Diabetic foot: Causes, treatment and care

Written By: Bhushan Hemade | Updated : June 5, 2015 3:15 PM IST

Rajesh is a 45 years old successful banker living in Mumbai. He suffering from diabetes for the past five years and needs to take daily doses of insulin to keep diabetes in check. Recently Rajesh developed a small sore on his heel due to shoe bite but he kept on ignoring it as he was feeling no pain on the wound and continued with his daily routine. One day he realized that the sore had grown over time and looked much tender and raw than before. On the insistence of his wife, Rajesh visited his doctor who informed him that he is suffering from Diabetic Foot.

What is Diabetic Foot?

Also Read

Mr. Bhushan Hemade of Diaped, a chain of multi-disciplinary foot clinics explains that, Diabetes represents several diseases in which high blood sugar levels over time can damage the nerves, kidneys, eyes, and blood vessels. When diabetes is not well controlled, damage to the organs and impairment of the immune system is likely. Foot problems commonly develop in people with diabetes and can quickly become serious. With damage to the nervous system, a person with diabetes may not be able to feel his or her feet properly. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired. These factors together can lead to abnormal pressure on the skin, bones, and joints of the foot during walking and can lead to breakdown of the skin of the foot. Damage to blood vessels and impairment of the immune system from diabetes makes it difficult to heal these wounds. Bacterial infection of the skin, connective tissues, muscles, and bones can then occur. These infections can develop into gangrene. Because of the poor blood flow, antibiotics cannot get to the site of the infection easily. Often, the only treatment for this is amputation of the foot or leg. If the infection spreads to the bloodstream, this process can be life-threatening.

What causes Diabetic Foot?

Several risk factors increase a person with diabetes chances of developing foot problems and diabetic infections in the legs and feet.

Footwear: Poorly fitting shoes are a common cause of diabetic foot problems. If the patient has red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new properly fitting footwear must be obtained as soon as possible. If the patient has common foot abnormalities such as flat feet, bunions, or hammertoes, prescription shoes or shoe inserts may be necessary
Nerve damage: People with long-standing or poorly controlled diabetes are at risk for having damage to the nerves in their feet. Because of the nerve damage, the patient may be unable to feel their feet normally. Also, they may be unable to sense the position of their feet and toes while walking and balancing. With normal nerves, a person can usually sense if their shoes are rubbing on the feet or if one part of the foot is becoming strained while walking. A person with diabetes may not properly sense minor injuries (such as cuts, scrapes, blisters), signs of abnormal wear and tear (that turn into calluses and corns), and foot strain. Normally, people can feel if there is a stone in their shoe, then remove it immediately. A person who has diabetes may not be able to perceive a stone. Its constant rubbing can easily create a sore.
Poor circulation: Especially when poorly controlled, diabetes can lead to accelerated hardening of the arteries or atherosclerosis. When blood flow to injured tissues is poor, healing does not occur properly.
Trauma to the foot: Any trauma to the foot can increase the risk for a more serious problem to develop.
Infections: Athlete's foot, a fungal infection of the skin or toenails, can lead to more serious bacterial infections and should be treated promptly. Ingrown toenails should be handled right away by a foot specialist. Toenail fungus should also be treated.
Smoking: Smoking any form of tobacco causes damage to the small blood vessels in the feet and legs. This damage can disrupt the healing process and is a major risk factor for infections and amputations. The importance of smoking cessation cannot be overemphasized.

Can Diabetic Foot be prevented?

A person with diabetes should do the following:

Foot examination: Examine your feet daily and also after any trauma, no matter how minor, to your feet. Report any abnormalities to your doctor. Use a water-based moisturizer every day (but not between your toes) to prevent dry skin and cracking. Wear cotton or wool socks and avoid elastic socks and hosiery because they may impair circulation
Eliminate obstacles: Move or remove any items you are likely to trip over or bump your feet on. Keep clutter on the floor picked up
Toenail trimming: Always cut your nails with a nail cutter and not any other device. Cut them straight across and leave plenty of room out from the nail bed or quick. If you have difficulty with your vision or using your hands, let your doctor do it for you or train a family member how to do it safely

Footwear: Wear sturdy, comfortable shoes whenever feasible to protect your feet. To be sure your shoes fit properly, see a podiatrist (foot doctor) for fitting recommendations or shop at shoe stores specializing in fitting people with diabetes. If you have flat feet, bunions, or hammertoes, you may need prescription shoes or shoe inserts
Exercise: Regular exercise will improve bone and joint health in your feet and legs, improve circulation to your legs, and will also help to stabilize your blood sugar levels. Consult your doctor prior to beginning any exercise program.
Smoking: If you smoke, quitting can be one of the best things you can do to prevent problems with your feet. Smoking accelerates damage to blood vessels, especially small blood vessels leading to poor circulation, which is a major risk factor for foot infections and ultimately amputations.
Diabetes control: Following a reasonable diet, taking your medications, checking your blood sugar regularly, exercising regularly, and maintaining good communication with your doctor are essential in keeping your diabetes under control. Consistent long-term blood sugar control to near normal levels can greatly lower the risk of damage to your nerves, kidneys, eyes, and blood vessels

People with diabetes must be fully aware of how to prevent foot problems before they occur, to recognize problems early, and to seek the right treatment when problems do occur. Although treatment for diabetic foot problems has improved, prevention - including good control of blood sugar level - remains the best way to prevent diabetic complications. People with diabetes should learn how to examine their own feet and how to recognize the early signs and symptoms of diabetic foot problems. They should also learn what is reasonable to manage routine at home foot care, how to recognize when to call the doctor, and how to recognize when a problem has become serious enough to seek emergency treatment.

Read more about causes, symptoms, diagnosis and treatment of diabetes.

Treatment of diabetic foot:

There are basically three stages to the treatment of diabetic foot.

The first step is debridment: This is the process of removing all the dead and dying tissue from the area. It also involves cleaning the area well and cleaning out any pus that may be present.

The second step is drainage: This is mainly for wounds that have pus in them. It has been found that only treating the wound with antibiotics does not help in diabetic. Proper and timely drainage has helped a number of people retain their limbs.

The third step is bandaging and infection control: This is the process of bandaging the wound properly and treating the patient with appropriate antibiotics.

After this procedure the patient is required to take care of the wound till it heals. It is adviced that a patient does not put any weight on the region, this can cause further spread of the condition.

There are times when a small ulcer on the foot can become gangrenous. This is a condition where the wound becomes infected and the skin and tissue starts to die due to the infection. This condition comes about if the patient has ignored a non healing ulcer for a long time. In such cases a doctor may suggest amputating the limb. The extent to which the limb will be amputated depends on how far the gangrene has spread.