Dr. Jitendra Singh
The commonest non-traumatic cause of foot amputations or lower limb amputations in this country continues to be Diabetes Mellitus. It is strange that while enormous funds are being pumped in by international agencies including the World Health Organisation (WHO) to set up artificial limb centres and rehabilitation centres in under-developed or developing countries including India, little attention is paid to the preventive aspects of this incapacitating handicap which could be avoided with timely care and awareness.
George Bernard Shaw once wrote, a surgeon gets paid more for amputating a limb than for saving a limb. The current focus on preventive aspects of Diabetes has brought to light the risk of diabetes related lower limb amputation getting doubled or even tripled with the use of improper footwear.
Vulnerability Factors
The risk of amputation obviously increases with the duration of Diabetes and the extent to which Diabetes has been kept under control. Certain laboratory parameters like glycosylated hemoglobin (Hb AIC) serve as an indicator of how well the Blood Sugar levels have been under control over a period of time and thus could also predict the underlying vulnerability of a Diabetic to develop various complications including diabetic foot that often precedes an amputation.
Available data reveals that amputations are more likely in those Diabetics who have a previous history of foot ulcers or limb infections, neuropathy accompanied with dimunition of sensation in the extremeties and peripheral vascular disease involving narrowing of arteries resulting in impaired blood circulation in the limbs.
Fashion Shoes not always Safe
In the current era of consumerism with a penchant for marketing products which are unusual, innovative and somewhat exclusive, the use of fashion shoes has also come under a question mark. A report published in one of the world’s most reputed medical journals “Diabetes Care” states that wearing fashion shoes may be associated with as much as fourfold increased risk of amputation in Diabetics.
Figures gathered from surveys among diabetic population make some interesting revelations. The lower limb amputation risk was found to be nearly tripled by going barefoot in men, doubled by wearing sneakers regularly to work in women, increased fourfold by wearing sneakers to town and doubled by wearing rubber thong sandals. In other words, high-risk footwear seems independently associated with 2 to 4 fold increased risk of minor or major amputation.
Needless to reiterate, the feet of a Diabetes affected individual are susceptiple because of diminished sensation unable to perceive minor trauma or pressure effect due to inadequate footwear. Peripheral Vascular Disease leading to reduced blood circulation increases the chances of a noticed or an unnoticed sore getting complicated and uncontrolled Blood Sugar levels contribute to unrelenting infection at the site. It is with this consideration that Diabetics should be reminded to conduct a careful daily self-inspection/examination of their feet and particularly look for any pressure areas, scratches, injury marks etc. Significantly, some of the studies claim that daily self-examination of feet is associated with as much as 80% reduced risk of amputation.
In a nutshell, a health strategy that aims to improve footwear particularly in those who already have diabetic foot disease and that seeks better diabetes education with emphasis on preventive self-care coupled with early medical help-seeking behavior can certainly help reduce the burden of lower limb amputation among Asian Indians.
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