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How to take care of Diabetic Foot?

When a person is diagnosed to have diabetes- along with diet restrictions and medicines, he is advised to walk. No doubt diabetic patient should walk regularly but along with it, he should know what foot care needs to be taken to avoid complications resulting from Diabetes or Diabetic neuropathy.
India has become the capital of Diabetes in the world. We have the largest number of diabetic people. Diabetes is a disease which can be controlled but there is no cure. Hence when it is long-standing it is associated with some of the systemic complications like- Kidney affection- nephropathy, Eye affection- retinopathy. Similarly when it affects the nerves- its called as Neuropathy and usually, it affects feet- although it may affect other body parts also.

What is Diabetic Neuropathy?
Due to long-standing Diabetes nerves may get affected impairing their function like sensations or movements. Usually, its sensory components which will affect the sensations like superficial touch, temperature, joint position sense. It can affect any body part but feet are affected more often.

What are its ill effects
– Ulcer- wounds
– Deformity- Charcot’s joints
– Infections
– Skin and nail problems

1. Ulcers / Wounds

Diminished superficial touch, temp, or pain will result in unnoticed injuries. Patients notice these injuries very late when others see their wounds or themselves when wounds are seen or palpated accidental.
These wounds take lot of time for Diabetics to heal because of
– Increased sugar levels- predisposing to infection
– Maybe decreased blood supply
– Loss of protective sensations
– Due to which patient keeps on loading the injured part abnormally preventing the healing. Person with normal sensations when gets a wound
– Due to the pain he reports early to the doctor, does not bear weight on it and takes the treatment on time so that the wound heals rapidly.

2. Charcot Joints-

A diabetic person with neuropathy gets the destruction of joints without much pain. These joints are called as Charcot’s joints.They need to be protected in shoes or braces throughout life. In some cases, the deformities may need to be corrected with surgery to avoid ulcer formation. But even if they are operated lifelong support and care is needed.

3. Infections

Wounds in Diabetics may get infected. There may be soft tissue infections or bony infections. Infections may remain local or may spread to become life-threatening systemic infections. Local infections can be treated with debridements- i.e cleaning of wounds and antibiotics Itraconazole Without Prescription life-threatening infections few times amputation of the toe, foot or leg may be required.

4. Skin and nail problems

Corns-
Patient with neuropathy has fewer sensations than normal. The common misconception in general population is corn results secondary to thorn rock or foreign body injury. But in Diabetics its Pressure callosity- means resulting from Pressure. Basically, the superficial touch, Temperature or joint position sensations are protective for the individual. Due to impaired joint position sense, the person starts loading the joint abnormally. The parts of the sole which are not supposed to bear weight if they are loaded- then it results in corns. They need not be excised with surgery as they will recur. Special footwear or special insoles are needed to redistribute the weight.

Cracks / fissures –
Diabetic neuropathy causes fewer secretions in the skin increasing the dryness of skin. Hence there is a tendency to form fissures or cracks on the sole. These cracks, later on, may become infected. It can be avoided by using moisturizer or Vaseline in the cracks before going to bed.

Nail bed infections –
There may be repeated nail bed infections which need to be taken care by cutting the nails properly. Avoid cutting the nails too short as it may result in ingrowing
toenails.

Who will suffer from neuropathy?
Not every diabetic patient will suffer from diabetic neuropathy. Usually, long-standing diabetics have diabetic neuropathy. Neuropathy is independent of the sugar control.

What is the treatment of neuropathy?
Actually, there is no cure for neuropathy. Once neuropathy is developed every care should be taken to prevent the complications of neuropathy. The aim of treatment is to keep the foot ulcer free and plantigrade.

Pressure + Neuropathy = Wound

Neuropathy cannot be treated.
Hence to treat the wound we need to take away the pressure. In a normal person due to the pain he himself takes away the pressure by not waling on the wound, but in a neuropathy, person patient keeps walking on the wound. This repetitive trauma makes it difficult for the wound healing. Special shoes or insoles in the shoes are needed for the offloading.

Management of Neuropathy Prevention is better than Cure.

We need to understand the foot care in people who have Diabetic neuropathy. It is also helpful for people who are prone to develop neuropathy.

– Maintain good control of blood sugar
– Walk regularly, but never walk Barefoot
– Wear cotton socks
– Take care to dry the feet completely after washing with water.
– Wet areas between toes will cause maceration and also fungal infection.
– One should always examine his feet with his hands as hands have better sensation than feet
– One may use the mirror with the handle to see the bottom part of the foot which is not easily seen in elderly patients.
– Family members should check feet of diabetic patients every weekend and periodic follow up with doctors will help to detect some early changes.
– What is to be seen on Daily, Weekly or monthly check?
– one should see if there are hard callosities, callosities or fissures.
– To avoid dryness or fissures while going to bed one may use moisturizer or Vaseline.
– To check the footwear regularly, as a damaged footwear may also be a cause for a wound.
– Pl buy a footwear of correct size ( Best to buy in the evening as feet are swollen in the evening)
– Avoid footwear with narrow toe box.
– If you note any corn or callosity please do not excise or remove on your own as many time it is not necessary to remove it.
– Custom made insoles will redistribute the load and they will heal on its own.
– Many times some interventions at home in nonsterile conditions may result in infections.
– Stop smoking. Diabetes and smoking is the worst combination for the feet.

What are Complications of Diabetic Neuropathy?
– Non-healing wounds- chronic non-healing ulcers over few months or years
– Osteomyelitis- infection of the underlying bone
– Amputation – removal of a toe and some part of a foot or leg may be necessary to salvage the limb or sometimes life also.

Hence, Regular checks, Proper footwear and awareness about the complications
of diabetic neuropathy are keys to success in prevention and treatment of
Diabetic Neuropathy.