HEALTHWATCH
Foot care
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Preventive measures greatly limit the damage caused to the feet as a result of diabetes, says Dr. V. BALAJI.
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DIABETES is one of the leading chronic diseases in our country and its incidence is expected to explode further in the next decade. It is extremely important to have a tight control of the disease as it can cause other complications.
Infection of the foot is one of the most common complications affecting diabetic patients. If not looked after properly this may lead to loss of a part or whole of the limb. It is estimated that amputations occur 40 times more in diabetic individuals compared to the general population. These problems can be prevented at least in 85 per cent of the patients if adequate care is given.
Unfortunately diabetic foot ulcers are common. Every year, two to three per cent of diabetic patients develop ulcers and they usually precede major complications. The reasons for the development of ulcers are neuropathy (loss of sensation), ischemia (poor circulation) and infection. Ulceration develops because patients lack protective sensation to warn them of injury to the foot. As a result, these punctured wounds go unnoticed until other complications set in. This is because the disruption of the protective layer of skin leads on to infection with skin organisms and in addition poor blood circulation delays healing of wounds.
The structure of the foot also changes in diabetic patients due to bony dislocation and collapse of the arch of the foot. This is called neuropathic arthropathy. The structural derangements continue the cycle of abnormal weight bearing, excessive pressure and ulceration.
Complete evaluation of the legs is vital in undertaking the treatment of foot ulcers in diabetic patients. This includes assessment of infection, neuropathy and peripheral vascular disease. The presence and extent of infection directly affects the outcome. Identifying vascular problems can be more difficult than expected because diabetes itself can mask the problem. Absence of pulsation, loss of hair on the top of the foot and toes and unhealthy nails are the signs of poor circulation.
Successful treatment in diabetic foot problems depends on reducing or eliminating pressure, resolving infection, correcting the circulation problems and maintaining an environment that promotes wound healing. Very close follow-up is critical for assessing patient response to treatment. Pressure on the foot should be removed immediately by rest and elevation of the limb. If resting is not possible, use of crutches, walkers or wheel chairs can be advised. When a patient wants to walk improper fitting foot wear should be replaced with "healing" sandals or special shoes.
Sometimes in view of underlying bony prominences, early surgical intervention to correct the deformity may be necessary. Infection is controlled by administration of appropriate and adequate antibiotics. This usually is a combination of agents as infection is caused by different groups of micro organisms. The wound should be cleaned and all the unhealthy tissues should be removed (debridment). Any pus present should be drained. In deep ulcers, bone involvement may be present in which case removal of infected bone should also be performed.
Correction of vascular disease is important as it's the only factor in itself which will necessitate foot amputation. Slow healing in spite of proper care denotes vascular disease and calls for immediate opinion by a vascular surgeon. In diabetes both small and large blood vessels of the leg are affected and further assessment is necessary to find out the level and extent of occlusion. These days, it is possible to stretch the occlusions by a balloon inserted inside the blood vessel to increase circulation (angioplasty). If this procedure is not possible or feasible, then bypass surgery can be performed which increases blood circulation to the affected leg which in turn helps the wound healing.
Diabetic foot complications can be limited considerably with conscientious attention to preventive measures. These include patient education, tight diabetic control, regular foot inspection and proper foot wear selection. Regular assessment of blood circulation is also necessary and early intervention if indicated will go a long way in preventing complications. Early identification of risk factors, careful and regular evaluation and aggressive treatment in a multidisciplinary team approach prevent amputations in most cases of diabetic foot ulcers.
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Check your feet every day routinely.
Look for red spots, swelling and cuts. Use a mirror to inspect the heel, sole and both sides of your feet. If you cannot check properly, call one of your family members.
Seek medical attention if you find anything abnormal. Don't attempt to treat yourself with over the counter medications.
Wash your feet with warm water every day. To check the temperature, use your elbow. Dry your feet thoroughly, especially in between the toes.
Trim the toe nails and file them smooth. Cut nails straight across and not down into the corners.
Never walk bare foot. Wear slippers even when indoors. Choose strong comfortable shoes that fit well and support your feet including your heels.
Wear new shoes only for short periods. Inspect your feet for red spots every time you remove new shoes.
Always wear cotton socks so that your shoes don't rub against your skin and cause blisters.
Check inside your shoes for stones or ridges before wearing them.
Dr. V. BALAJI
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