Pamper Your Feet

Did You Know?• Nearly 1 in 4 people with Diabetes may develop a foot ulcer.• More than half of all foot ulcers (wounds) may become infected, requiring hospitalisation.• Almost 20 per cent of infections may result in surgical removal of the toe and foot (amputation).• After a major amputation, 1 in 2 people may have their other limb amputated within two years.• The relative 5-year death rate after limb amputation is 68 per cent..A case studyA 70-year-old gentleman who had Type 2 Diabetes for 30 years was admitted to a multispecialty hospital. He had an infection on his left foot and his big toe had blackish discolouration. The infection had started after a blunt injury to the left big toe a week ago. He had a fever for 2 days before presenting to the hospital. He delayed seeking medical attention for his foot problem for a week due to the ongoing COVID-19 pandemic. He also had other medical conditions like hypertension (high blood pressure) and ischemic heart disease.During the foot examination, his left foot pulse was undetected, hinting towards reduced blood supply. His left big toe was infected and was gangrenous (gangrene is a complete death of the part due to decreased blood flow). His foot and limb were cold to touch (cold limb indicates reduced blood flow). The foot X-ray was normal and the ultrasound (an imaging test that helps in detecting abnormalities in any part of the body) of the foot showed changes of cellulitis (infection of the skin). His arterial doppler test of the limb (to detect the status of blood flow) showed a reduced blood flow in the left lower limb with no blood flow in the main blood vessel supplying blood to the foot. His blood test including random blood sugar level showed a very high blood sugar level of 407 mg/dL and his white blood cell count was elevated indicating infection in the blood.He was started on a higher level of intravenous (IV) antibiotics and an antiplatelet (a medicine to improve the blood flow). His foot condition was bad and the need for a below-knee amputation was explained to the relatives. The patient and his family members were reluctant to proceed with this surgical option thus the medical management was continued. But the next day, his condition started deteriorating with abnormal vital signs (an essential body function which includes temperature, blood pressure, heart rate and breathing rate). Seeing his deteriorating condition, his relatives finally consented toa below-knee amputation. Post-surgery, he was shifted to the Intensive Care Unit (ICU) and he continued to show signs of sepsis which was treated with higher antibiotics. The next day, his white blood cell count slightly dropped with continued on and off fever spike. His amputated stump was healthy. After 3 days, his condition improved well.He was discharged with advice to continue antibiotics, antiplatelet therapy and regular follow-up at an out-patient clinic for dressing.Key message: People with Diabetes who are known to have poor blood flow to the feet are at higher risk of developing gangrene. Regular foot examination for people with Diabetes is necessary as this may help in early diagnosis and management of foot problems. especially in those with poor blood flow (peripheral arterial disease) and nerve damage (peripheral neuropathy). It is imperative to have your nerves and blood flow tested on an annual basis. This simple checking helps avoid major foot problems.Diabetes complicationsDiabetes refers to a group of disorders that affect how the body uses blood glucose, commonly called blood sugar. Glucose is vital for our health because it's an important source of energy for the cells that make up our muscles and tissues. It is also our brain's main source of fuel.The glucose in the blood is processed by a hormone secreted by the pancreas called insulin. When food is consumed, carbohydrates are released which get converted into glucose. This glucose is processed by insulin to provide energy to the body. If insulin secretion is impaired or completely absent, the glucose gets deposited in the system, leading to Diabetes or high blood sugar levels.High blood sugar levels give rise to various microvascular complications (affect small blood vessels, creating problems with the eyes, foot, and kidneys). In addition, people with Diabetes may also develop macrovascular (affecting the larger blood vessels taking a toll on the heart, legs and brain) complications.Diabetes and your feetOver time, high blood sugar levels lead to nerve damage also called peripheral neuropathy, resulting in decreased sensation in the feet. Most of the time, a person presents to the physician's office with an increasingly troublesome burning .on the