We all know that India is fast becoming the diabetes capital of the world. There are about 69.2 million diabetes patients in India which is expected to reach 123.5 million by the year 2040. Development of foot ulceration is a common problem in patients with longstanding diabetes. Life time risk of developing foot ulcer may be as high as 25%. Foot ulceration is one of the leading causes of hospital admission in patients with diabetes mellitus. 60% of admissions in diabetes patients are for foot problems. 1% of diabetes patients may lose a portion of their limb in lifetime. In India prevalence of foot ulcer in people with diabetes is 3%.
The reason why diabetes patients are more prone to foot problems are vasculopathy i.e. involvement of blood vessels, neuropathy i.e. involvement of nerves, development of infection and many other co-existing problems such as old age, immunosuppressive states, hypoproteinemia and poor blood sugar control. The blood vessels in diabetic patients are affected by atherosclerosis i.e. deposition of fat inside blood vessels causing lead pipe arteries with resultant loss of its elastic property. Further calcification of blood vessels lead to poor distal blood flow.
Neuropathy, the involvement of nerves can occur because of autonomic, sensory and motor neuropathy. Autonomic neuropathy is the loss of autonomic control resulting in inhibition of thermoregulatory function and sweating. It results in dry, scaly and stiff skin that is prone to cracking and allows the entry of bacteria. Sensory neuropathy is the loss of protective sensation. It starts distally and migrates proximally in stocking distribution. Motor neuropathy results in foot deformities like hammer toes, claw toes, hallux valgus and flat feet.
Presence of high plantar pressure due to obesity, deformities in the foot, limited joint mobility further leads to development of foot ulcer. Ill-fitting footwear may further aggravate the situation. Majority of ulcer occur below head of 1st metatarsophalangeal joint. Diabetic foot are usually classified as neuropathic foot or neuroischaemic foot meaning either only nerve is involved or both nerve and blood vessels are involved. There are various type of therapy available to treat diabetic foot ulcer ranging from simple surgical debridement to hyperbaric O2 therapy, vacuum therapy, injections of G-CSF/Zolendronate.
Prevention of the developing ulcer is better than cure
– Feet should be washed daily using warm water and soap. After washing, feet should be dried with a dry towel especially between the toes followed by application of moisturizing lotion.
– Avoid wearing socks with rough seams as seamless diabetic socks are available.
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