Diabetes is deadly enemy of your feet

Dr K K Pandey
Nowadays, as the number of diabetic patients is increasing rapidly due to unhealthy life style, the condition of their feet is also deteriorating at the same pace due to neglect and improper care of the feet.. In our country , the average rate of amputation of feet in diabetic patients is ten percent per year, that means, out of hundred diabetic patients, ten patients lose their feet every year. People do not know that the risk of amputation of feet in diabetes patients is about one and a half times more than in people without diabetes. A long standing diabetes,uncontrolled amount of sugar in the blood, presence of albumin in urine, poor vision, smoking, tingling in the feet and low blood supply to the feet etc., all these things become the direct or indirect cause of losing feet in diabetic patients.
Worst Scenario in our country
The people of our country do not know that diabetes sooner or later attacks all the organs of the body. It affects the heart and brain but the legs are its most important victims. Diabetes patients do not understand that diabetes is the biggest enemy of their legs. People walk barefoot knowingly or unknowingly. And moreover, people mistakenly believe that walking barefoot on grassy land daily by a diabetic patient provides great benefit to all the organs of the body, especially the legs. If pain or tingling occurs in the feet while walking, it is ignored. People do not understand that the careless attitude shown by a diabetic patient can become the direct reason for his disability. Leave aside legs, people are not even serious about controlling the amount of sugar in their blood.
How does diabetes destroy the legs?
If pain arises while walking and it becomes unbearable after walking for a long distance, a diabetic patient should understand that the health of his legs and feet is not good. Two things cause the most damage to the feet in diabetics. One is neuropathy and the other is the decrease in blood supply to the feet. There are two reasons for the decrease in the supply of pure blood to the feet. One is that due to the continuous accumulation of fat and calcium inside the wall of blood pipes of the legs, the blood pipes start constricting. With the result, the supply of pure blood going to the legs gets decreased. If the corrective measure is not taken in time, the blood supply to the feet stops completely. This is a serious condition and may eventually lead to gangrene of the feet..
Diabetes decreases the blood supply to the skin of feet
The second reason for the decrease in the blood supply to the skin of the feet is a special type of neuropathy which is called ASN (Autonomic Sympathetic Neuropathy) in medical language. Due to this particular neuropathy, pure blood is not able to reach its destination in the skin of feet. This is because of short-circuiting of pure blood. Just like a railway passenger whoboards the trainand mid-waystops the onward journey and then start return journey instead of reaching the final destined station. In the same way due to short circuiting, a significant drop in the blood supply occurs, with the result there is unbearable pain in the legs and the colour of the skin starts changing. A diabetic patient should immediately consult a vascular surgeon in such a condition.
Dryness of feet is dangerous in diabetics
In diabetes, excessive dryness develops in the skin of the legs and feet. Due to this dryness, cracks and pits are formed in the skin, which become the cause of infection in the feet. A major reason for dry skin in diabetes is diabetic autonomic neuropathy, due to which the glands that produce sweat and keeps the skin smooth and moist stop working properly. Due to this dryness and cracking, wounds are formed quickly in the feet of diabetic patients and the infection reaches deep inside. A great difficulty is faced in controlling this infection. Sometimes an operation is required to keep the wound.,clean and infection-free.
Why do bunions(corns) develop more in diabetes?
In diabetes, the pressure on the bones of the foot increases due to the weakening of the foot muscles. Due to this unabated constant pressure, bunions are formed at pressure points in the skin. Due to this bunion or corn, the diabetic patient feels as if there is a pebble, stone or a small rock kept inside the shoe. Due to this bunion, the pain in the feet becomes unbearable and the chances of infection increase a lot.
Where to go in case of pain in the feet?
If a diabetic patient experiences pain in the feet while walking or complains of tingling sensation while lying on the bed at night, then consult a vascular surgeon without delay. It is very important to know the cause of the pain. Often people mistake this type of pain of diabetesfor arthritis or sciatica pain and thereforestart consulting a bone specialist. To know the cause of pain, some special tests like Doppler arterial study of lower limbsand CTperipheral angiographyare advisable. Therefore, always go to such hospitals where all these tests are available. The strategy of further treatment is decided on the basis of overall results of these special tests and clinical findings.
Modalities of treatment
To save the foot from amputation in diabetes, effective measures are undertaken to increase the blood supply of feet. One method is bypass surgery of the legs which is done to increase the blood supply to the leg muscles, thatwill help in healing the wound. In some carefully selected cases, angioplasty and stenting of the blood pipes of legs are preferred.over surgery. Therefore, one has to choose judiciouslythe right options forthe treatment. Always go to such hospitals where an experienced vascular surgeon is available and legbypass surgery and angioplasty-stentingof blood pipes of the legs are done quite frequently. To further increase the blood supply to the legs, one has to take the help of certain essential medicinesalso..
What prevention should be done to save the feet?
Diabetic patients should never walk barefoot either inside or outside the house and should never wear shoes without socks. Special types of socks and shoes are available these days for diabetic patients, choose them on the advice of your vascular surgeon..For diabetics, a regular walk for 5 to 6 kilo meters is the best way to increase the supply of pure blood to the feet and reduce the effect of neuropathy on the feet. Keep the feet clean and moisture-free. Always keep the glucose level in the blood under control. A persistently uncontrolled sugar in the blood is a clear predictor of losing the leg in future. Protect the skin of your legs from dryness and do not let bunions develop.
Finally, I would like to request all the diabetes patients to get their legs and feet checked by a vascular surgeon every three months. If at any stage blisters and red rashes appear on the legs, consult a vascular surgeon immediately without any delay. This is the only way to keep the legs safe.
(The author is Senior Vascular & Endovascular Surgeon, Indraprastha Apollo Hospital, New Delhi.)