The foot is a frequent site for complication with patients having diabetes.
People with diabetes usually suffer from impaired immune system which leads to easy infections in these patients. High blood glucose levels over time can damage the nerves, kidney, eyes and blood vessels.
People with diabetes should learn how to examine their own feet and to recognize the early signs and symptoms of diabetic foot problems.

Causes of foot problem

• Footwear
• Nerve damage(Neuropathy)
• Poor circulation
• Trauma to the foot
• Infections
• Smoking and Alcohol

Footwear
Improper footwear or poorly fitting shoes can cause blisters and boils on the foot and especially on the pressure point of the foot which can lead to injuries and infections.
If these wounds get infected are very difficult to heal if the blood glucose level is on the higher side.

Nerve damage (Neuropathy)
People with long standing diabetes and poor controlled diabetes are at risk of nerve damage leading to peripheral neuropathy. Due to neuropathy the patient is unable to feel the floor or the footwear while walking . There is lack or less of sensations in the feet.

Poor circulation
Due to poorly managed diabetes the blood vessels are more affected. There are chances of patient developing atherosclerosis. This can cause less blood supply to the affected part which delay healing of the wound and also deprive the part of pure blood leading to gangrene.

Trauma to the foot
The chances of getting injuries such as cuts scrapes, blisters, are more due to neuropathy (neuritis). Signs of abnormal wear and tear that turn into calluses, corns and foot strain can lead to small injuries. A person who has diabetes may not be able to perceive a stone. Its constant rubbing can easily create a sore.

Infections
Foot sweat and constant wet feet can lead to fungal infection which can easily get infected causing serious problems. Unhealthy skin of feet and ingrown toenails are easy house for fungal as well as bacterial infections.

Smoking and Alcohol
Smoking and alcohol consumption also cause hardening of the blood vessels, which lead to poor circulation of blood in the lower extremities. This Interrupts the healing process and are major risk factors for non healing foot ulcers and gangrene leading to amputation of the part. Smoking also causes less absorption of essential vitamins.

Patient education for foot care
Foot examination
The patient should learn to examine his feet regularly for any injuries Use of Water-based moisturizer every day for soft skin.(should avoid it in between the toes)Use of cotton or woollen socks, tight fitting footwear and elastic socks should be avoided.

Toenail trimming
Always cut your nails with a nail cutters and never a scissors. Cut them straight across and leave plenty of room out from the nail bed.

Footwear
Wear sturdy, comfortable shoes whenever feasible to protect your feet. If flat feet, bunions, or hammertoes, may need prescription shoes or shoe inserts. Exercise
Regular exercise will improve bone and joint health in your feet, improve circulation, and will also help to stabilize your blood sugar levels.

Smoking
Quitting Smoking can prevent problems with your feet.

Diabetes Control

• A Proper diet,
• Regular medications,
• Regular blood check up
• Regular exercising
• Timely follow up with your physician.

Reasons to Seek Medical Care

• Persistent pain with redness around wound and high fever can be symptom underlying infection and septicaemia.
• Blister, wound, or ulcer less than 1 inch across can become a more serious problem.
• Pain, redness, or swelling around a toenail indicate infected ingrown toe nail
• Constant numbness in the feet or legs can be a sign of diabetic nerve damage (neuropathy) or even of improper circulation.
• Painful and difficult walking can result from diabetic arthritis
• Calluses or corns developing on the feet should be professionally removed. Use of proper footwear can reduce the formation
• Pain in the legs or buttocks that increases with walking but improves with rest (claudication) Reduced growth of hair on lower extremities and hard and shiny skin on the legs are some of the other signs of improper circulation
• Puncture wounds to the feet (for example, stepping on a nail or being bitten by a dog or cat) carry a high risk of becoming infected
• Alteration sensorium may be a sign of severe infection or low or high BSL that could lead to death if not treated immediately.

Early diagnosis

Physical examination
Check for the vital signs like pain ,sore feeling, itching, redness, the sensorium of the feet are signs and symptoms of wound on the feet.

Laboratory test
A complete blood cytology blood glucose level ( Fasting and Post Lunch )

X-ray and Ultrasound
To rule out osteoporosis damage to bones and arthritis.
To locate gas under tissue this indicates gangrene.
Ultrasounds (Doppler ultrasound) check status of the blood vessels.

Dr. Swati Waghmare
- Speciality: Homoeopath & De-addiction Weight Management