If You Are A Diabetic, You Should Know How To Take Care Of Your Feet
By Dr KK Pandey
Surprisingly in our country, problem of diabetes is widely prevalent. According to one estimate the diabetic population in India, is the highest in the world. A drastic change in the life style, lack of exercise, avoidance of regular daily morning walk and no control over diet are some of the reasons, which are responsible for rapid rise in the number of diabetic patients in India. In diabetic patients, the leg becomes the commonest casualty due to disease itself. Quite often a diabetic patient takes no notice of small scratches, small blisters, small injury which do occur to his leg in day-to-day life. This small scratch gets converted into a full-fledged ulcer if not treated properly in time. Normally in a non-diabetic person these leg ulcers heal well after repeated dressings and antibiotics applications. But in diabetic patients, these foot ulcers generally do not respond to such treatment. Because of ignorance of this fact, a diabetic patient does not take his leg ulcer, which otherwise look simple, seriously and this results into a serious and complicated condition of the leg. Lack of timely care in its early stage causes later on, loss of money, time and leg as well. Therefore, always remember a diabetic patient must take his simple leg or foot ulcer very seriously and instead of consulting a general or an orthopedic surgeon he should consult a vascular or a cardiovascular surgeon and get the ulcer treated under his supervision. A diabetic patient must understand that the inadequate blood supply to lower limb and loss of sensitivity of leg skin are the two most important factors, which make leg ulcer complicated in any diabetic patient. Why a diabetic patient has problems of leg ulcer the most? In diabetic patients due to diabetic neuropathy, the sensitivity of leg and foot skin is considerably decreased. Because of reduced skin sensitivity, a diabetic patient never feels the sensation of pain, which a normal non-diabetic person otherwise feels in case of pressure abrasion and a superficial simple injury. If a diabetic patient does not pay attention at this stage, this small abrasion later on turns into a big ulcer. Diabetic neuropathy also causes weakness and partial paralysis of muscles of the foot resulting into constriction of the muscles. With the result, bones of the foot become more prominent and bulgy, and therefore are subjected to undue pressure and the end result is that a superficial ulcer in the foot becomes deep. One more reason of development of pus and gangrene in foot ulcer of a diabetic person is the inadequate blood supply to foot due to narrowing of arteries of lower limb, which carry pure blood to feet. In such a situation where blood supply to the foot as well as sensitivity of the skin of the foot are reduced, any kind of infection even minor one, caught by the foot ulcer in a diabetic patient, spreads very fast and reaches to a dangerous proportion. Where to go if a diabetic person develops a foot ulcer? If a diabetic patient develops a small superficial foot ulcer, he instead of a general or an orthopedic surgeon must consult a vascular or a cardiovascular surgeon and receive treatment under his supervision. Generally, these ulcers most of the time do not respond to simple antibiotics and dressing. For the treatment of such ulcers in a diabetic patient, the proper assessment of blood supply to the foot is of utmost importance. The cause of inadequate blood supply to the foot is generally narrowing of the lower limb arteries (blood pipes) due to deposition of fat, calcium and cholesterol in the inner wall of the artery. Due to deposition of these undesirable elements in the arterial wall, the arteries get narrowed that results into a considerably decreased in supply of pure blood. That is why the investigation of lower limb arteries is a must for the successful treatment of foot ulcers. For this, special investigations like Doppler Study, Multislide CT Angio, MR Angio, and Digital Subtraction Angiography are required. These specialized investigations determine the treatment strategy, to be undertaken later to restore the blood supply to the feet. On the basis of Angiography results modern treatments like arterial bypass surgery, angioplasty stenting, subintimal angioplasty are undertaken to augment the blood flow to the lower limbs. To decide the treatment strategy for an individual patient consideration of status of diseased arteries has to be taken into an account. Therefore one should always go to a hospital where 24-hrs availability of a full-time vascular surgeon is there and facility for