feet. It's the pain that forces the person to visit the hospital.Nerve damage causes the skin to become dry leading to cracks that become an entry point for infection. Loss of sensation takes away the ability to feel the ground while walking and endangers the person, increasing the occurrence of accidental falls and injuries. Small and easily treatable injuries or wounds get overlooked until they become deep and difficult to treat because the person does not feel the pain.blood supply also called peripheral arterial disease that reduces the healing time of an experience loss of injury or a wound. An injury or a wound in an ischemic (reduced blood flow) limb can lead to gangrene of the toes or foot that may end up in amputation.People with Diabetes may develop foot problems including:• Foot ulcers (open wound)• Calluses (hardened of skin)• Athletes foot (fungal infection that usually begins between the toes)• Bunions (bony bumps that form on the joint of the big toe towards the medial part)• Blisters• Corns• Ingrown toenails (nail grows into your skin instead of over it)• Charcot foot (deformity in the foot)Peripheral neuropathy(nerve damage)The American Diabetes Association states that roughly half of all people with Diabetes and people with have some form of nerve damage.Peripheral neuropathy (Nerve damage in the feet) is the most common problem among Major risk factors include a longer duration of Diabetes and poor blood sugar control. Diabetic peripheral neuropathy affects nerves responsible for various types of sensation. People with sensory neuropathy either complain of pain or suffer a complete loss of sensation. People with peripheral neuropathy may have symptoms of:• Numbness or a 'cotton and wool' sensation in the feet• Loss of feeling• Burning• Pricking• Tingling• Discomfort• Electric shock-like pain• Hypersensitivity to touchNeuropathy not only affects sensation but also affects muscle functioning resulting in structural deformity of toes and foot. Many times, people may have difficulty in gripping the footwear or may not even realise that the footwear has slipped off from the foot while walking. Imbalance andDiabetic foot ulcer or infection (DFU or DFl) is one of the most common, serious and costly complications of Diabetes. Theonset of DFU is not sudden, it initially starts with a small cut or a wound that may go unnoticed due to loss of feeling. Theperson continuously walks with the wound resulting in infection which often requires surgical intervention. In addition, a person may develop foot ulcer or infection due to:• Foreign body injuries that result in a wound/infection• Thermal injury - skin injuries caused due to exposure to heat or cold• High-pressure points resulting in calluses due to structural deformities• Changes in the walking cycle• Frictional Injury due to ill-fitting footwear Once the skin breaks down it becomes aneasy target for the bacteria. Pus and infection may sometimes spread upwards from the foot. DFU management requires proper antibiotic therapy to control the infection, wound care management via regular dressing of the wound and rest to the affected limb. The symptoms to look for include:• Persistent pain• Redness• Swelling of the feet or legs• Localised warmth• Drainage of pus from a wound• Fever or chillsFungal infections between the toes are common in people with Diabetes, this develops due to excessive moisture trapped between the toes either due to excessive sweating or when exposed to water in the feet. Keeping the webspace dry always helps prevent fungal growth. Many people with Diabetes have a combination of bacterial and fungal infections.Foot infections, if not treated in time, can gradually spread to the entire body and the person starts developing multiple organ failure and septicaemia (infection in the blood).Charcot neuroarthropathy (CN)People with peripheral neuropathy can develop a condition called Charcot's footthat affects the bones, joints, and soft tissues of the foot and ankle. In the early stages, the foot is swollen, red in appearance and hot while palpation. At a later stage, there may be deformity of the foot giving an appearance of a rocker bottom foot (collapsed arch).The early stage of Charcot foot presents with:• Swelling• Redness on the skin• Mild to moderate pain• Warm to touch as compared to the contralateral limbThe temperature difference of 2° C or more between both the foot indicates the presence of Charcot foot. This is usually measured using a special device called a laser infrared thermometer. They also require other tests such as an X-ray, a nuclear scan or MRI.The most important aspect in the medical treatment of

Pamper Your Feet

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