India, the ‘diabetes capital of the world’, is home to around 77 million diabetics, out of which 25% of them develop diabetic foot disease. Find out what it is, how it’s caused, what its risk factors are along with its symptoms, diagnosis and management.
What is diabetic foot?
Simply put, diabetic foot is the spectrum of conditions occurring as a consequence of diabetes that affects your feet.
Diabetes, especially when left untreated, can lead to a multitude of serious complications. When your blood glucose levels are very high, they cause damage to your nerves and blood vessels. When this occurs, it leads to numbness, tingling and loss of sensation, commonly called diabetic neuropathy. This loss of sensation can allow injuries to go unnoticed, leading to serious infections and possible amputations.
Severe, persistent nerve damage can lead to long-term changes in the shape of your feet, making it appear like ‘rocker bottom’, called Charcot’s foot.
How is diabetic foot caused?
Some common causes include –
- Extremely high blood sugar levels – High glucose levels can slow down the healing process of an infected foot ulcer. People with type 2 diabetes tend to have a harder time fighting off infections because of ulcers
- Poor circulation – Poor blood circulation results from vascular disease in which blood doesn’t flow to the feet effectively. This is majorly due to blockage of blood vessels because of fatty/plaque deposits (atherosclerosis a condition common in diabetes resulting in fatty/plaque deposits obstructing the blood flow)
- Nerve damage- Long-standing nerve damage can lead to the loss of sensation in the feet, a condition called neuropathy
- Irritated or wounded feet – Dry skin is common in diabetes, making the feet more prone to cracking, corns, bleeding and infections
Who is at risk of developing diabetic foot?
Factors that increase your risk of developing diabetic foot include –
- Older age
- Male sex
- Duration of diabetes
- Alcohol consumption
- History of heart disease
- Wearing poorly-fitted or poor-quality footwear
Additionally, certain sociocultural factors that increase the risk, especially in rural India are –
- Walking barefoot
- Poor knowledge of foot care practices
- Lack of easy access to healthcare services
- Lack of adequate podiatry services
What are the symptoms of diabetic foot?
Some common symptoms are –
- Tingling, discomfort, or burning in the feet
- Swelling and redness in the feet or legs
- Muscle weakness or soreness in the thighs, legs and feet
- Shiny, smooth or dry skin
- Dry, thickened toenails or cuticles
- Calluses, sores or ulcers in the feet
When should I see my doctor for diabetic foot-related problems?
You should visit your doctor if you’re diabetic and experiencing the following symptoms –
- Altered sensation or numbness in your feet
- A cut, wound or blister on your feet that is taking a long time to heal
- Tenderness and redness over the area involved
- Discoloured or black skin which is giving a bad smell
- An ingrown toenail which looks infected or is causing pain and swelling
How is diabetic foot treated?
Based on the type and severity of symptoms, your doctor will outline the best course of action.
- Blood glucose management: Uncontrolled diabetes can lead to many serious complications. It is important that your blood glucose levels are within the normal range to promote wound healing and prevent further complications
- Infection control: If you have an infected wound or ulcer, your doctor will prescribe antibiotics to treat the infection. It is imperative that you take the entire course of antibiotics as prescribed
- Wound management: This involves surgical debridement where dead and infected tissue is scrapped off to promote healing, after which wound dressing is done. Some newer types of treatment include hyperbaric oxygen therapy, negative pressure wound therapy (NPWT) and granulocyte-colony stimulating factor (G-CSF)
- Offloading: Offloading refers to relieving pressure from the wound area to help healing and promote better blood circulation. You can be prescribed special footwear, casts, walkers or crutches
- Surgery: In severe cases, your doctor may recommend surgery such as percutaneous transluminal angioplasty (PTA), a procedure to restore blood supply to your leg and foot and prevent amputation
What happens in Percutaneous Transluminal Angioplasty (PTA)?
Your doctor performs this procedure under local anaesthesia.
- They create an incision in the groin to access the femoral artery and a thin catheter is advanced over the blocked area
- Through the catheter, they insert a microthin wire with a deflated balloon at the site of the blocked blood vessel
- Once the wire reaches the site of blockage the balloon is inflated for 30 sec-3 min and later
- This restores the blood supply to the leg
- In certain cases, a stent can also be used to provide additional support to the blood vessel
What are the complications of diabetic foot?
Diabetic foot comes with several complications such as –
- Gangrene (death of the tissue)
- Foot deformities
Will I need to get my foot amputated?
Amputation is required in advanced cases, where the wound is severe enough to damage the bone. In India, there are approximately 40,000 amputations yearly due to improper foot care. Factors that increase your chances of having to undergo an amputation include –
- Uncontrolled blood sugar levels
- Co-existing conditions such as high blood pressure, kidney disease, atherosclerosis
- Diabetic neuropathy
How can I protect myself from developing diabetic foot?
To minimise your chances of developing diabetic foot, follow the below recommendations –
- Frequently check your blood glucose levels and ensure that you maintain them within the normal range
- Examine your feet every day for any signs of wounds, cracks, sores or ulcers. Watch out for any pain, numbness, tingling sensation or changes in the shape of your feet.
- Maintain good feet hygiene. Wash your feet every day, dry them by applying gentle pressure and moisture well
- Trim your toenails regularly
- Seek immediate medical treatment if you identify any wounds, sores, cuts, redness or skin changes
- Follow your doctor’s advice and apply antibiotic creams and sterile bandages as advised.
- Wear proper, well-supporting and high-quality footwear. Absolutely avoid walking barefoot.
- Visit your podiatrist every 3 months
- Move your feet and toes several times throughout the day to promote blood flow