Dr. Pradeep Ghadge alerts the doctors on essential footcare practices with diabetic patients which can go a long way in preventing serious complications.

Why foot care is important in diabetic patient?

When left uncontrolled, diabetes can cause a number of complications, including foot health issues. If diabetes is not treated properly, it can cause neuropathy, or nerve damage in the feet called neuropathy. Neuropathy is a loss of feeling heat, cold or pain.

The loss of sensation can make it difficult to feel injury, such as burning from hot sand or blisters forming from your shoes. When left untreated, even the smallest of injuries can lead to major complications like serious infection and potentially amputation.

Diabetes also affects the flow of blood throughout the body. This lack of effective blood circulation makes it harder for a sore or cut to heal. If patient's foot sustains an injury and there isn’t adequate blood flow to help heal the wound, there is a risk of the tissue developing necrosis, or dying and eventually becoming gangrene. In order to stop the spread of gangrene, the dead tissue needs to be removed completely from the body. In serious cases, amputation is used to remove a toe, foot or portions of the leg with gangrene. With proper care and treatment, this can be prevented.

Though there are many factors causing diabetes foot pain, the Peripheral artery disease (PAD) and the Peripheral neuropathy are the two main conditions which might cause the increased risk of various foot problems in diabetic patients.

There are increased chances of having the risk of ulcers and damage to feet in diabetes.There are various foot problems seen in patients with diabetes. Some of the major foot problems during diabetes conditions includes the bunions, fungal infections, hammertoes, corns & calluses, dryness of the skin etc.

There may be a necessity of surgery so as to treat some of the foot problems in diabetes. There are many diabetic foot problems which can be prevented by controlling the blood sugar level in diabetes and an absolute foot care.

There are some major factors which causes the foot pain in diabetes. Peripheral neuropathy is one of the most common conditions which lead to foot pain in diabetes. In this condition, there is damage to the nerve in the diabetic feet which causes the pain and other neuropathic symptoms in the foot like burning, tingling, etc. Basically there are three major types of neuropathy seen in diabetes foot pain, namely the sensory neuropathy, motor neuropathy and the autonomic neuropathy.

Being aware of the warning signs of potential foot problems is imperative. While all of these issues can arise with anyone, diabetics are at a higher risk for more serious complications, due to the tendency for them to experience poor circulation and blood flow.

Several signs as a doctor you should never ignore when it comes to patients feet are listed below.

Increase swelling of legs or feet, change of skin colour, ingrown toenails, slow to heal sores,cracks between toes,blisters, bunions & hammertoes, planters warts, corns, calluses, athlete’s foot, loss of hair on toes or legs.

Diabetic foot care tips for the doctors 

• Regular examination of the feet: Examining the feet on a regular follow up of the patients under normal conditions as well as after any trauma is essential so as to know about any alarming features of the serious diabetes foot pain
• Advice on toenail trimming: It is one more important thing to tell our patients about diabetic foot care at home, i.e. the toenail trimming
• Look for circulation problems, nerve damage, skin changes, and deformities (like hammer toes, bunions or other foot changes)
• Ask the patients about symptoms, their home care routine and about their shoes and socks, too
• During every follow up doctor should ask the patient questions about their symptoms and should examine them. This examination should include the patient's vital signs (temperature, pulse, blood pressure, and respiratory rate), examination of the sensation in the feet and legs, an examination of the circulation in the feet and legs, a thorough examination of any problem areas.
• The doctor should ask vascular surgeon, orthopedic surgeon reference, or both to the patient. These specialists are skilled in dealing with diabetic lower extremity infections, bone problems, or circulatory problems.
• Referral to podiatrist or orthopedic surgeon: If the patient has bone-related problems, toenail problems, corns and calluses, hammertoes, bunions, flat feet, heel spurs, arthritis, or have difficulty with finding shoes that fit, a physician should refer patient to one of these specialists.
• Treatment for diabetic foot problems varies according to the severity of the condition. A range of surgical and nonsurgical options are available. A doctor can attempt to treat diabetic foot problems without using surgery.

Some methods include:

• Keeping wounds clean and dressed
• Wearing immobilisation devices, such as a cast boot or total contact cast
• Closely observing any gangrene on the toes until self-amputation occurs, which is when the toes fall off due to lack of blood flow

Surgical options include:

• The removal of decaying or dead tissue
• Amputation, ranging from single toes or sections of foot to amputation of the leg below or even above the knee
• Surgical stabilisation of Charcot's Foot
• An arterial bypass for peripheral vascular disease, which assists blood flow to the area endovascular surgery with placement of stents, which uses small devices to keep blood vessels open

Be especially vigilant about the patient's diabetes care while they are healing a foot or leg infection. Good glycemic control is good not only for healing an ulcer the patient already has, but also for preventing future ulcers.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.