Diabetic Foot Dangers: Prevention is the Best Cure
Say hello to your feet. Often, feet do not get much respect and credit despite taking us everywhere. Perhaps the most neglected part of our body. Our feet are complex mechanical structures and brilliant examples of evolutionary engineering. They help us to stand, walk, and balance the whole torso. This support in essence is much more important when our body is engulfed in a fight with ‘mother of all diseases – Diabetes Mellitus’. Millions of people worldwide are affected by Diabetes and India is often dubbed as the diabetes capital of the world. There is hardly any organ in the body which escapes the wrath of diabetes. Be it brain, eyes, heart, arteries, kidneys, gut or feet, literally from head to toe each organ is involved. Diabetes significantly overburdens healthcare systems globally.
About one-third of people with diabetes develop a foot ulcer during their lifetime. Diabetic foot ulcers affect about 18.6 million people worldwide. Approximately half of diabetic foot ulcers become infected, and about 20% of these infections result in amputation of part of the foot or the whole foot. Diabetes commonly causes problems with blood flow and damage to nerves in feet. This can cause pain, tingling or numbness in your feet. As nerve damage progresses, one may not feel a sharp object which can puncture the foot due to decreased sensation of pain and pressure. Foot deformities and dry skin, which often occur with diabetic patients, can lead to formation of a callus on the foot.
Repetitive stress from walking or minor cuts and scrapes on the foot can cause a callus to develop into an ulcer. Moreover, walking barefoot, poor fitting footwear, smoking and being overweight besides poorly controlled diabetes increase the chances of diabetes foot ulcer risk. Ulcers are often painless, leading to a delay in presentation to a health professional. Tissue around the ulcer may become black, and gangrene may develop. These ulcers are prone to infection which can even progress deep into the bone which is very hard to treat.
Infected diabetic foot ulcers need treatment with antibiotics, appropriate dressings, or surgical removal of infected or dead tissues. Unfortunately for many diabetics, the end result of an ulcer can be amputation which can have enormous physical and mental impact on the patient. A clinician may need an ultrasound or angiography to check the blood flow of the limb or an x-ray or MRI to look for a bone infection. Diabetic foot ulcers take weeks to months to heal, and the recurrence rate is alarming.
As mentioned, the diabetic foot ulcers are nasty to treat, prevention remains the most effective way to avoid complications. As a rule, the better the control of your diabetes, the less likely you are to develop complications including foot ulcers. Diabetic patients should engage in daily foot check-ups. Inspecting feet on a daily basis including between toes remains the essential ritual of preventing ulcers. Looking for minor superficial cuts or ulcers and fungal infections between the toes and prompt evaluation by a clinician improves healing. Using a moisturising cream helps to prevent cracks. Wash your feet regularly and dry them well especially between the toes. Cut your nails by following the shape of the end of your toe.
Do not cut down the sides of the nails, or cut them too short, or use anything sharp to clean down the sides of the nails. These things may cause damage or lead the nail to develop an ingrown nail. Never walk barefoot. There are high chances of puncturing your skin without you noticing it. Do not wear tight fitting socks as they may impair circulation. Shoes with pointed toes and high heels should be avoided. Always feel inside footwear before you put footwear on to check for stones and rough edges.
Dr Murtaza Rashid M.R.C.P (U.K) is a Senior Clinical Fellow, Diabetes and Endocrinology, Queen Elizabeth Hospital, KL, United Kingdom
