KEEP YOUR FEET IN DIABETES!!!

THE DIABETIC FOOT

INTRODUCTION

Diabetes Mellitus is a fast growing pandemic afflicting people of all age groups. The disease affects all the systems of the body and all the tissues also. Numerous patients come to realize that they are suffering form this disease when the small ulcer on their foot does not heal and starts to make the foot look black (gangrene).Diabetic patients have 15– 40 times higher risk of under going amputation (cutting of the dead limb/foot) than normal population.

HOW DOES A DIABETIC FOOT OCCUR?

High blood glucose levels lead to nerve damage causing a significant decrease in the sensation of the feet. So any trauma, nail prick, ill fitting shoe, heat or cold; leads to formation of ulcers/ blisters on the feet which are ignored as the patient does not check the condition of his/her feet everyday. As the skin also becomes dry, the cracks that appear on the skin start harboring bacteria which increase the risk of ulceration.

Diabetics have a propensity to accelerated atherosclerosis (occlusion of blood vessels) of the limbs which reduces the blood flow and makes the foot susceptible to ulceration. These factors together can lead to abnormal pressure on the skin, bones, and joints of the foot during walking and can lead to breakdown of the skin of the foot. High blood sugars also have a detrimental effect on the immune system leaving the body susceptible to infections.

WHAT SHOULD I DO EACH DAY TO STAY HEALTHY WITH DIABETES?

• Follow the healthy eating plan that you and your doctor or dietitian have worked out.
• Be active a total of 30 minutes most days. Ask your doctor what activities are best for you.
• Take your medicines as directed.
• Check your blood glucose every day. Each time you check your blood glucose, write the number in your record book.
• Check your feet every day for cuts, blisters, sores, swelling, redness, or sore toenails.
• Don't smoke.

HOW DO I KNOW THAT I HAVE A DIABETIC FOOT?

• Persistent pain.
• Redness.
• Swelling of the feet or legs can be a sign of underlying inflammation or infection, improperly fitting shoes, or poor venous circulation.
• Other signs of poor circulation include the following:
• Pain in the legs or buttocks that increases with walking but improves with rest (claudication)
• Hair no longer growing on the lower legs and feet
• Hard shiny skin on the legs
• Localized warmth.
• Any break in the skin is serious. Calluses and corns may be a sign of chronic trauma to the foot. Toenail fungus, athlete's foot, and ingrown toenails may lead to more serious bacterial infections.
• Drainage of pus from a wound is usually a sign of infection. Persistent bloody drainage is also a sign of a potentially serious foot problem.
• A limp or difficulty walking can be sign of joint problems, serious infection, or improperly fitting shoes.
• Fever or chills in association with a wound on the foot can be a sign of a limb-threatening or life-threatening infection.
• Red streaking away from a wound or redness spreading out from a wound is a sign of a progressively worsening infection.
• New or lasting numbness in the feet or legs can be a sign of nerve damage from diabetes, which increases a persons risk for leg and foot problems.

WHAT ARE COMMON DIABETES FOOT PROBLEMS?

Anyone can have corns, blisters, and other foot problems. If you have diabetes and your blood glucose stays high, these foot problems can lead to infections.

• Corns and calluses are thick layers of skin caused by too much rubbing or pressure on the same spot. Corns and calluses can become infected.
• Ingrown toenails happen when an edge of the nail grows into the skin. The skin can get red and infected. Ingrown toenails can happen if you cut into the corners of your toenails when you trim them. You can also get an ingrown toenail if your shoes are too tight. If toenail edges are sharp, smooth them with an emery board.
• A bunion forms when your big toe slants toward the small toes and the place between the bones near the base of your big toe grows big. This spot can get red, sore, and infected. Bunions can form on one or both feet. Pointed shoes may cause bunions. Bunions often run in the family. Surgery can remove bunions.
• Plantar warts are caused by a virus. The warts usually form on the bottoms of the feet.
• Hammertoes form when a foot muscle gets weak. Diabetic nerve damage may cause the weakness. The weakened muscle makes the tendons in the foot shorter and makes the toes curl under the feet. You may get sores on the bottoms of your feet and on the tops of your toes. The feet can change their shape. Hammertoes can cause problems with walking and finding shoes that fit well. Hammertoes can run in the family. Wearing shoes that are too short can also cause hammertoes.
• Dry and cracked skin can happen because the nerves in your legs and feet do not get the message to keep your skin soft and moist. Dry skin can become cracked. Cracks allow germs to enter and cause infection. If your blood glucose is high, it feeds the germs and makes the infection worse.
• Athlete's foot is a fungus that causes itchiness, redness, and cracking of the skin. The cracks between the toes allow germs to get under the skin and cause infection. If your blood glucose is high, it feeds the germs and makes the infection worse. The infection can spread to the toenails and make them thick, yellow, and hard to cut.

