Preventing Foot Ulcer in Diabetes

Dr. Kailash C. Behil
Diabetes mellitus (increase blood sugar) is a serious, life-long condition causing death worldwide. The magnitude of problem in India can be assessed by the fact  that  the estimate of the disease in  2011 was 61 millions  and the projected figure for 2030 is around 100 millions.
Diabetes mellitus is  a condition in which there is a  failure of Beta cells of pancreas  and  there is also insulin resistance  resulting in chronic  hyperglacemia (increased blood sugar) which causes  pathology in various organs like eyes, kidneys, nerves, blood vessels and heart. In diabetes patient there is increased risk of diabetic foot ulcer, about 25% at some point on their life time and out of which 14 to 25% of the people with foot ulcer will require amputation. The risk of diabetic foot ulcer increases with age especially in more than 50 years and older. Men with diabetic foot ulcer are at increase risk than women.
People with low socio-economic group tend to be at increased risk for diabetic foot ulcer because of poor access to resources. In diabetic foot ulcer which is one of the most common complication for diabetes there is a loss of sensations of touch, pain, heat or cold, there are not felt easily in the foot or even totally absent in advanced cases and in very advanced cases   joint sense is also blunted and the foot becomes twisted and distorted which is called CHARCOT’s FOOT. In diabetic foot there is peripheral neuropathy due to which there is loss of sensations in the feet results in injuries going unnoticed which leads to foot ulceration.
The other causes of foot ulcer is foot deformity which leads to formation of calluses on weight-bearing areas. Also repeated minimal trauma can also lead to foot ulceration in diabetes. People with diabetic related heart and kidney diseases are also at increased risk of diabetic foot ulcer. Depression is more common in people with chronic diabetes which leads to lack of self care leading to skin infection or injury which ultimately leads to foot ulceration. Poor vision especially in older people  and those with diabetic related eye conditions, may result in falls and foot injury which leads to food ulceration.
So education is very must regarding the risk factors and management of diabetic foot ulcer in diabetic patients. Every diabetic patient should inspect  the feet daily for  blisters, cuts and  scratches and if possible  mirrors  can be used  to see the bottom of feet.
Wash feet daily, dry carefully especially between the toes. If  feet feel cold  at night, wear socks.  Do not apply hot water bottles, heating pads or electric blanket. Diabetic people should not  soak feet in hot water.
Diabetic people should be advised not to walk on hot surfaces such as sandy beaches or on cement around swimming pools and they are also warned not to walk bear-footed. Shoes should be inspected daily to see for any foreign objects, nail points, rough areas and if people have poor vision he should take the help of family members to inspect feet daily and trim nails. For dry feet, thin coat of lubricating oil or cream should be applied after bathing and then dry the feet. Diabetic should be advised to  wear proper fitting socks and change them daily. Shoes should be comfortable not too tight not too loose. Diabetic peoples should not use chemical agents for removal of corns and calluses. They are also advised not to use adhesive tapes on foot and not to bear shoes without stockings. There patients should keep their blood sugar level within normal limits.
It is possible to reduce the burden of diabetic foot complications by educating the patient regarding foot care. If diabetic patients apply all these methods regarding their foot care then the amputation rates can be reduced to 50%.
(The author is Senior resident in the department of Medicine GMC, Jammu)


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