Diabetic foot

Diabetic foot is a complication of diabetes mellitus, often affecting patients with uncontrolled diabetes.

Diabetic patients has an increased risk of developing complications like:

-       Diabetic neuropathy

-       Peripheral arterial disease

-       Infections

-       Decreased capability to fight infections

Due to these complications, diabetic patients are at a risk of developing severe foot infections and problems that can eventually lead to gangrene and even amputation.

In diabetic patients, autonomic, sensory and motor nerve fibers may be affected, and thus:

-       As their sensory nerves are damaged, protecting against pressure, trauma and heat isn’t adequate and thus can result in infections and leg ulcers

-       Charcot foot impairs the ability to sustain pressure

-       Undue physical stress due to motor nerves abnormalities

-       Infected foot ulcer can lead to gangrene and can be limb or even life threatening

Due to these complications, monitoring to detect and manage diabetic neuropathy is an important part of diabetic patients review.

Risk factors for diabetic foot

Risk factors for diabetic foot include:

-       Peripheral neuropathy

-       Peripheral arterial disease

-       Previous history of amputation

-       Previous history of ulceration

-       Joint deformity

-       Presence of callus

-       Diabetic retinopathy (vision issues)

-       Mobility issues

-       Male gender

Peripheral arterial disease is one of the major factors in causing diabetic foot ulcers. Risk factors of peripheral arterial disease include:

-       Smoking

-       Hypercholesterolemia

-       Hypertension

Presentation of diabetic foot ulcers

Diabetic foot has a characteristic appearance and presentation, such as:

-       Diabetic foot ulcers are usually painless

-       They have historical or present infection with pus, erythema, edema, crepitus and malodor

-       Neuropathic ulcers usually occur on the plantar surface of the foot while the neuro-ishemic ones occur on the margins of foot

-       Neuropathis foot is usually warm, with:

o   Bounding pulse

o   Distended vains

o   Callus around the ulcer

o   Reduced sensation

-       Neuro-ishemic foot tends to be cool, with:

o   Pink color

o   Atrophic skin

o   Absent pulses

o   Painful

o   Little callus

Management of diabetic foot

Management of diabetic foot is essential to prevent any limb threatening or even life threatening condition. It includes:

-       Educating the patient

o   Patient should be well aware of the disease and its progress in detail

o   Patients should know the importance of various routine podiatry care tasks for prevention of diabetic food

o   Patient should wear appropriate footwear

-       Check your feet everyday

-       Patient should report any cuts or sores that don’t heal immediately

-       Any swelling, puffiness or skin part that feels hot should be reported immediately

-       Diabetic control is mandatory

-       Control blood cholesterol

-       Control blood pressure

-       Weight management and control

-       Stop smoking

-       Prevent foot ulcers through various mechanical foot interventions

-       Risk assessment

-       Antibiotics

o   To manage infections

o   To prevent infections

-       Management of peripheral arterial disease

o   Including bypass surgery if needed

-       Wound management

o   Keeping the wound clean

o   Keeping the wound dry

o   Debridement of dead tissue

Diabetic food patient’s education

Educating the patient regarding self-assessment and care of diabetic foot is important to prevent any complications and structural and functional loss of the foot.

Patient’s education for diabetic foot includes:

-       How to self-examine them and monitor their foot and skin daily

-       Examine feet for various problems and:

o   Change in color

o   Breaks in skin

o   Swelling

o   Numbness

o   Pain

-       Understand the importance of correct and well fitting footwear and should chose the best one to avoid friction and other problems

-       Hygiene

o   Wash and dry your feet carefully daily

o   Moisturize dry skin areas

-       Care for nails

-       Understand the dangers associated with:

o   Skin removal

o   Over the counter foot problems related preparations

-       Understand when to seek advice from healthcare professional, especially when:

o   Skin breaks, swells or changes in color or any other form such as:

§  Corns

§  Calluses

§  Numbness

§  Pain

o   Self-care isn’t possible or difficult due to lack of understanding or else issues with mobility

-       Understand the consequences of neglecting your feet and potential complications

-       Benefits of prevention and early and prompt detection of issues and their treatment

Patients with increased risk of foot ulcers, additional education is necessary, including:

-       Take extra care if neuropathy is present and take extra precautions to protect the feet

-       Do not walk barefooted

-       Avoid hot water, electric blankets, foot spas, getting close to fire, etc. and take special care of numb feet

-       Don’t wear new shoes when planning to go out

-       Give adequate rest to the feet to avoid additional stress on them, they might not hurt due to numbness but may get damaged a lot

-       Use sun blocks on feet

-       Take care of any foot injury or sore immediately

-       Seek help if any problem arises

-       Report any foot smell or any unexpected change

If you experience any symptoms of diabetic foot or have any query related to it, discuss in detail with your doctor to prevent any irreversible damage.