Diabetic Foot is a condition found exclusively in patients suffering from uncontrolled Diabetes Mellitus. It is a complication of Diabetes when the patient is unable to have good control over blood glucose level. Diabetic foot ulcer is a major cause of hospitalizations and non-traumatic lower limb amputation. World Health Organization (WHO), defined Diabetic Foot as, the foot of diabetic patients with ulceration, infection and destruction of the deep tissues, associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb.
According to a research study by Dr. Nicholas Katsilambros, Dr. Konstantinos Makrilakis, Dr. Nicholas Tentolouris,Dr. Panagiotis Tsapogas in European Manual of Medicine, The prevalence of Diabetic foot ulcers in general population is 2.2-5.9%. Approximately 40-70% non-traumatic lower limb amputations are performed on patients suffering from Diabetic foot.
According to another study The diabetic foot: prevention and management in India 2016, published by the Indian Ministry of Health and Family Welfare , Diabetic Foot affects 6% of people with diabetes. Between 0.03% and 1.5% of patients with diabetic foot require an amputation.
1. Uncontrolled blood sugar:
High blood sugar levels damage the arteries permanently making it difficult for the arteries to transport nutrients and oxygen to lower limbs. As a result the lower limb tissues become more vulnerable to damage and infections.
2. Poor Blood circulation:
People suffering from Diabetes Mellitus are at a higher risk of developing Peripheral Artery diseases as a result of long lasting higher blood sugar levels. This leads to reduced blood flow to the lower limb and slow healing process of the wounds present in the lower limb. More over mild skin infections turn into moderate to severe infections due to slow and poor circulation.
Higher blood glucose level leads to nerve damage and cause peripheral neuropathy. Peripheral neuropathy leads to loss of sensations of the skin and tissues of the lower limb. As a result small cuts and wounds go unnoticed and untreated and turn into serious infections and diabetic foot.
People suffering from Diabetes mellitus have a weak immune system and are more susceptible to infections. The most common pathogen causing diabetic foot infection is gram positive Staphylococci Aureus. In 10-30% cases Methicillin-resistant Staph Aureus is the causative agent making recovery a challenge. Anaerobic bacteria are involved in necrotic wounds leading to severe infections.
5. Weak Immune system:
Immune system plays a great role in fighting against infections and wound healing. Diabetic patients have weaker immune system that makes healing a slow process. Moreover poor circulation causes reduced transfer of white blood cells to the infection site that can fight against the bacteria.
It is possible to diagnose Diabetic foot clinically. It is a combination of infection, ulceration and purulent discharge. Thorough examination by a physician is the key towards diagnosis. Moreover Ultrasound Doppler of lower limb helps in making the management plan.
After diagnosis of Diabetic foot, it is possible to control infection by using strong Antibiotics. Penicillin is the best in this regard. 3rd generation Cephalosporin are also helpful for diabetic foot infections. The use of antibiotic is given for longer periods as the healing process is slow due to reduced circulation. Apart from antibiotics, regular wound debridement is required to remove the damaged infected tissue and to drain the pus if present. In most cases, patient suffers from peripheral neuropathy making pain a very rare symptom hence analgesia is not required. But if there is mild to moderate pain and burning, then Non-steroidal anti-inflammatory helps to subside pain and inflammation.
Following are the measures that help Diabetic patients in preventing Diabetic foot:
Good Glycemic Control:
Proper diet, regular walk and proper blood sugar monitoring help in controlling this.
Proper foot examination by the patient in order to make early diagnosis of any wound or cut that may go unnoticed due to the presence of peripheral neuropathy.
Use of proper, good fitting foot wear and socks in order to prevent the risk of getting cuts, wounds, blisters, corns etc.
Keeping the lower limbs clean and free from dirt.
Proper trimming of the toe nails so as to avoid possibility of ingrown nails that may lead to infection.