Dr. Ashok Kumar Jhingan, Senior Director, Centre For Diabetes, Thyroid, Obesity & Endocrinology, BLK Max Super Speciality Hospital reports that around 15 to 25% of patients with diabetes mellitus will develop a diabetic foot ulcer during their lifetime. We see 3-4 patients with diabetic related foot problems everyday in our OPD.
What increases one’s chances of foot amputation is not only a diabetes diagnosis but also two related complications – peripheral artery disease (PAD) and diabetic neuropathy. “PAD can narrow the arteries that carry blood to your legs and feet and make you more likely to get ulcers (open sores) and infections. When you don’t have good circulation, it also can make those things heal more slowly.
Dr. Sachin Kumar Jain, Head, Department of Endocrinology, Amrita Hospital, Faridabad further adds, “Patients should not ignore lasting numbness, hard shiny skin, loss of hair from feet or leg, or swelling of feet or leg, trouble in walking, any ulcer/sore/bunions/corns— if there is a bad or foul smell.”
Why does diabetes make one’s feet vulnerable?
Uncontrolled diabetes can damage your nerves and even the blood vessels in the body. Dr Ashok explains how. If your nerves are damaged, you might not feel pain, heat, cold, sharp objects, or other symptoms of ulcers or infections. If you have neuropathy in your feet, you could walk around all day with a rock in your shoe and not know it. That means you could get a bad cut and not notice until it gets infected. Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Moreover, patients who have long term diabetes can develop neuropathy, which is basically a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain and one may not even be aware of the problem. Your podiatric physician can test feet for neuropathy with a simple and painless tool called a monofilament, he adds.
The risk of foot amputation
Many diabetic patients end up having amputation of one or multiple toes, forefoot, or leg, because the infection is not coming under control or ulcers or wounds are not healing. It leads to further cellulitis, fasciitis, and osteomyelitis (neuropathy and vascular disease contribute to this), and because of arterial disease neither the nutrients nor antibiotics nor drugs reach the local site in adequate amounts. Multiple amputations may occur over a period of time, shares Dr Sachin.
Check your feet daily!
So what should people with diabetes do? It’s extremely important for them to check their feet daily.
Check your feet: Check it once a day for blisters, cuts, cracks, sores, redness, tenderness or swelling. If you have trouble reaching your feet, use a hand mirror to see the bottoms of your feet. Put the mirror on the floor if you can’t hold it, or ask someone to help you.
Wash your feet every day: Wash your feet in lukewarm (not hot) water once a day. Dry them gently, especially between the toes. Use a pumice stone to gently rub the skin where calluses easily form.
Put talcum powder or cornstarch between your toes to keep the skin dry: Use a moisturizing cream or lotion on the tops and bottoms of your feet to keep the skin soft. Preventing cracks in dry skin helps keep bacteria from getting in.
Don’t remove calluses or other foot lesions yourself: To avoid hurting your skin, don’t use a nail file, nail clipper or scissors on calluses, corns or warts. Don’t use chemical wart removers. See your provider or foot specialist (podiatrist) to remove any of these issues.
Cut your toenails carefully: Cut your nails straight across. Carefully file sharp ends with an emery board. Ask someone for help if you can’t trim your nails yourself.
Don’t keep the feet warm: Don’t do anything to warm the feet. Do not use very tight socks and wear comfortable footwear.
