Diabetes Foot Care

what is diabetic foot ?

Dr. Rajesh Jain May 7, 2019 107

DIABETES IN FOOT

Diabetic foot is one of the significant common, costly, and severe complications of diabetes. Amputation in folks with diabetes is ten to twenty times more common than in folks while not diabetes, and it’s estimated that every thirty seconds, a lower limb or a part of a lower limb is lost somewhere within the world as a consequence of diabetes.

A diabetic foot is any pathology that results directly from peripheral arterial disease (PAD) and sensory neuropathy affecting the feet in diabetes mellitus; it is a long-term (or “chronic”) complication of diabetes mellitus.^[1]^[2] The presence of several characteristic diabetic foot pathologies such as infection, diabetic foot ulcer, and neuropathic osteoarthropathy is called diabetic foot syndrome.

Due to advanced peripheral nerve dysfunction associated with diabetes (diabetic neuropathy), patients’ feet have a reduced ability to feel pain. This means that minor injuries may remain undiscovered for a long while and may progress to a full-thickness diabetic foot ulcer. The feet’ insensitivity to pain can quickly be established by 512 mN quantitative pinprick stimulation.^[3] Research estimates that the lifetime incidence of foot ulcers within the diabetic community is around 15% and may become as high as 25%.^[4]

In diabetes, peripheral nerve dysfunction can be combined with peripheral artery disease (PAD), causing poor blood circulation to the extremities (diabetic angiopathy).^[5] Around half of the patients with a diabetic foot ulcer have co-existing PAD.^[6] Vitamin D deficiency has been recently associated with diabetic foot infections and increased risk of amputations and deaths.^[7]

Where wounds take a long time to heal, the infection may set in, spreading to bones and joints, and lower limb amputation may be necessary. Foot infection is the most common cause of non-traumatic amputation in people with diabetes.

The diabetic foot may result in a crucial economic, social, and public health burden, especially in low-income communities, if there’s neither associate degree acceptable instructional program nor adequate and appropriate footwear.

SYMPTOMS OF FOOT PROBLEM CAUSED BY DIABETES

People with diabetes are at increased risk for problems with the feet. Some symptoms related to diabetic food are given below:-

Cracking of the skin of the feet, especially the heels, due to dry skin
Diabetes can lower the amount of blood flow in your feet.
Hammertoes or bent toes due to muscle weakness.
Fungal infections of the nails can appear as thickened, discolored, and at times brittle nails.
Enough blood flowing to your legs and feet can make it hard for a sore or an infection to heal.
Charcot’s foot may start with redness, warmth, and swelling.
It may develop due to abnormal alignment of the feet or abnormal weight

RISK FACTOR

Common risk factors for the development of foot ulcers in diabetics include:

Peripheral vascular disease
Neuropathy
Poor glycemic control
Cigarette smoking
Diabetic nephropathy
Previous foot ulcerations/amputations

TREATMENT

Treatment of diabetic foot ulceration can be challenging and prolonged; it may include orthopedic appliances, surgery, antimicrobial drugs, and topical dressings.^[10]

Most diabetic foot infections (DFIs) require treatment with systemic antibiotics. The choice of the initial antibiotic therapy depends on several factors, such as the severity of the disease, whether the patient has received another antibiotic treatment for it, and whether the disease has been caused by a micro-organism that is known to be resistant to usual antibiotics (e.g., MRSA). The objective of antibiotic therapy is to stop the infection and ensure it does not spread.^[13]

It is unclear whether any particular antibiotic is better than any other for curing infection or avoiding amputation. One trial suggested that ertapenem with or without vancomycin is more effective than tigecycline for resolving DFIs. It is also generally unclear whether different antibiotics are associated with more or fewer adverse effects.^[8]

However, it is recommended that the antibiotics used for the treatment of diabetic foot ulcers be used after deep tissue culture of the wound. Tissue culture and not pus swab culture should be done. Antibiotics should be used at correct doses to prevent the emergence of drug resistance. It is unclear if local antibiotics improve outcomes after surgery.

Treatment depends upon the type of foot problem treatment. Some cases are given below:-

Diabetic socks or thick padded socks should be worn inside shoes that fit correctly and offer good support.
Surgery may be necessary to correct severe cases for some conditions like hammertoes, bunions, and ingrown toenails.
Keeping blood sugar levels under control (in the ranges advised by your doctor) and following your recommended diet and exercise program are the best way to prevent all complications of diabetes, including foot problems.
Don’t walk barefoot. Even at home, always use slippers while walking.
Be sure your feet do not get burned by walking on the scorching pavement in summer.
Check your feet daily for any sores or problems.
Always wash your feet with warm water and dry them well after washing.

Prevention

Prevention of diabetic foot may include optimizing metabolic control via the regulation of blood glucose levels; identification and screening of people at high risk for diabetic foot ulceration, especially those with advanced, painless neuropathy; and patient education to promote foot self-examination and foot care knowledge. Patients would be taught routinely to inspect their feet for hyperkeratosis, fungal infection, skin lesions, and foot deformities. Control of footwear is also essential as repeated trauma from tight shoes can trigger ^[9], especially where peripheral neuropathy is present. Evidence is limited that low-quality patient education courses have a long-term preventative impact.^[10] A recent work critically evaluated the existing foot screening guidelines to examine their completeness in terms of advancement in clinical practice, technology improvements, and socio-cultural structure changes. This work highlighted that limitations of currently available guidelines and lack of evidence on which the guidelines are based are responsible for the current gaps between policies, standard clinical practice, and the development of complications. To develop common recommendations and everyday clinical practice, it will be necessary to pay more attention to the limitations of guidelines and the underlying evidence.^[11]

According to a 2011 meta-analysis, “Of all methods proposed to prevent diabetic foot ulcers, only foot temperature-guided avoidance therapy was found beneficial in RCTs.”

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Dr. Rajesh Jain

Dr. Rajesh Jain MD PG Diploma Diabetes, UK

The diabetesasia is the advocate for the people currently living with diabetes Burden & NCDs Risk. Global Diabetes Walk campaign remind us to Prevent diabetes.

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