Nerve and blood flow impairment are primarily responsible for Diabetic foot. Neuropathy (nerve impairment) leads to sensory, motor and autonomic dysfunction. Loss of sensory and motor modalities like touch, pressure, pain, temperature, sense of position and motor weakness leads to postural and coordination problems thus causing foot deformities and callus formation.
Angiopathy (affects blood vessels) leads to ischemia caused by poor blood flow. All the above factors make the foot more susceptible to trauma and ultimately lead to amputation. Foot ulcerations are the most common cause of hospital admissions for Diabetics and are expensive to treat, may lead to amputation and need for chronic institutionalized care. So it is best to be prevented.
Prevention of Diabetic Foot Diseases
Check, Clean, Care – 3C
To prevent injury the diabetic must develop a daily routine of checking, cleaning, taking proper care of the foot and keep certain precautions in mind. To check place a mirror on the floor and check soles of both the feet. Also check top, sides, heels and in between toes.
Exclude injury, infections, redness and swelling of feet. Next clean both the feet with luke warm water and mild soap. Check the temperature of water by dipping elbow into it as the sensation of fingers and palm may also have been affected. Don’t use harsh soaps. Pat dry the skin with a clean towel, especially between toes. Care should be taken to soften the dried skin with lotion, jelly or oil. Don’t lubricate in between toes.
Before cutting toe nails soak in luke warm water and cut nails straight. Analgesia and impaired vision may cause minor trauma to go unnoticed, so make regular timely visits to a podiatrist. Don’t use antiseptic solutions on toes as they are too strong and can cause injury. Never attempt to remove corns and calluses by yourself, it should be done by a professional.
Regular physical activity to promote good blood circulation slows down progression of disease. Smoking should be decreased as it has adverse effects on blood circulation.
Cross leg sitting and standing for prolonged periods also hampers circulation of blood to legs. Avoid walking on hot pavement or on hot sand beaches. Wear thick socks if going inside a temple to save feet from extremes of heat and cold. Socks should not be too tight to impair blood circulation.
Choosing Proper Foot Wear Prevents Injury
Buy shoes in evening when feet are swollen, wear new shoes for short duration of time to start with and always rotate between 2-3 pairs of shoes. Never walk bare foot. Shoe should have a proper support with adjustable straps, with strap that prevents heel from slipping. Inspect inside of shoes regularly for any fallen objects that might cause injury to foot.
As with other complications of diabetes, early and careful management of blood glucose levels, hypertension, lipid levels are key factors in controlling and preventing diabetic foot problems. Patient education is the key factor in prevention and management of foot ulcers resulting from the above said factors. Medications and physical therapy may be helpful in pain management and injury prevention. A multi-disciplinary approach is definite answer to management, but the solution lies in prevention. Remember most feet can be spared…at least for a while!!!