with Diabetes Mellitus in India. 50 per cent of people who have Diabetes in India remain undiagnosed bringing Diabetes related deaths in India each year to over 1 Million. Around 30 million people are prediabetic in India. This results in an enormous socio-economic burden not only on the affected population but also on the society at large. Diabetes is not a disease of only the developed world. Four out of five people who have Diabetes and are going to die by this non-communicable disease live in the developing world.

Diabetes and foot complications

With Diabetes the most common reason that people are admitted in a hospital is not a heart attack, stroke or high blood pressure. It is due to a foot complication. The reason is that these problems are frequently silent. People with Diabetes develop neuropathy– nerve damage resulting in loss of sensation

The reason that diabetic foot ulcers develop is that people with diabetes lose the 'gift of pain [a phrase coined by Dr Armstrong's mentor the world-renowned orthopaedic specialist Dr Paul Brand (1914–2003)]. The condition arises because diabetics typically undergo prolonged exposure to high blood sugar. High blood sugar and the narrowing of blood vessels affects the blood flow. This can then cause nerve damage known as peripheral neuropathy, which can lead to a loss of feeling in the feet. They have a 'hole' in their foot like they would have a 'hole' in their sock. That hole is an ulcer that leads to inflammation and further damages the foot. The ulcer becomes infected frequently and can lead to amputation. Approximately, 20 per cent of those infections lead to an amputation.

Need for trained medical personnel

A common problem that exists is that many physicians and surgeons during their formative years of training never get exposed to the complications affecting the extremity of the body. At most a day or two is spent on the extremity such as the foot. This is because there are too many other complications associated with Diabetes that affect major organs such as kidneys, eyes, etc. The end of the body is often regarded as the least important thing.

Foot related problems often have silent symptoms at first. When a patient has a medical emergency the issue with the silent symptoms is not deemed sufficient priority and is often missed in the early stages. The doctor is going to treat it differently from acute symptoms as well. Here the absence of symptoms is a problem. Like silent heart attacks, people with Diabetes also have silent foot attacks. Minor symptoms which start early, often neglected by doctors and patients, need to be highlighted early for better outcome.

A podiatry department is an essential addition to every Diabetes care centre. Podiatry is the science of treating abnormal feet. A podiatrist is a doctor of podiatric medicine (DPM). Podiatrists diagnose and treat conditions of the foot, ankle, and related structures of the leg. People with Diabetes must consult a podiatrist annually, as chronic wounds require specialized podiatry care. Exposure of pre-existing calluses, corns, bruises, cuts and wounds to the advent of fungus, bacteria and other infections increases the risk of infection.

Nip it in the bud

There is a very easy way people with Diabetes can ensure that their feet remain problem free. All you have to do every day is remove your foot wear and look at your feet every day. If you can't look at your feet or see your feet then have someone in your family help you. This way you would notice any problem early which can be identified if something is different than it was yesterday (especially a wound, ingrown nail, a callus). A callus for a person with Diabetes and neuropathy is as indicative as a breast lump is for breast cancer. This simple test does not need the expertise of a nurse or a doctor. All you need to do is look at your feet every day. This little thing makes an enormous difference as it helps save legs and keeps people alive longer.


In spite of diabetic foot complications being easily avoidable, millions of people continue to be afflicted by diabetic foot complications every year. People spend time in hospitals for treatments and often become permanently disabled when one of their limbs has to be amputated. It is essential to not only maintain a good blood sugar control but also to ensure that foot checkups become an important part of your annual check up.

Prevention is always better than cure. Poor foot care results in nerve and blood vessel damage, foot deformity and non-healing 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 good glucose control along with habitual tender, loving care.

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