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| Foot
care and Prevention of Amputation in Diabetic Patients |
| The foot of
the patient with a long standing Diabetes is often the site of neuropathic
and vascular process which pose a considerable threat, not only to the
lower limb but also to the life of the patient. This demands much care
and attention by both the patient and health care personnel. Two major
problems which predispose the diabetic patients to amputation are the development
of neuropathy due to uncontrolled diabetes over several years while result
in damage to the nerves in the feet leading to the loss of sensation. They
also develop certain high pressure points under the feet which result in
the formation of callus which later turns in to an ulcer. In addition cigarette
smoking will lead to nerve damage and reduced blood flow in the feet.
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| Early
diagnosis of foot problem |
| All the patients
are examined for loss of sensation (neuropathy) and also for reduced blood
flow towards the limbs (peripheral vascular disease). Neuropathy is diagnosed
by simple foot examination and by the use of very simple devices like Biothesiometry,
Monofilament and Nerve Conduction studies and Peripheral Vascular disease
by Peripheral and Colour Doppler test at the hospital.. These tests are
very simple and very in-expensive. |
| Improper
foot care |
| Lack of awareness,
together with a host of other factors, play an important role in the neglect
of the feet by people with diabetes who have insensitive feet. It is common
practice to use a blade or a pair of scissors to cut one's toenails. Thiscan certainly
cause an injury in this area. Fissures in the heel are a very common occurrence
in the feet of people who often walk barefoot. Infection of these fissured
soles is one of the causes of the diabetic foot. The constant contact of
the feet with water during the washing of clothes, or other cleaning jobs,
could lead to fungal infection of the nails between the toes. In addition
to the above, the importance of foot care, with regular cleaning of the
toes, is not understood by many, even in the urban areas. Improper footwear,
tight or ill fitting, could also cause foot injury. Thorough education
in proper foot care, especially for people with diabetes is highly necessary
to avoid the detrimental effects of the diabetic foot. |
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| Disease
Process |
The diabetic
is especially susceptible to foot complications because of the poor blood
circulation to the foot and leg. This condition is called Peripheral Vascular
Disease (PVD) or arterial insufficiency and nerve disease is called peripheral
neuropathy.
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| Prevention |
Aspects of
prevention must include the maintenance of as near to normoglycaemia (normal
blood glucose level) as possible. This is accomplished by a team approach,
reinforcing lifestyle adjustments in eating and exercise patterns , pharmalogical
support in the form of oral or parenteral hypoglycemia agents , and last
but not the least , continuous and sustained diabetes education and support.
The person with diabetes must be advised on how to care of the foot. They
need to carry out regular routine inspections of the foot , and promptly
visit a health care facility at the slightest indication of a problem.
A small foot lesion may lead to infection or even gangrene and can even
result in loss of toes, foot or leg if neglected. However, you can prevent
this from happening by following the under mentioned do's and don'ts.
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| PVD |
| PVD - Peripheral
arterial insufficiency with gangrene in a diabetic foot Diabetes is a risk
factor for atherosclerosis, which leads to peripheral ischaemia, as well
as to coronary artery insufficiency and stroke. Thrombo-embolic occlusion
of a stenosed atheromatous artery leads to tissue infarction with non-viable
ischaemic tissue rapidly becoming infected, leading to life-threatening
gangrene. |
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