The Hindu : Tamil Nadu News : Diabetic Foot

Online edition of India's National Newspaper
Wednesday, Nov 14, 2007
ePaper

Tamil Nadu

Tamil Nadu

Diabetic Foot

Diabetes is a disease characterised by inappropriately high blood sugar level resulting from either low levels of the insulin secretion or from resistance to insulin. It damages organs like kidneys, eyes, blood vessels, nerves and impairs the immune system of the body. It was over 110 years ago that PRYCE, a surgeon working in England, recognised the connection between diabetes and foot ulcer.

Long-standing or poorly controlled diabetes cause damage to the nerves in the feet, the medical term for which is diabetic peripheral neuropathy. Normal sweat secretion and oil production that lubricates the skin of the foot are impaired due to diabetes.

This leads to abnormal pressure on the skin, bones and joints of the foot during walking and can lead to breakdown of the skin. This condition also leads to not being able to feel minor injury to the feet. Symptoms like numbness, burning pain, pins and needle sensation, slipping of chapels, cotton wool appearance of the floor may be experienced. Poorly fitting shoes lead to red spots, sore spots, blisters and calluses. Foot abnormalities such as flat feet, hammer toes add to the problem. Poor circulation due to atherosclerosis (clogging of blood vessels and reduced blood flow to the foot) leads to impaired wound healing. This can be aggravated by smoking.

If the wounds or ulcers in the foot or legs become infected, they cause serious problems. The immune system, which is already impaired due to diabetes can not fight against the infection.

Severe infections can be life threatening and necessitate amputations. Approximately 40-72% of all foot or leg amputations are related to diabetes. Amputation is 15 times more likely in diabetic patients.

Self-Care at Home:

1) Regular foot examination: Examine your feet daily and also after any trauma. Use a water-based moisturizer every day (but not between your toes) to prevent dry skin and cracking. Wear cotton or wool socks. Avoid tight fitting elastic socks and hosiery because they may impair circulation.

2)Toe-nail trimming: Always cut your nails with a safety clipper, never a scissors. Cut them straight across and leave plenty of room out from the nail bed.

If you have difficulty with your vision or using your hands, let your doctor do it for you or train a family member to do it safely. If you have ingrown toe nails, consult your doctor.

3) Footwear: If you have flat feet, bunions, or hammer toes, you may need prescription shoes or shoe inserts. Do be sure your shoes fit properly.

4) Exercise: Regular exercise will improve bone and joint health and improve circulation to your legs and also stabilize your blood sugar levels.

5) Smoking: If you are smoker, it leads to poor blood circulation. So quit smoking.

Medical Treatment:

Treatment plans may include surgical debridement (removal of dead, damaged and infected tissue) of your wound, improvement of circulation through surgery or therapy, wound care and dressings and monitoring of your blood sugar. If your doctor determines that a wound or ulcer on your feet or legs is infected, antibiotics will be prescribed to treat the infection.

It is very important that you take the entire course of antibiotics as prescribed. For limb- or life-threatening infections, you will be admitted to the hospital and given intravenous antibiotics.

Referral to a podiatrist (specialist in foot disorders) or orthopaedics surgeon might be required if you have bone-related problems, corns and calluses, bunions, heel spurs, arthritis or have difficulty with finding shoes that fit. They create shoe inserts, prescribe appropriate shoes, remove calluses and have expertise in surgical solutions for bone problems.

Following a reasonable diet, taking your medications, checking your blood sugar regularly, exercising regularly and maintaining good communication with your physician are essential in keeping your diabetes under control. Yearly foot examinations with podioscan to see pressure points, biothesimeter to assess sensation and Doppler study to assess blood circulation is useful in preventing foot ulcers.

Dr.A.Arunagiri MD, PGDHS [Diabetes],

Consultant Physician And Diabetologist,Shifa Hospital,Tirunelveli.

The author can be contacted at

aagiri5a@gmail.com

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