Question

Foot Care In Diabetes Mellitus!

Dr.B Ramya · Accepted Answer

Diabetes Mellitus is a metabolic disorder, which when left uncontrolled, can lead to irreversible complications. Hence it is highly essential that Diabetic patients not only do regular tests but also do regular self-examination, especially of their feet to detect any abnormality at the earliest.
In long-standing Diabetes, especially if the control is not satisfactory, the following mechanisms make the feet highly prone to ulcers and infections which form a vicious cycle with high blood sugars:

1) DRY SKIN - Sweating is crucial to the maintenance of normal skin moisture. However, when the autonomic nerves controlling sweat glands are affected in Diabetes, sweating decreases, leading to dryness of the skin. Dry skin, in turn, is at greater risk of cracks or ulcers that can eventually get infected.

2) DECREASED BLOOD SUPPLY TO THE LOWER LIMBS - Long term Diabetes can lead to changes in the blood vessels in such a way that the blood supply to the legs is reduced. This is called PERIPHERAL VASCULAR DISEASE ( PVD). Patients with PVD will eventually have severe pain, frequent ulcers, infections and delayed wound healing. That, in turn, may result in GANGRENE ( DEATH of tissue presenting as blackish discoloration) requiring amputation.

3) DECREASED PAIN SENSATION - PAIN is indeed a protective sensation which brings to our notice the slightest injury at the earliest. However, in Diabetes when the nerves carrying pain are affected, the patient's ability to perceive pain is greatly impaired. Hence minor ulcers or injuries may go unnoticed.

4) ABNORMAL FOOT ARCHITECTURE - The presence of a normal muscle tone is of paramount importance in holding the bones and joints in the right position, thereby maintaining the normal foot architecture. However, in longstanding, uncontrolled Diabetes, the nerves controlling muscles are affected resulting in loss of muscle tone. This results in the abnormal structure of the foot. When body weight is borne on such an abnormal foot, it results in callus or ulcers.

5) DECREASED IMMUNITY - Diabetes can also impair the immune response of the body, Hence recovery from infections is often difficult and delayed.

Hence FOOT CARE in Diabetes is of utmost importance. The components of Foot Care by the patient himself, are as follows :

1) DAILY FOOT EXAMINATION AT HOME: This is the easiest and best way to prevent and detect serious complications pertaining to the feet.
This involves the following simple steps that do not require anybody's assistance and can be quickly performed -

Daily thorough cleaning of both feet, soles and spaces between toes
Careful examination of the feet to detect callus ( thickened skin), fissures, ulcers, boils
To look for fungal infection in the spaces between toes
To look for the change of color of nails and the surrounding tissue
To look for any discoloration of the skin ( reddening/blackening)
To check if there is any numbness or burning sensation

If any of the above reveals an abnormality, it should be immediately reported to the doctor.

2) AVOIDANCE OF BAREFOOT WALKING - As the feet are already at high risk it is not advisable to walk without appropriate footwear.

3) RIGHT KIND OF FOOTWEAR - The footwear must be roomy and not tight so that excess accumulation of sweat can be avoided. In addition, excess pressure on any part of the foot is to be avoided. Those who already have foot problems should go for customized footwear.

4) TO DO PERIPHERAL ARTERIAL DOPPLER to check the adequacy of blood flow to the feet and BIOTHESIOMETRY to check the sensations. These tests are done once a year or as advised by the doctor

5) To keep the blood sugars, blood pressure and cholesterol under good control.

6) AVOIDANCE OF SMOKING AND ALCOHOL

7) REGULAR WALKING

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