Diabetes is raised sugar or glucose level in the blood.
So any part of the body with blood flow is susceptible to diabetes.
This means from head to foot, diabetes takes its toll.
Foot requires special mention since it is the part of the body which bears all the weight and is subjected to maximum physical trauma during walking.
Since the nerves and vessels to the feet are the longest as they are most distant from the heart and spinal cord, they are exposed to the maximum amount of raised glucose levels.
Hence the clinical effects of diabetes can be first detected here.
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Diabetic foot
The primary symptoms of diabetic foot is the loss of pain sensation or altered sensation due to nerve damage called neuropathy.
The patient is blissfully unaware of any injury to the foot and continues to neglect it till the problem presents itself as an ulcer, abscess, gangrene or deformity of the foot.
Acute (immediate) injuries like burns, pin / needle penetrations, injuries while trimming nails, shoe bites and scratch marks also need immediate attention.
The three most common types of such injuries are callosities, ingrowing toenails and intertrigo.
Callosities: Formation of layers of dead hardened skin, due to loss of sensation in foot.
Momentary stoppage of blood flow to feet while standing in the same position for a while results in uncomfortable sensations, forcing the person to shift their weight.
This does not happen in a diabetic person with neuropathy, leading to callosities.
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Ingrowing toenails: Ingrown toenails results in injuries which later become infected.
In a diabetic, since there is no sensation, the nail edges continue to grow and damage the surrounding tissue causing an infection that very often results in the toe or higher amputations if neglected.
Intertrigo: Intertrigo or fungal infection between toes is very common because of the humid climate and rains.
Prevention
This can be done by taking care of two things – good control of blood sugar levels and adequate protection for your feet.
Follow the 10 commandments, to protect your feet.
- Do not walk barefoot. Buy two pairs of diabetic footwear with MCR / MCP -microcellular rubber / microcellular polymer insoles for inside and outside use.
- Inspect the feet daily for blisters, wounds, bleeding, smell, increased temperature and oedema.
- Do not use hot fomentation / cold compresses / electric heating pads, strong balms or pumice stone on the legs and feet
- Use correct footwear. Always wear footwear with socks with loose elastic.
- Do not walk bearing weight on an affected /ulcerated foot
- Do not sit cross-legged for a long time.
- Do not remove footwear during travel and expose your feet to a hot or cold surface.
- Cut the nails regularly, trimmed square.
- Do not cut corns /calluses with a blade or a knife.
- Clean the feet twice daily with soap and water. Wipe the wet spaces dry and apply softening agents.
Stages
Cellulitis of foot or leg: This is the earliest sign of infection of the leg. The affected area shows reddish discolouration and swelling.
Abscess: This is the next stage where the infection has spread deeper and results in the formation of pus.
Infection has to be cleaned surgically. Pus or tissue from the abscess has to be send for culture to identify the foreign organisms and antibiotics to kill them.
Osteomyelitis: Sometimes the infection reaches the bone and infected pieces of bone have to be removed.
Necrotising fasciitis: In this stage, the infection starts spreading rapidly tolayers below the skin.
Early surgery and antibiotics are required to control the infection.
Gangrene: In this stage, the part of the foot dies but remains attached.
Usually happens due to lack of blood supply to the part or rapid infection.
Foot has to be removed surgically or amputated, ideally after measures are taken to increase the blood supply to the remaining parts .
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Damage control
Callosities have to be removed / scraped or abraded on time, so that they do not form ulcers For intertrigo / fungal infection, the solution is to keep the space between toes dry and proper application of anti-fungal ointment.
Ingrowing toenails and infection can be controlled by antibiotics or removal of that part of the nail or nail bed using a chemical or heat.
By Dr Visakh Varma
The author is podiatric and plastic surgeon at SUT Pattom, Kochi.
(The views expressed are his own)
