Diabetes mellitus is a chronic metabolic disorder that presents with abnormally increased blood sugar levels. It occurs due to absolute or relative insulin deficiency. There is reduced production of insulin in the pancreas or resistance to the action of insulin. Diabetics are prone to develop foot problems like deformities, ulceration and death of tissue (gangrene).
What leads to foot problems in diabetes?
Diabetics with advanced cases have many complications like neuropathy resulting in numbness of feet and weakness of foot muscles leading to foot deformities. Peripheral arterial disease results in reduction of blood flow and delivery of less oxygen and nutrients to peripheral tissues. Therefore any injury to foot results in delayed healing. Deformities of the foot alter foot biomechanics leading to the development of areas of high pressure on the sole during ambulation. This pressure-induced trauma increases the risk of foot ulceration and also the risk of amputation.
What is the risk of amputation of foot in diabetes?
Diabetes is the leading cause of non-traumatic amputation of the foot. Research has shown that 2.5% of diabetic patients develop foot ulcers each year and 15% develop ulcers during their lifetime. An amputation not only reduces the quality of life but also increases health and socio-economic problems. Its adds to the financial burden of the affected person as well as the state. Early recognition and management of risk factors for foot complications as well as proper foot care may prevent amputations. The following advice has been found very useful and is recommended in all diabetic patients.
Regular foot care: The affected person should inspect the foot daily for any skin damage in the form of cuts, blisters or abrasions. A mirror should be used to view the underside of foot. In case of poor vision, this may be done by another family member, although a regular visit to a foot care specialist is recommended. Moisturiser should be applied daily after washing and drying the feet. The area between the toes should be cleaned. Avoid prolonged soaking of feet in water to prevent maceration of skin especially between the toes. This is usually done before going to bed. Moisturiser prevents cracking of skin. Trimming of nails should be done regularly. Avoid walking barefoot.
Protection from heat and cold: Avoid using very hot water to wash feet. Burns may occur especially in people whose feet are numb as a result of neuropathy. The temperature of the water should be checked by somebody at home. They should be careful before stepping on barefoot on a beach as the sand may be very hot. Even the area around a swimming pool may also be quite hot.
During winters, feet may be kept warm by wearing socks and keeping indoors in warm environment. Direct application of heat from hot water bottle, heating pad or electric blanket should be avoided.
Avoid using sharps on your foot: It is advisable not to perform any bathroom surgery for corns with a blade. Use of a corn cap may also damage adjacent skin. Any minor foot problems should be dealt by a chiropodist or a surgeon.
Footwear: For loose fitting footwear, buy shoes one size larger. It is preferable to buy a new pair in the evening when the foot size may be larger due to dependency associated swelling. The inside of the shoes should be soft and gentle with adequate cushioning. Inspect it daily for any objects like stones or nails. Always wear shoes with socks so as to avoid friction between the feet and shoes.
No smoking: Use of tobacco in any form should be completely stopped.
Dr. Uday Singh Dadhwal
(Specialist General Surgery)
Bahrain Specialist Hospital