Sixty to eighty per cent of all non-traumatic amputations have to be performed due to complications caused by diabetes. Over half of these amputations can be prevented by prompt and aggressive treatment if the complications are identified in time. Dr Narendranadh Meda, a vascular surgeon at KIMS Hospital, explains why it’s important for diabetics to inspect their feet every day for signs of injury, infection, or even a change in colour or shape.
1. What are foot-ulcers?
Foot-ulcers are a common complication observed in patients with poorly-controlled diabetes. They form as a result of the breakdown of skin tissue, which exposes the inner layers, and they usually develop under the big toe or on the ball of the foot. Diabetics are prone to the formation of ulcers because of the associated peripheral vascular disease and peripheral neuropathy.
2. Can mild scratching lead to foot-ulcers in diabetics?
Yes, prolonged diabetes damages the nerves of the feet, and the absence of pain can cause small injuries to go unnoticed. Diabetes also reduces blood flow to the feet, especially if accompanied by high blood pressure, smoking, high cholesterol levels, or obesity. A combination of these conditions predisposes a patient to secondary infections, which is why it is important for diabetics to check their feet daily to identify calluses, corns, infections, or ingrown toenails that can develop into ulcers.
3. In a person suffering from peripheral artery disease (PAD), is the condition aggravated by the onset of diabetes?
Yes, diabetes can aggravate and accelerate PAD and the hardening of arteries. One in every three diabetics over the age of 50 is likely to develop PAD. The disease causes the blockage of arteries, a reduction in blood supply resulting in claudication pain, a delay in the healing of wounds, and even gangrene, which can cause limb-loss if left untreated.
4. Is PAD preventable or treatable?
Diabetics, hypertensive patients and smokers are prone to develop PAD, and the three conditions can have a cumulative effect. Treatment of PAD is possible if these three conditions are managed. It involves debridement, offloading and infection control. Dressings may be applied on wounds to improve healing.
5. What are the consequences of leaving foot ulcers and PAD untreated?
Diabetic foot ulcers are associated with high morbidity and mortality rates. The mortality rate associated with ischaemic (PAD) ulcers is higher than that associated with neuropathic ulcers. Amputation of the lower limbs is also much more common among diabetics than non-diabetics; five out of every six amputations are performed on diabetics. The data shows that 25 per cent of diabetics admitted to hospitals are admitted for foot lesions, and 40 per cent of them require amputations.
6. What are the measures that a diabetic patient can implement to prevent foot ulcers and PAD?
The best strategy is to manage diabetes through a healthy diet, regular exercise, blood sugar monitoring and adherence to the prescribed medication regimen. Taking proper care of the feet and seeking prompt medical care in case of any sign of a problem is also important.
a) Inspect feet daily — Check feet every day for blisters, cuts, cracks, sores, redness, tenderness and swelling.
b) Wash feet daily — Wash feet in lukewarm water once a day, and pat them dry. Sprinkle talcum powder or cornstarch between the toes to keep the skin dry. Use a moisturising cream or lotion on the top and bottom of your feet to prevent the formation of cracks.
c) Don’t try to remove calluses or lesions — Make sure you don’t use a nail file or scissors on calluses, corns, bunions or warts.
d) Buy the right shoes — Buy your footwear in the evening as the feet tend to expand then. Avoid high-heels and opt for Velcro shoes rather than ones with laces. Keep at least 2-3 pairs of shoes in your rotation, and replace them once a year.
h) Don’t smoke — Smoking impairs circulation and reduces the amount of oxygen in your blood. This can result in more severe wounds and poor healing.