Diabetic Foot

Diabetic foot is the most common difficulty faced by diabetic patients if glycemic control is poor. It spans from minor foot diseases like dry skin to life threatening conditions like necrosis and gangrene. Any foot pathology in a diabetic patient can be called a diabetic foot.

Keyhole Clinic offers Diabetic Foot Ulcer Treatment, Chronic Wound Management, Reconstructive Surgery, Angioplasty, Podiatry, Diabetology, Medications.

Why is it important to know about this condition?

If proper care is not taken in time, it leads to loss of limb and loss of life even.

Why are foot pathologies happening more commonly in diabetics?

In diabetics, there is thrombosis or blockage of the arteries that carry fresh blood to all organs. When it happens to the arteries in the leg, that leads to decreased blood supply of legs. This damages the peripheral nerves also (neuropathy). There is pins and needle sensation, burning sensation, anesthesia, or paresthesia of the limb. The patient doesn’t feel pain when some injury happens to the foot. They try to ignore the injury. Whenever they walk, as they are not getting the feel of the ground, they walk stamping their feet. This damages the ligaments and bones and leads to deformities. Certain regions of the foot will get more pressure due to the stamping, and small trophic ulcers develop at those regions. These ulcers form nidus for infections. Nails become brittle and deformed. Fungal infections of the nails also develop. Trauma to the toes also leads to the deformity of the nails. At times the nails are so thick that patients are not able to cut the nails properly. Apart from this, hyperglycemia per se increases the risk of infections. We all know that sweet dishes do go bad early when compared to salty dishes. Likewise, when the blood has more sugar in it, the bacterial growth and spread is hastened. Just like a vegetable is getting rotten, our feet also start to get rotten. If proper care is not given in time, the infection spreads to the entire body, through the blood, which is known as septicemia. It happens very quickly.

Poor glycemic control leads to all these conditions. So, the most important message to any diabetic patient should be a strict control of blood sugars. Every patient should get a machine to regularly check their blood glucose levels. They should calibrate the machine too. They should also go to the clinic regularly and check the blood sugar level as well as HbA1C as per the advice of their physician.

How do the patients know that they have a diabetic foot?

They have to take proper care of their feet. Just like a pubertal girl inspects her face, they have to inspect their feet every day. Whenever she gets free time she examines her face in a mirror. Likewise, a diabetic patient should examine his feet on a daily basis. They should spend enough time examining their feet.

What do they have to look for?

They have to see the upper surface of the foot. Is the skin glossy? They have to check their nails. Are the nails getting brittle? Is there any infection or any powdery things under the nails? Some people walk around without any slippers and their feet are ugly. They have to examine the space between toes for intertrigo (fungal ulcer) and undersurface of the foot for trophic ulcers.

Most diabetic patients are old. They may not be able to inspect the under surface of their feet because of their lack of flexibility. They can use an ordinary hand mirror to examine the under surface. If any change is noticed it should be shown to the podiatrist and proper advice needs to be followed. Most of these patients have vision problems due to diabetic retinopathy or cataract. If so, they can get the help of their attendants to check their legs daily.

They have to check the sensation of their feet with a small cotton wick. They can compare it with the sensation felt on their hand. They can touch their leg and appreciate whether the leg feels cold. Our body is warm. If it feels colder, there may be an arterial problem. It feels warmer during infection or cellulitis.
The single golden rule in diabetic foot, if somebody asks me, I say it is the inspection of one’s feet every day. And the best treatment for the diabetic foot is strict control of blood sugars.

What are the facilities available in a diabetic foot clinic?

Diabetologist/Endocrinologist / physician who can get control of diabetes. Podiatrist who can take care of the nails and the ulcers.

Surgeon experienced in diabetic foot care, to take care of infections or deep ulcers and surgical correction of the deformities.

Cardiologist who is good at doing peripheral angioplasty of the lower leg for correction of vascular diseases.

Dermatologist to take care of the dry skin and eczema.

Dietitian who can counsel what all to eat.

Controlled intake of calories, avoiding sugar and adequate protein and fiber intake.

Trained nurse to counsel how to do the home care.

If the nails are too thick to be cut with a nail cutter, they can soak the leg for 30 minutes in lukewarm water with shampoo, and then cut the nails. Scissors are available in the market to cut thicker nails. If skin has grown on the undersurface of the nails, the cutting of nails should be done by a podiatrist, with sterile precautions under local anesthesia, preferably in an operation theater. Callosity can be removed with a pumice stone and can be done after soaking in lukewarm shampoo water. In between the toes they can clean with the help of a Gauze. A wet gauze can be rubbed along the interdigital space. If fungal infection is present, appropriate ointments can be applied. Dressings of ulcers can also be taught. Vaseline or any moisturizer can be applied after a bath. Massaging of the foot also increases blood flow to the leg. All that counseling can be done by a trained nurse.

Precision custom made Foot Orthotics proper footwear should be used by the patient if they have callous ulcers or deformities.

What should be taken care of while walking?

Walking is always good for diabetic patients. It increases the blood supply of legs. The footwear should be non traumatizing. Because of reduced sensation, these patients walk with a stamping gait. So, caregivers should examine their gait and they should be counseled to walk gently with appropriate footwear. In diabetic neuropathy, some special footwear like acupressure slippers, is available that can help to make them feel better.

How can we stage a diabetic foot?

Stage 1 – is normal foot.
Stage 2- there are some diseases in the foot and it is at high risk – at any point of time, it can lead on to higher stages.
Stage 3 – an ulcer.
Stage 4 – presence of infection.
Stage 5 – presence of necrosis or dead devitalized tissue.

Diabetic patients need to control their blood sugar levels, the feet need to be examined daily and regular visits at the clinic to be done as advised. Don’t delay in getting medical care for foot diseases.

Diabetic Foot Specialists at Keyhole Clinic

Keyhole Clinic offers comprehensive Diabetic Foot Care with a multidisciplinary treatment approach including Diabetic Foot Surgeons, Diabetologist, Cardiologist, Dermatologist, Trained nurse to counsel how to do the home care. General Surgery Department at Keyhole Clinic has the best General Surgeons in Kochi specializing in Diabetic foot treatment and care.

Other Doctors Part of the Team