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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.

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. This can 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.

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.

Prevention

Aspects of prevention must include the maintenance of as near to normoglycemia (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.

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.