Angiography, Bypass Surgery, and Angioplasty are routinely available. Quite often it has been seen in our country that a diabetic patient who is suffering from foot ulcers generally go to a small clinic or hospital and get his ulcer cleaned and dressed daily. Due to inadequate blood supply to the foot, this method of daily cleaning and dressing neither heal the small ulcer nor prevent it from developing into a large deep ulcer and ultimately this leads to infection and gangrene. At this juncture we are left with no other choice except amputation of foot. Our family physicians and general physicians do not seem to be very serious about the management of foot ulcer in their diabetic patients. They try to get the ulcer healed with simple antibiotics and dressings. During the treatment of diabetic foot ulcer, a proper care of ulcer and prevention from the infection are the most important components of treatment. In no condition, pus should be allowed to stay back. One should avoid solution like Betadine or Hydrogen Peroxide for dressing purposes. Special kinds of medicines for blood thinning are used to keep the blood diluted. In some patient latest medicine like Collagen or P.D.G.F. dressing are required. Sometimes special medicines like prostaglandins are administered intravenously, which help in the healing of ulcers indirectly. In special circumstances, uses of Skin Grafting and Myocutaneous Flaps’ are used to facilitate the ulcer healing. How to prevent foot ulcers in diabetic patients? 1. Must get your legs and foot checked-up once by a vascular or a cardiovascular surgeon for evaluation of leg arteries and its blood supply even if you have no complaints. Keep consulting him every third month. If at any moment, blood circulation to your feet starts decreasing, he can formulate preventive as well as corrective strategies in time before you are too late. 2. Must keep your blood sugar under control either by insulin injection or oral anti-diabetic drugs under strict guidance of a diabetologist or your own local physician. Keep in constant touch with your physician and seek his regular advice about your diet, your food preferences and exercise. 3. Must never walk barefooted, even inside your house. Avoid wearing chappals, slippers and sandals. Never expose your feet and toes to outside injuries and to extreme cold during winters. Keep your feet warm and covered with socks. Do not apply heat. Use of silicon insoles inside the shoes is very helpful in preventing development of ulcer. 4. Must keep your feet dry and clean. Never allow moisture or water to stay inside the space between the toes. Avoid wet and sweaty socks. Changes your socks twice a day especially during monsoon and summer seasons. 5. Must clean your feet, toes and toe-spaces twice daily with methylated spirit and then sprinkle Neosporin powder on the toes and inside the space between the toes. 6. Must inspect daily your feet, look for any abrasion, blisters, any raw area and thickened skin. Consult your vascular/cardiovascular surgeon and seek his advice. Never ignore and sit idle, in case of any injury to feet, or any development of ulcer or red patches over your feet, consult him immediately. 7. Must avoid tight and uncomfortable shoes. Discard immediately the shoes, which bite your feet. Shoes must be soft, very comfortable, well-cushioned and not exerting any pressure on your feet, especially bony prominences. Do not save money on shoes, go for a good brand. Use of special diabetic silicon insole inside the shoe is beneficial. 8. Must never smoke. Tobacco in any form (Pann Masaala with Zarda, Khaini, Chaini, Mainpuri Tambakhoo and tobacco-mixed toothpaste) is injurious to your diabetic feet. 9. Must keep your weight under check. Obesity is very harmful for your legs and feet. Avoid oily and cholesterol-rich food. High level of blood cholesterol will clog your arteries and significantly reduce blood flow to your feet and leg. Get your blood cholesterol checked-up every six months and seek advice in this regard from your Surgeon. 10. Must do daily morning walk for 6-8 kms. It will increase blood circulation in your legs and feet. In special case, like, in presence of ulcer use of Pneumatic Walker are very helpful in keeping the regular blood flow to the feet as they are scientifically desired. 11. Must never shave off any corn (Thickened skin) developed on your feet. Do not cut your nails deep; it may lead to painless minor injury which is harmful especially in a diabetic person. *** Dr KK Pandey is a Senior consultant in the Department of Cardiothoracic & Vascular Surgery at Indraprastha Apollo Hospital, New Delhi.
(Courtesy: The Sangai Express)