Diabetes mellitus is a metabolic condition that results in elevated blood sugar levels in people either due to reduced insulin production by the pancreas called Type I diabetes mellitus or due to the body’s inability to effectively utilise the insulin produced called Type 2 diabetes mellitus. Chronically elevated blood sugar levels can lead to an array of complications that affect organs like the heart(cardiovascular disease), nerves(neuropathy), kidney(nephropathy), eyes(retinopathy), brain, foot and skin.

Diabetic foot complications, however, remain one of the most frequently observed problems in people with long-term uncontrolled diabetes mellitus, especially in developing countries such as India with an approximate incidence of 15 to 25 % per year.

CAUSES

Diabetic foot complications arise as a result of long-term uncontrolled blood sugar levels which tend to affect both the major and minor blood vessels in the body causing reduced blood flow to the peripheries like the hands and feet. Peripheral vascular disease, can in turn lead to nerve damage causing symptoms such as numbness, tingling sensation, pain, and eventually resulting in reduced or loss of sensation in the feet. This loss of sensation can thereby increase the risk of foot infections, cuts, blisters, pressure sores and ulcers.

PEOPLE AT HIGHER RISK

Although any person diagnosed with diabetes mellitus can develop foot ulcers or other foot-related complications, there are certain factors that seem to be associated with an increased risk. These factors include old age, male sex, people of particular ethnicities like African Americans and Hispanics, people from poor socioeconomic backgrounds, smoking, history of diabetes for more than 10 years, patients not on strict blood sugar control or not on anti-diabetic medications, previous history of ulcers, history of systemic vascular disease, and structural foot deformity.

SYMPTOMS

The signs and symptoms of a diabetic foot can range from minor infections to severe complications that may be life-threatening. Early features include loss of sensation, numbness or tingling, small blisters or open wound without associated pain, swelling, itching, dryness, calluses, discoloration, warmth, loss of hair in legs or feet and minimal oozing or discharges from the open wound. These symptoms when left untreated for a long time can result in severe complications like sepsis in which a person can present with complaints of fever, chills, uncontrolled blood sugars, reduced blood pressure and requires emergency hospital management.

Other complications associated with the diabetic foot are large non healing ulcers with foul-smelling discharge due to secondary bacterial infection, involvement of tissues and structures surrounding the ulcer resulting in osteomyelitis or cellulitis, gangrene - where an infection causes tissue death and structural deformity of the foot called Charcot foot.

MANAGEMENT & TREATMENT

The different treatment available for diabetic foot depends on the severity, duration and extent of the wound. Regular monitoring of sugar levels with optimal anti-diabetic medications, self foot care by diabetic patients, and conservative medical management like antibiotics, analgesics, antiplatelets and nerve supportive medications remains the mainstay of treatment for mild to moderate diabetic-related foot problems.

Long standing diabetic foot ulcers with associated deformities or infection may require surgical interventions like, wound debridement or removal of dead tissue, surgeries to improve the arterial flow and hyperbaric oxygen therapy that improves wound healing. However, Amputation of the feet or toes may be the only option in case of long-standing chronic ulcers not responsive to medical management or severe life-threatening infections that may increase the risk of mortality.

PREVENTION MEASURES

Of the different strategies advised to prevent complications, maintaining a strict blood sugar control and daily self foot examination have shown to reduce the overall occurrence significantly.

The other simple recommendations that help reduce the risk of diabetic foot complications are

• Wash feet daily, preferably with lukewarm water and dry it thoroughly
• Watch daily for any small changes like colour, temperature, sensation, blisters in the feet especially in between toes and seek immediate medical help when noticed.
• Advised to use diabetic friendly footwear, clean socks and to avoid walking barefoot
• Toenails should be trimmed regularly and cut straight to prevent ingrown nail
• Corns or calluses should never be trimmed or cut using sharp objects
• Periodic foot examinations by a medical professional
• Staying active with exercises that are gentle on the feet like walking or swimming
• Avoid smoking
• Regular health check-ups including assessment of blood flow to the peripheries by general practitioners, diabetologists or podiatrists who are medical professionals trained in diagnosing and treating feet related problems.