Jaslok Hospital and Research Centre,
Foot complications are, unfortunately, still the most important complication in our people with diabetes. Ask your doctor and you will be told that this is the most common problem which is seen in their patients with diabetes. Go to any hospital, and you will be told that the vast majority of patients who are admitted with diabetes related problems are with foot complications. Not only this, they have the longest stay in the hospital and most often they come so late that they end up with an amputation.
About 30% of people with diabetes will develop foot ulceration at some point, and 14% to 24% of these will have to have an amputation. The majority of these - almost 60% - occur in people who are 40 and older. The risk for foot ulceration leading to amputation increases in people over 40 who have had diabetes for 10 years or longer.
In fact, the second biggest cause of foot amputations is diabetes. The first…..accidents!
And yet this should not be so.
Let us meet Dr. Foot and let him tell us how.
Of all the complications associated with diabetes, foot problems are not only the most preventable, but even if you get a foot problem, early and correct treatment can definitely save your foot.
AND IT'S SIMPLE!
First let us understand why people with diabetes are more prone to foot problems.
Why People with Diabetes are Prone to Foot Ulcers.
Individuals with diabetes share a common disorder that results in elevated blood sugars. The effects of the elevated blood sugars will vary from individual to individual.
(1) Neuropathy: Many of you with diabetes have neuropathy. In many cases, this leads to a numbness and insensitivity. People with neuropathy are unable to "feel" pain, heat or cold. It is like having "Burglar alarms" on your feet which do not work. You will not be warned if you develop minor cuts, scrapes, blisters, boils or other injuries. This is made worse by our habit of walking barefoot at home and many other places where one is asked to take off one's shoes or sandals such as religious places etc. If you have neuropathy, you may not realize that your shoes or sandals are too small and are "biting" your feet until an ulcer has formed.
If these minor injuries are left untreated, because you do not "realize" that you have an injury, complications may result and lead to infection, ulceration and possibly even amputation. Your doctor can test you for neuropathy, but chances are you will recognize the signs of neuropathy, signs that include burning, tingling or numbness in the feet. In fact, as we have discussed below, you can ask your doctor for a monofilament and check it out yourself!
(2) Foot deformity: Neuropathy also leads to foot deformities such as bunions, hammer toes and other deformities. Moreover, many foot conditions which would be minor in most people become risky if you have diabetes.
(3) Prior history of foot ulcers
(4) Loss of circulation: Diabetes may also affect blood flow in your legs and feet, making it harder for cuts or sores to heal. Then a small infection can become very serious. Smoking when you have diabetes makes blood flow problems much worse.
(5) Proneness to infections: People with high blood glucose levels and deficient blood supply to the legs makes one prone to infections. These also are more difficult to treat and take much longer to heal. It is important to treat foot ulcers and infections as soon as possible, because the longer one delays treatment, the greater the chance of developing a more serious problem which may even lead to an amputation. The signs that an ulcer is infected include redness, swelling, increased drainage, sudden elevations in blood sugar, fever, chills and fatigue. Pain may be lacking because of neuropathy.
The risk for developing a foot ulcer increases with the number of risk factors.
The overall risk of an individual developing a diabetic foot ulcer is determined by a combination of factors. In general, the risk is higher if:
At the same time, it is worth remembering that with a little care, you can avoid foot problems. In many cases, even if you get a minor foot problem, serious problems can be prevented by an understanding of what can happen to feet and how to take care of them, correctly and promptly!
1) Inspect your feet daily for blisters, cuts, and scratches. The use of a mirror can aid in seeing the bottom of your feet. Always check between your toes.
2) Wash your feet daily, using warm (not hot) water and a mild soap. If you have neuropathy, you should test the water temperature with your elbow before putting your feet in the water. Do not soak your feet in hot water or in any water for a long time, as the skin can get macerated and infected.
Dry your feet carefully with a soft towel, especially between the toes. Dry with a soft cloth. Apply a moisturiser cream if they are dry or a powder if they are prone to excessive perspiration. Do not use oil or cream between your toes as this increases the chances of an infection.
3) Avoid walking barefoot! This is especially true about walking on hot surfaces such as footpaths, hot floor tiles, hot sand, rocks, etc. Always wear shoes and sandals that fit. Place protective slippers or shoes right beside your bed to wear as soon as you get out of bed to avoid walking barefooted.
4) Examine your shoes before putting them on to make sure they have no tears, sharp edges, or objects in them that might injure your feet. Always wear shoes and sandals that fit. Do not wear shoes without stockings. Wear socks that fit you properly. Choose socks that are made of cotton or wool. Be cautious not to wear socks that are too tight that can cut off circulation to the feet.
Choosing the correct shoes is extremely important. Below we will discuss how you should choose shoes for yourself.
5) Avoid exposing your feet to excessive heat or cold. If your feet feel cold at night, wear socks. Do not apply hot water bottles or heating pads.
6) Learn to cut your nails correctly! The best time to trim toenails is after bathing. The nails are softer and easier to trim at that time. Cut your toenails straight across and not too short. Do not cut into the corners of your nails. Be careful not to leave any sharp corners that could cut the next toe. Consult a doctor if your nails are too thick and difficult to cut.
7) Have any corns, calluses, bunions, warts etc., treated by a doctor. Do not use chemical agents for the removal of corns and calluses. Do not use strong antiseptic solutions on your feet. Do not use adhesive tape on your feet.
Don't try any home remedies!
8) Wiggle your toes and move your ankles up and down for 5 minutes, 2 or 3 times a day. This increases the blood flow to your feet.
Any change in the colour of your foot or toe.
Any new pain or throbbing in your feet. Report any foul smell even if your feet do not hurt.
Any swelling in the leg, foot or toes
Any boils, cracks, corns, blisters should be reported to you doctor at once.
Do NOT try any home remedies.
5) Avoid sitting with your legs crossed. Crossing your legs can reduce the flow of blood to the feet.
The circles represent the places on the foot to test with the monofilament.
Consider your feet to be "at risk" if you cannot feel the 10gm monofilament at any of the sites marked.
Caring for your feet is easy if you follow some of these simple tips. Many of you will be able to avoid getting a foot problem. But if you do get a foot problem, do NOT take it lightly. See your doctor at once. Prompt treatment can heal your foot problems.
Remember, give an "inch" to your diabetes foot problem and it will take a "foot"!
Your feet are in your "hands"
Take good care of them and they will last you a lifetime!