The Diabetic Foot

Introduction
The human foot according to Leonardo Da vinci, is the most marvelous of machines and a work of art. It is made a work of art. It is made up of 27 bones, 19 muscles and 32 joints. It is estimated that by the time a person is 55 years old he may have walked nearly 70,000 miles, the equivalent of circling the globe two times.

What is a “Diabetic Foot”?
It is the term used to describe changes which occur in the foot in patients with diabetes mellitus. These include changes in sensation where the nerves have been affected and sensations altered, blunted or completely absent. The sensation of touch, pain, heat or cold is those that are affected. Eighty-five percent of diabetes- related amputations begin with into the foot leading to an infection. In some cases gangrene may set in.

• Every year 4 million people worldwide get a food ulcer?
• One in every 6 people with diabetes will develop a foot complication in their life time?
• People with diabetes are up to 40 times more likely to undergo a lower limb amputation

Why do diabetic patients develop problems in the feet?
There are two main reasons for the foot complications
Some diabetic patients develop diabetic peripheral neuropathy characterized by loss of sensation in the feet. Such patients have a high risk of injuries which often go unnoticed.

Diabetic patients particularly those with neuropathy often develop abnormal pressure points under the ball of the feet. In these areas, the skin often thickness into a callus which if it becomes excessively thick can lead to an ulcer. Chronic infection in the ulcer ultimately leads to amputation of a toe or the whole foot. Some diabetic patients have reduced blood circulation in the feet. These two groups of patients are considered to have “High Risk Feet”.

How can we diagnose patients with a high risk foot?
We do not require any expensive gadgets to diagnose high risk foot in diabetic patients. A physician should check for sensation in the feet with simple devices like a tuning fork, feet the pulsations in the feet and look ofr deformities in the feet to diagnose a high risk foot in a person with diabetes mellitus. People who have loss of sensation should never walk barefoot even inside their homes. This is necessary to prevent injuries and reduce the high pressures under the feet. The footwear which could be a sandal should have soft insole, heel counter, Veicro straps in the footwear upper. Hawai chappals, sandals with toe grips should not be worn since the strength of the small muscles in the foot is weak.

The diabetic foot complication is preventable to a very large extent, if the patients take proper care of the feet. However, even today the majority of people with diabetes do not perform regular, daily inspection of their feet, do not wear adequate foot wear or practice proper foot care. These three elements essential to the prevention of foot ulcers.

In an Amputation Prevention Study at Diabetes Research Centre, it was shown that strategies such as intensive management and foot care education were helpful in preventing newer problems and surgery in diabetic foot disease. It was published in the journal Diabetes Care in May 2005, In this study, patients were provided with simple foot care management like daily examination of foot, performing pedicure and usage of footwear.

Conclusion:
Diabetic foot complications are preventable or treatable with patient education, properly designed and fitted footwear and careful periodic follow-up. It is important to remember that all persons with diabetes, even those without any risk factors, must be careful with their feet.

• Regular examination of the feet by the physicians
• Identification of persons with high risk foot
• Proper care of feet by regular pedicure
• Avoiding barefoot walking and usage of right type of footwear
• Good control of diabetes to prevent loss of sensation and blood circulation in the feet.
  
  The Hindu November 14 2006