Video
Event on “Diabetic Foot & Related Complications” held on November 25, 2022. Speaker: Dr Narendra Reddy, Vascular Surgeon, Manipal Hospital, Varthur
To watch the Video click here: https://www.youtube.com/watch?v=tGz92qyhVBQ
Article:
India is often called the 'diabetes capital' of the world and studies show that 26.1% of urban citizens aged 60 years or more are diagnosed with it. That means about a quarter of us living in cities have diabetes, which makes it important for us to find out what complications may arise from it.
One of the most significant and devastating complications of diabetes is Diabetic Foot. It is defined as a foot affected by ulceration that is associated with neuropathy and/or peripheral arterial disease (PAD) of the lower limb in a diabetic patient. The risk of foot ulceration and limb amputation increases with age and the duration of diabetes. The prevention of diabetic foot is crucial, considering the negative impact on a patient’s quality of life and the associated economic burden. Diabetic foot ulceration is a major health problem and its management involves a multidisciplinary approach.
PAD can narrow the arteries that carry blood to your legs and feet and make you more likely to get ulcers (open sores) and infections. When you don’t have good circulation, it also can make those things heal more slowly.
Neuropathy is nerve damage. High blood sugar levels caused by diabetes can damage the nerves and blood vessels in your body. That includes the ones in your feet and legs. If your nerves are damaged, you might not feel pain, heat, cold, sharp objects, or other symptoms of ulcers or infections. If you have neuropathy in your feet, you could walk around all day with a rock in your shoe and not know it. That means you could get a bad cut and not notice until it gets infected.
That raises your risk of serious infection or gangrene, which refers to the death of your tissue. In some severe cases, the only way doctors can treat the infection or gangrene is to amputate, or remove, the area that's affected.
How to Protect Your Feet
Good diabetes management and regular foot care can help prevent severe foot sores that are difficult to treat and may require amputation. The good news is that managing your diabetes and taking care of your feet can help prevent foot ulcers.
Factors That Lead to A Higher Risk of Amputation Include:
· High blood sugar levels
· Smoking
· Nerve damage in the feet (peripheral neuropathy)
· Calluses or corns
· Foot deformities
· Poor blood circulation to the arms and legs (peripheral artery disease)
· A history of foot ulcers
· A past amputation
· Vision problems
· Kidney disease
· High blood pressure, above 140/80 millimetres of mercury (mm Hg)
Preventing Foot Ulcers
Taking care of your feet will help prevent problems and can ensure you get medical care quickly when you see problems. Proper foot care includes the following:
· Look at your feet daily. Check your feet once a day for blisters, cuts, cracks, sores, redness, tenderness or swelling. If you have trouble reaching your feet, use a hand mirror to see the bottoms of your feet. Put the mirror on the floor if you can't hold it, or ask someone to help you.
· Wash your feet every day in lukewarm (not hot) water once a day. Dry them gently, especially between the toes. Use a pumice stone to gently rub the skin where calluses easily form.
· Put talcum powder or corn-starch between your toes to keep the skin dry. Use a moisturizing cream or lotion on the tops and bottoms of your feet to keep the skin soft. Preventing cracks in dry skin helps keep bacteria from getting in.
· Don't remove calluses or other foot lesions yourself. To avoid hurting your skin, don't use a nail file, nail clipper or scissors on calluses, corns or warts. Don't use chemical wart removers. See your foot specialist (podiatrist) to remove any of these issues.
· Cut your toenails carefully. Cut your nails straight across. Carefully file sharp ends with an emery board. Ask someone for help if you can't trim your nails yourself.
· Don't go barefoot. To keep from hurting your feet, don't go barefoot, even around your house.
· Wear clean, dry socks. Wear socks made of material that pulls sweat away from your skin. This includes cotton and special acrylic fibres — not nylon. Don't wear socks with tight elastic bands. These bands reduce circulation. Avoid socks with seams that could irritate your skin.