TELL YOUR DOCTOR ABOUT ANY FOOT PROBLEM AS SOON AS YOU SEE IT.

WHAT CAN I DO TO TAKE CARE OF MY FEET?

Look at your feet every day to check for problems.

• Wash your feet in warm water every day. Make sure the water is not too hot by testing the temperature with your elbow. Do not soak your feet. Dry your feet well, especially between your toes.
• Look at your feet every day to check for cuts, sores, blisters, redness, calluses, or other problems. Checking every day is even more important if you have nerve damage or poor blood flow. If you cannot bend over or pull your feet up to check them, use a mirror. If you cannot see well, ask someone else to check your feet.
• If your skin is dry, rub lotion on your feet after you wash and dry them. Do not put lotion between your toes.
• File corns and calluses gently with an emery board or pumice stone. Do this after your bath or shower.
• Cut your toenails once a week or when needed. Cut toe nails when they are soft from washing. Cut them to the shape of the toe and not too short. File the edges with an emery board.
• Always wear slippers or shoes to protect your feet from injuries.
• Always wear socks or stockings to avoid blisters.
• Wear shoes that fit well
• Before putting your shoes on, feel the insides to make sure they have no sharp edges or objects that might injure your feet.
• Eliminate obstacles: Move or remove any items you are likely to trip over or bump your feet on. Keep clutter on the floor picked up. Light the pathways used at night - indoors and outdoors.
• Having a doctor examine the patient's feet at least once a month.

WHAT CAN I DO TO TAKE CARE OF MY SKIN?

• After you wash with a mild soap, make sure you rinse and dry yourself well especially between the toes.
• Keep your skin moist by washing with a mild soap and using lotion or cream after you wash.
• Check your skin after you wash. Make sure you have no dry, red, or sore spots that might lead to an infection.
• Tell your doctor about any skin problems.
• Prevention & good control of blood sugar level - remains the best way to prevent diabetic complications.

                      

HOW CAN SPECIAL SHOES HELP MY FEET?

Special shoes can be made to fit softly around your sore feet or feet that have changed shape. These special shoes help protect your feet. Talk with your doctor about how and where to get them.

WHAT INVESTIGATIONS WILL I NEED?

Medical evaluation includes a thorough history and physical examination and may also include laboratory tests, x- rays (angiogram) studies of circulation in the legs, and consultation with specialists. Ideal Fasting blood glucose is <120 mg/dl and Ideal HbA1c <7% (which denotes the long term diabetic control).

WHICH DOCTOR SHOULD I CONSULT?

Management of a patient with a diabetic foot requires a team of doctors out of which any one can be the first contact:  

• Physician: Family doctor is usually the first referral.
• Endocrinologist: Medical management of Diabetes.
• Plastic Surgeon: Wound management, soft tissue coverage and microvascular bypass surgeries.
• Vascular Surgeon: Management of blocked major arteries.
• Physiotherapist: Rehabilitation of patients.
• Dietician: Proper diet is the backbone of management of diabetes.

THE PATIENT IS THE MOST IMPORTANT MEMBER OF THE TEAM. No matter how qualified the other members are, if the patient does not believe they can master the problem and keep their own two feet intact for the rest of their lives, everything else will be a failure.