Live Well With Diabetic Foot

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What is Diabetic Foot? What are the chances of developing diabetic foot (?) 

Author: Dr Sunil Kumar Kota

 MD (Medicine), DNB (Endocrinology)

Consultant Endocrinologist

 DIABETES & ENDOCARE Clinic, Berhampur

 Email: This email address is being protected from spambots. You need JavaScript enabled to view it.  Ph: +91-7749804401


Diabetic foot is defined as “The foot of a diabetes patient that has potential risk of pathologic consequences including infection, ulceration and /or destruction of deep tissues associated with neurologic abnormalities, various degrees of peripheral vascular disease and/or metabolic complications of diabetes in the lower limb (World Health Organization 2011)”. Early identification & treatment of foot disease that are prevalent in Diabetes patients is of prime importance: else the condition may lead to serious health issues. A small injury can later develop infections and those complications may end up in amputations. The prevalence of diabetic foot in India varies from 7.4% to 15.3%. At least one in 10 people at the time of diagnosis of Type 2 Diabetes has risk factors for foot damage.


Why is it necessary to check the feet everyday on detection of diabetes?      

To identify factors like callus, corn, infections of skin or nailbed, onychocryptosis or ingrown toe- nail that lead to ulcers and prevent them; it is necessary to check the feet everyday on detection of diabetes. Checking the feet everyday helps initiating prompt treatment of acute problems viz. Rat-bite, toe-ring injury, tight shoe or slipper-strap injury, inter digital mycosis, thermal injury etc. Diabetes damages the nerves of the feet and the absence of pain can cause small injuries to go unnoticed. Diabetes also reduces the blood flow to the feet especially if there is associated high blood Pressure, smoking, high cholesterol levels, and obesity. Reduced blood flow and absence of pain predisposes to secondary infections which further aggravates the problem.


What are the other associated complications of diabetic foot?           

 Ulceration, infection, septicaemia, gangrene, deformity, limb loss are some of the associated complications of diabetic foot.


What are the probable causes of developing diabetic foot?           

 The probable causes are peripheral neuropathy (Nerve damage), vasculopathy, (obstruction of blood vessels), foot deformity, infection and oedema (swollen feet).


How diabetic foot can be treated? What are the treatment options for diabetic foot?           

 Successful treatment of diabetic foot ulcers consists of addressing these three basic issues; debridement, offloading and infection control.


Debridement: - Debridement consists of removal of all necrotic tissue, peri-wound callus, and foreign bodies down to viable tissue.


Offloading: - Having patients use a wheelchair or crutches to completely halt weight bearing on the affected foot is the most effective method of offloading to heal foot ulceration.


Infection control: - An infection is a serious complication of a foot ulcer and requires immediate treatment. Not all infections are treated the same way. Generally longer duration of antibiotic treatment is recommended for increasingly deep infections. Sometimes intravenous antibiotics too are to be used in moderate to severe cases. Tissue surrounding the ulcer may be sent to a lab to determine which antibiotic will help.


 Apart from these 3; doctors may use reduction of oedema. Revascularization, photodynamic therapy (PDT), hyperbaric oxygen therapy, growth factors and vacuum-assisted negative pressure therapy to treat diabetes foot.


How can one prevent the development of diabetic foot? 

Inspect your feet every day, and seek care early if you do get a foot injury. Your health care provider should perform a complete foot exam at least annually - more often if you have foot problems. Patients should remember to take off their socks and shoes while waiting for physical examination. One should consult health care provider if there are any cuts or breaks in the skin, or an ingrown nail. Health care provider should be intimated regarding any change in color, shape of feet or just feels different (for example, becomes less sensitive or hurts). Health care provider can trim the corns or calluses and even toenails if patients cannot do so safely. One can prevent development of diabetes foot by optimizing glycaemic control, offering patient education including daily feet examination, nail care, proper foot wear and utilizing emollients to moisturize the feet . Health care providers should also provide a list and explain the do's and don'ts of foot care to each and every diabetic patient.


How should one take care of feet? 

Take care of your diabetes: Work with your health care team to keep your blood glucose in your target range. 

Check your feet every day: Look at your bare feet for red spots, cuts, swelling, and blisters. If you cannot see the bottoms of your feet, use a mirror or ask someone for help. 

Be more active: Plan your physical activity program with your health team. 

Wash your feet every day: Dry them carefully, especially between the toes. 

Keep your skin soft and smooth: Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between your toes. 

If you can see and reach your toenails, trim them when needed: Trim your toenails straight across and file the edges with an emery board or nail file. 

Wear shoes and socks at all times: Never walk barefoot. Wear comfortable shoes that fit well and protect your feet. Check inside your shoes before wearing them. Make sure the lining is smooth and there are no objects inside.


Protect your feet from hot and cold: Wear shoes at the beach or on hot pavement. Don't put your feet into hot water. Test water before putting your feet in it just as you would before bathing a baby. Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it.


Keep the blood flowing to your feet: Put your feet up when sitting. Wiggle your toes and move your ankles up and down for 5 minutes, two (2) or three (3) times a day. Don't cross your legs for long periods of time. Don't smoke.


What is the significance of selecting right footwear in diabetes foot? What precautions should one take while selecting footwear (?) 

Customized footwear obviates pressure points and helps in offloading. Footwear should be bought in the evening as there can be increase in size due to dependent oedema. High heels should be avoided. An adequately roomy shoe with adequate forefoot space without pointed tip and high heels should be chosen. Shoes with Velcro are preferred over the ones with shoe laces. Each time 2-3 different shoes should be used on a rotation basis. Shoes have to be changed once a year. Hygroscopic socks (that can absorb sweat) without wobbles to be used, preferably prepared of cotton material.


Does one need to see the doctor even if there is small shoe- bite(?) 

Definitely, 85% of lower limb amputatios are preceded by trivial foot lesions.



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2018-02-22 17:56