· Buy shoes that fit correctly. Buy comfortable shoes that provide support and cushioning for the heel, arch and ball of the foot. Avoid tightfitting shoes and high heels or narrow shoes that crowd your toes.
· If one foot is bigger than the other, buy shoes in the larger size. Your doctor may recommend specially designed shoes (orthopaedic shoes). These shoes fit the exact shape of your feet, cushion your feet and make sure your weight is the same on both feet.
· Don't smoke. Smoking makes it harder for your blood to go through your body. It also reduces the amount of oxygen in your blood. These problems can make wounds worse and slow down healing. Talk to your provider if you need help quitting smoking.
· Schedule regular foot check-ups. Your podiatrist can look at your feet for signs of nerve damage, poor circulation or other foot problems. Have a foot exam at least once a year or more often if recommended by your doctor.
Signs of Trouble
Contact your doctor if your feet have:
· Ingrown toenails
· Blisters
· Flesh-coloured bumps with dark specks (plantar warts) on the bottoms of your feet
· Athlete's foot
· An open sore or bleeding
· Swelling
· Redness
· Warmth in one area - If its colder or warmer than usual, that can also be a sign something's wrong. Run a feather or light object along your foot to make sure you can feel it.
· Pain (though you may not feel anything if you have nerve damage)
· Discoloured skin
· A foul odour
· An ulcer that lasts longer than 1 to 2 weeks
· An ulcer bigger than 3/4 inch (2 centimetres)
· A sore that doesn't quickly begin to heal
· An ulcer so deep you can see the bone underneath
· Different colours, a sign of a problem with your blood supply
Avoid Amputation
· You’re much more likely to avoid a foot amputation if you make your health and your feet a priority. If you have diabetes, high blood pressure, or high cholesterol, try to get it under control.
· If you can't check your own feet, ask a family member to help you. If you notice a problem or aren't sure if something's normal, call your doctor.
· Don't smoke. Like PAD and diabetes, smoking damages your small blood vessels and affects blood flow to your feet. It also makes it harder for your body to heal. Those things raise your risk of amputation.
· Get some exercise. It can help you control your diabetes and improve blood flow to your feet.
· See your doctor at least once a year. If you have nerve damage, you may need to see a foot doctor (podiatrist) or your diabetes doctor (endocrinologist) as often as every month or two. They can help keep your blood sugar under control with medication, diet, and exercise. They'll also look at your feet and legs to make sure there's nothing wrong. The earlier you catch ulcers and other problems, the better.
Alternatives to Foot Amputation
Even with a bad infection or a wound that won’t heal, your doctor may not suggest foot amputation right away. Depending on your condition, they might instead recommend:
· Surgery to clean the wound and remove dead tissue
· Antibiotics, which you’ll get at the hospital through a tube (an IV) into your vein
· Amputation of one or more toes
· Surgery that brings new blood flow to your foot, called revascularization
What If Amputation is the Only Option?
Treatments for foot ulcers depend on the wound. Most of the time, the treatment is to remove dead tissue or debris, keep the wound clean, and help with healing. Wounds need to be checked often, at least every 1 to 4 weeks. When the ulcer causes severe loss of tissue or an infection that threatens your life, an amputation may be the only treatment.
A surgeon will remove the damaged tissue and keep as much healthy tissue as possible. After surgery, you'll stay in the hospital for a few days. It may take 4 to 6 weeks for your wound to heal completely.
Even after amputation, it's important to follow your diabetes treatment plan. People who've had one amputation are at higher risk of having another. Don’t think of it as a failure of your diabetes treatment. Think of it as a way to help you heal faster, so you can get back to the activities you enjoy.
Also, keep in mind that you may be getting rid of a serious infection that could have led to the amputation of your entire leg. Many people who get a foot amputation even enjoy better health after the surgery.
Eating healthy foods, exercising regularly, controlling your blood sugar and not smoking can help you prevent more diabetes complications.
- Compiled by Anita Natu
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