Effects of diabetes on heart, kidney and the eye are well known. The changes in the foot are often ignored. No more ‘My Foot’ attitude warns Consultant General and Vascular Surgeon Dr.G.Sivakumar
1. Why is the foot at risk in a patient with diabetes?
The long-term effect of diabetes is widespread and affects almost every structure of the foot. The nerves are predominantly affected and this leads to loss of protective sensation. This leads to structural changes in the foot (arch collapse). The blood vessels are clogged by macroangiopathy and this results in ischaemia. Sepsis ravages the already delapitated foot.
2. Can a diabetic avoid foot complications?
All diabetic foot ulcers are predictable and preventable. The insensitive foot of the diabetic patient is an important forerunner. Simple screening of the diabetic foot requires less than two minutes per patient. Preventive screening can identify the patients in whom attention to education and footwear could potentially prevent the majority of major amputations. Physicians should never forget routine foot screening and patients should seek periodic foot evaluation.
Also read: Tips to choose the right diabetic footwear
3.Who are at a risk to develop foot ulcers?
The most common event that may lead to amputation is an “ulcer” – this occurs because a person could not feel the injury and is caused by nerve damage due to prolonged diabetes. This is called “neuropathy”. Patients with loss of protective sensation or with poor circulation in the feet have deformed feet that alters the foot contact to the surface during walking. This altered foot pressure creates pressure points which ulcerates.
Also read: Is Stress Linked to Diabetes
4.Who manages these foot complications in the diabetics?
The diabetologist primarily manages the holistic care of diabetes. The team members who implement preventive and therapeutic strategies are foot surgeons, vascular surgeons, plastic& reconstructive surgeons, and orthopaedic surgeons, podiatrists, physiotherapists, and rehabilitation specialists.
Also read: Stress and Diabetes
5.How does a diabetic develop foot ischaemia?
Diabetes mellitus along with cigarette smoking, hypertension, and hyperlipidemia, is a major risk factor for the development of arterial disease in the lower extremity. 15 to 20 % of the diabetics have reduced blood flow to the limb. The arterial disease is characteristically a major vessel occlusive complication involving the iliac, femoral, tibial and peroneal arteries.
6.How is the foot ischaemia assessed?
The diagnosis is made by a good clinical examination. Doppler measurement of the ratio of the ankle blood pressure to the brachial blood pressure is useful. Non-invasive arterial duplex ultrasound scanning is done when symptoms and physical findings suggest a vascular occlusion. When occlusion warrants reconstructive surgery arteriography is done.
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7.How is ‘neuropathy’ assessed?
Most of the foot problems are primarily a consequence of neuropathy due to loss of protective sensation. A quick & effective method of screening for neuropathy is the Semmes-Weinstein monofilament. This can be done by the patients themselves and assess their impaired sensation in the foot.
8.Does it also affect the joints in the limb?
Neuropathy produces joint destruction and this is termed Charcot’s joint. The first symptoms of the Charcot foot are swelling and warmth of the foot and ankle. Most patients with diabetic foot do not feel any pain.
9.Are ‘corns’ in the sole dangerous?
Callosities in the foot of diabetics are mainly trophic in nature and they should not be mistaken for ‘corns’. This requires carefully designed shoes by an experienced professional for prevention of complications. All patients with loss of sensation must have protective and correct footwear.
Barefoot walking is dangerous and leads to foot sepsis.
Also read: Clinical signs of Diabetic Foot syndrome
10.Why does infection in a diabetic foot takes a long time to heal?
Every foot needs to be assessed individually and when treated appropriately the foot infection gets controlled and amputations can be averted. The mainstay in therapy is adequate rest to the foot so that the insensitive foot heals. If major vascular occlusion is identified and reconstructable, prompt vascular surgery heals the ulcer in the diabetic foot.
Pic courtesy: indiatoday.in