Prevent diabetic foot to save your feet
With damage to the nervous system, a person with diabetes may not be able to feel his feet properly. Smoking disrupts the healing process and is a major risk factor for infections.If not treated or controlled early, diabetic foot problems may lead to amputation of legs or feet
DrJohnyKannampilly, Consultant Diabetologist& Diabetic Foot Specialist,
Lakeshore Hospital & Research Centre Ltd
Diabetes mellitus (DM) represents several diseases in which high blood glucose levels over time can damage the nerves, kidneys, eyes, and blood vessels. Diabetes can also decrease the body's ability to fight infection. When diabetes is not well controlled, damage to the organs and impairment of the immune system is likely. Foot problems commonly develop in people with diabetes and can quickly become serious.
- With damage to the nervous system, a person with diabetes may not be able to feel his or her feet properly. This is called peripheral neuropathy. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired. These factors together can lead to abnormal pressure on the skin, bones, and joints of the foot during walking and can lead to breakdown of the skin of the foot. Sores may develop.
- Damage to blood vessels and impairment of the immune system due to diabetes make it difficult to heal these wounds. Bacterial infection of the skin, connective tissues, muscles, and bones can then occur. These infections can develop into gangrene. Because of the poor blood flow, antibiotics cannot get to the site of the infection easily. If the infection spreads to the bloodstream, this process can be life-threatening.
Fifteen per cent of diabetics will have diabetic foot problems, 50 per cent of these will undergo amputation and 80 per cent of these amputations can be prevented if treated early by the diabetic foot specialist.
Several risk factors increase chances of developing foot problems and diabetic infections in the legs and feet.
- Footwear: Poorly fitting shoes are a common cause of diabetic foot problems.
- If the patient has red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new properly fitting footwear must be obtained as soon as possible.
- If the patient has common foot abnormalities such as flat feet, bunions, or hammertoes, prescription shoes or shoe inserts may be necessary.
- Nerve damage: People with longstanding or poorly controlled diabetes are at risk of havingdamage to the nerves in their feet. The medical term for this is peripheral neuropathy.
- Because of the nerve damage, the patient may be unable to feel their feet normally. Also, they may be unable to sense the position of their feet and toes while walking and balancing. With normal nerves, a person can usually sense if their shoes are rubbing on the feet or if one part of the foot is becoming strained while walking.
- A person with diabetes may not properly sense minor injuries (such as cuts, scrapes, blisters), signs of abnormal wear and tear (that turn into calluses and corns), and foot strain. Normally, people can feel if there is a stone in their shoe, then remove it immediately. A person who has diabetic neuropathy may not be able to perceive a stone. Its constant rubbing can easily create a sore.
- Poor circulation: Especially when poorly controlled, diabetes can lead to accelerated hardening of the arteries or atherosclerosis. When blood flow to the injured tissues is poor, healing does not occur properly.
- Trauma to the foot: Any trauma to the foot can increase the risk for a more serious problem to develop.
- Athlete's foot, a fungal infection of the skin or toenails, can lead to more serious bacterial infections and should be treated promptly.
- Ingrown toenails should be handled right away by a foot specialist. Toenail fungus should also be treated.
- Smoking: Smoking any form of tobacco causes damage to the small blood vessels in the feet and legs. This damage can disrupt the healing process and is a major risk factor for infections and amputations.
- Persistent pain can be a symptom of sprain, strain, bruise, overuse, improperly fitting shoes, or underlying neuropathy.
- Redness can be a sign of infection, especially when surrounding a wound, or of abnormal rubbing of shoes or socks.
- Swelling of the feet or legs can be a sign of underlying inflammation or infection, improperly fitting shoes, or poor venous circulation. Other signs of poor circulation include:
- Pain in the legs or buttocks that increases with walking but improves with rest (claudication)
- Hair no longer growing on the lower legs and feet
- Hard shiny skin on the legs
- Localised warmth can be a sign of infection or inflammation, perhaps from wounds that won't heal or that heal slowly.
- Any break in the skin is serious and can result from abnormal wear and tear, injury, or infection. Calluses and corns may be a sign of chronic trauma to the foot. Toenail fungus, athlete's foot, and ingrown toenails may lead to more serious bacterial infections.
- Drainage of pus from a wound is usually a sign of infection. Persistent bloody drainage is also a sign of a potentially serious foot problem.
- A limp or difficult walking can be a sign of joint problems, serious infection, or improperly fitting shoes.
- Fever or chills in association with a wound on the foot can be a sign of a limb-threatening or life-threatening infection.
- Red streaking away from a wound or redness spreading out from a wound is a sign of a progressively worsening infection.
- New or lasting numbness in the feet or legs can be a sign of nerve damage from diabetes, which increases a person’s risk for leg and foot problems.
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