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Courtesy : Subhadra Nambudiri Foundation
Diabetic Foot And Inherent Dangers
Diabetes Mellitus is known to affect the eyes,
kidney and even sexual prowess over a period of time but not many patients know
that a diabetic foot could lead to frog foot, ulcers, gangrene and ultimately
amputation. Even an insignificant work like cutting of nails could cause
unimaginable problems, if one is suffering from a diabetic foot. . Diabetic foot
is present in two per cent of the country's diabetic population. Compared to
non-diabetics, gangrene and chances of an amputation of the leg are 53 times
higher in males and 71 times higher in females.
Diabetic foot involves multiple important
structures of the foot. The foot muscles are involved leading to frog foot. The
prominent bones at the base of the toes press against the ground while walking ,
causing ulcers. Adding to the problem is reduction in blood supply as the
smaller arteries of the foot and distal leg are narrowed and thickened (Micro -Angiopathy)
This leads to lack of nutrition and protection of foot tissue by White Blood
Cells.
The combination of above factors causes ulcers
which get infected leading to abscess and ultimately gangrene with the end
result being an amputation. According to Dr. Jaisom Chopra, Vascular Surgeon
with Batra Hospital , New Delhi. "The dreaded complication of diabetic foot
is that it affects nerves, causing inability to recognize cold/hot or pain
sensation."
One should suspect a Diabetic Foot , if he has
diabetes and develops minor injury followed by redness or blackness. Pain may or
may not be present. "Infact if you note any abnormal change in your foot
contact a Doctor." Says Dr. Chopra. . Dr. Chopra says micro-angiopathy
starts even before the patient is diagnosed as a diabetic and cannot be
controlled by keeping blood sugar in check nor has it any relation to the
severity of diabetes. It progresses at its own pace.
Treatment of Diabetic Foot · The treatment
starts at home which includes taking meticulous care of the diabetic feet, much
before ulcers develop. · To avoid direct heat by hot water bottles or fire
places. · In case of cold feet, use warm socks or gauge the temperature of the
hot water bottle with your hands which have normal sensation, before using it ·
Avoid injury to your feet while cutting nails.
According to Dr. Chopra, causing injury to one's
feet while cutting nails is a very common cause of infection followed by
gangrene and foot lose. Should you injure your feet, do consult a vascular
surgeon immediately.
"If ulcers or gangrene of the feet develops
one should get admitted at the hospital as it is the safest way to save your
feet from amputation," he says.
Hospitalization is necessary due to the following
reasons:- · Lack of pain makes you neglect them · Many Diabetics have poor
vision due to retinopathy and therefore can't do a good job. · Many Diabetics
suffer from heart failure with oedema which needs correction as it worsens
ulcers. This can be done in the hospital only. · Once in hospital the doctor
will closely examine the ulcer, paying particular attention to its base as the
infection is tracking deeper than anticipated and may be involving the bone
Diabetic Ulcer is caused due to many factors ,and
it can be of three types:- (a) Involving Arteries (b) Involving nerves (c)
Involving both arteries and nerves.
According to Dr. Chopra, should the Ulcers be
superficial involving the skin and subcutaneous tissue, sparing the deep tissue,
the treatment is to avoid weight bearing and take care of the ulcer by regular
dressings.
If the ulcers are deep, they need to be dealt
with in the operation theatre by removing all the dead tissue and the involved
portion of the underlying bone.
"It is pleasing for the patient and doctor
to see a healed ulcer. But by no means is the treatment over. The management is
life long," he says, adding once the ulcer is healed, special shoes are
ordered to avoid overload on the area of ulcer. If there is infection or
discharging wound or non- healed ulcer, avoid wearing shoes.
Dr. Jaisom Chopra warns that the pus in the foot
could be dangerous as it can quietly creep into the blood , making one very
sick, though the patient remains unaware that his or her life is in danger
because of Sepsis (bacteria in the blood), Along with this may be present
uncontrolled diabetes (blood sugars in 400s) and heart failure.
In such circumstances, one should not resist
hospital admission. The treatment available is urgent ICU admission, where Intra
-venous antibiotics +vigorous control of your diabetes+ control of your heart
failure are done on a war footing.
In majority of cases, cleaning of the foot would
suffice. Regular dressings will be needed in hospital till there is no
infection. The last resort available is Skin Grafting done to close the wound
.Dr. chopra However, cautions that "one should always remember that other
foot of the affected person is not safe. Statistics show that 46% develop ulcers
in the other foot within 2-3 years and 20% land up with amputation of both
legs".
Another presentation in diabetics is non-
infective, dry gangrene of the foot, which does not bother the patient , which
the the patient tends to ignore, but Dr Chopra warns patients and says that the
patient should consult a vascular surgeon at the earliest.
"Do not say no, to amputation of toes if the
doctor advises so, as in no time this harmless looking gangrenous toe or foot
will get infected and in such cases the patient will not only be in danger of
losing his leg but his life too may be at risk", he says.
Diabetic foot and smoking is the worst
combination and are partners in crime. "If you do not give up smoking ,the
chances of your losing your foot increase manifold". Says Dr. Chopra.
So the Golden Rules for those suffering from the
Diabetic Foot are do not neglect it ever. If the vascular surgeon says so, get
admitted to the hospital. Do not resist surgery as that may be the only chance
to salvage your limb.
However, for those who end up with an amputation,
Dr Chopra has words of hope. With advanced prosthesis, your mobility will hardly
be affected and your social life will remain the same, he says.
Sunita Govind
Health Reporter
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