Preventive Foot Care in Diabetes

Introduction:

A majority of the diabetic patients admitted to various hospitals come for the management of lower limb and foot infections as well as gangrene. Most of these problems happen due to poor management and a general lack of awareness among the public about the repercussions of these problems. An amputation of a limb is a life-altering disability. Often, this procedure is undergone by the sole earning member of the family, and this causes a financial crisis within the household.

What Are the Ten Points for the Prevention of Diabetic Foot Problems?

Following are the measures to care for feet and prevent diabetic ulcers:

• Inspect the foot twice a day for abnormal findings.

• If callosities or ulcerations are found, consult a podiatric surgeon to prevent complications.

• Check the foot for early signs of infection and take immediate action.

• If anything abnormal is found, the first and most important step is to ‘offload’ the foot, meaning it should bear no weight.

• If blood circulation to the foot is low, seek the doctor’s advice for revascularization if necessary.

• Consult a podiatric surgeon to discuss the best type of diabetic footwear for individual needs.

• Share these foot care tips with friends with diabetes so they can also care for their feet.

• Keep blood sugar levels under excellent control with the expert advice of a diabetologist.

• Avoid foot amputation unless foot infection threatens life.

Could Nerve Damage Be Present in Diabetic Patients?

Individuals with diabetes are susceptible to nerve damage. Certain factors that heighten this risk of developing nerve damage are mentioned below:

1. Difficulty in managing blood sugar levels.

2. Long-standing diabetes, particularly with frequent elevations above target levels.

3. Being obese or overweight.

4. Age exceeding 40 years.

5. Presence of high blood pressure.

6. Elevated cholesterol levels.

Nerve damage is another complication of diabetes. This, coupled with poor blood flow, increases the risk of developing a foot ulcer, sore, or wound that could become infected and heal poorly. If an infection fails to respond to treatment, surgical amputation of the toe, foot, or part of the leg may be necessary to prevent the disease from spreading and to preserve life.

Regular foot examinations enable early detection and prompt treatment of issues, significantly reducing the risk of amputation. To prevent nerve damage or keep it from worsening, aim to keep the blood sugar within the target range as often as possible. More good habits for managing diabetes include:

• Avoid smoking (as it lowers blood flow to the feet).

• Stick to a healthy eating routine with more fruits and vegetables and less sugar and salt.

• Stay physically active, aiming for ten to 20 minutes a day rather than doing an hour once a week.

• Take the prescribed medications as directed by the doctor.

Why Should Amputations Be Avoided in a Diabetic Patient?

In diabetes, the blood vessels are the major target organs. So, all the organs in the body subsequently get involved. When the lower limb has a peripheral obstructive vascular disease, nearly all the organs are already affected by ischemia. The blood vessels of the heart are also greatly damaged. Many studies have shown that in a diabetic patient, walking, even with the best of a prosthesis, strains the heart by over 15 percent. Many studies have proven that in a diabetic patient who walks routinely with a below-knee prosthesis, there is a 50 percent mortality rate in five years due to cardiac failure. With an above-knee prosthesis, there is a 50 percent mortality rate in three years due to cardiac failure. Thus, the primary reason one tries to prevent major amputations in diabetic patients is not to improve their quality of life but to increase their longevity.

In a diabetic patient, one of the significant tissue changes is due to ‘nonenzymatic glycation,' which affects all the soft tissues in the patient’s body. This, in turn, immensely lowers the cell-mediated immunity. In such a case, if a lower limb infection occurs and it is improperly managed, the disease can spread like 'wildfire' and can cause a loss of limb or even life.

The surgical treatment of lower limb infections in people with diabetes is managed with proper debridement. Once thoroughly debrides the infected areas, the tissue is sent for bacterial and fungal culture and sensitivity. The patient is then administered culture-specific antibiotics and, if required, anti-fungal medication. An appropriate wound dressing, strict offloading of the involved limb, and supportive therapy are necessary.

When Are Reconstructive and Corrective Foot and Ankle Surgeries Done?

Another serious foot and ankle problem that can happen in an uninformed diabetic is osteoarthropathy of the foot and ankle bones. This is also called the ‘Charcot foot.' In this condition, the foot bones become soft and lose density due to the autonomic neuropathy in diabetes. As an analogy, consider a wooden board soaked in water for over six weeks. It would become soft, soggy, spongy, and brittle. Patients who walk with these soft feet bones develop fractures, erosion, and severe destruction. When detected early, they can be managed conservatively. In untreated cases, the foot and ankle bones become severely destroyed, and usually, the patient is subjected to a below-knee amputation. In specialized centers, though, the foot can be salvaged by undergoing a 'reconstructive foot and ankle surgery' with excellent results.

What Are Some Tips for Maintaining Healthy Feet?

The tips for maintaining healthy feet include:

• Check feet daily for cuts, redness, swelling, sores, blisters, corns, calluses, or skin or nail changes. If one cannot see the bottom of the feet, use a mirror or ask for help.

• Wash feet daily in warm water, not hot. Dry thoroughly and apply lotion to the top and bottom, avoiding between toes to prevent infection.

• Always wear shoes and socks or slippers indoors to prevent injury. Check shoes for debris and ensure the lining is smooth.

• Choose well-fitting shoes, trying them on at the end of the day when one’s feet are largest. Break in new shoes gradually and wear socks with them.

• Trim toenails straight across and file sharp edges. Have a podiatrist trim them if the patient cannot see or reach the feet.

• Avoid self-removal of corns or calluses and refrain from using over-the-counter products to prevent skin burns.

• Have feet checked at each healthcare visit and see a podiatrist annually (more frequently with nerve damage) for a comprehensive exam.

Conclusion:

The diabetic foot and lower limb diseases commonly encountered by individuals include extensive lower limb necrotizing fasciitis, diabetic foot infections including gangrene with peripheral vascular disease, and Charcot’s foot, some with marked destruction of the foot and ankle bones and grossly deformed toes and feet. These deformed feet and toes can develop high-pressure points, callosities, and ulcers, which in these immunocompromised patients are portals for bacterial entry, leading, as said earlier, to limb and life-threatening infections. Hence, these foot abnormalities must be surgically corrected. Suitable molded footwear and proper foot care can often avoid serious complications and prevent surgery.