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Prevention of Diabetic Foot Problems- |
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Introduction:
In a lifetime human foot with its multiple moveable parts walks seventy five thousand to one hundred thousand miles - three to four times around the world and it is exposed to significant pressures with each step. In Diabetic population foot problem is a very common problem. Seventy percent of leg amputees are diabetics. Every thirty seconds a person loses a limb somewhere in the world due to diabetic foot problems. According to the reports of Centre of Disease Control in the United States of America there has been a progressive increase in hospitalization for diabetic foot problems between the year 1980 and 2003. Diabetic foot problem is not only a problem of developing nations, rather it is a major problem in Western countries as peripheral arterial disease is more common among them than Asian countries. However most foot problems are preventable through early identification and prompt treatment by skilled health professionals.
Foot Complications:
More than seventy percent diabetics develop foot ulcers in their lifetime. They are vulnerable for foot ulcers because of the frequent complications of Diabetic Peripheral Neuropathy (DPN), Peripheral Vascular Disease (PVD) and Limited Joint Movement (LJM) with superadded high risk of infection.
More then fifty percent diabetic foot ulcers are due to peripheral neuropathy and that makes the ulcer painless in nature. Thirty percent cases are due to PVD. Those leads to the final cataclysmic events like gangrene and amputation.
Economic Burden:
Diabetes itself has huge economic burden worldwide and foot complications are having major share in that! Prevention of diabetes and its complications of eye, heart and kidney and foot do not require any complex involvement of medical intervention. Rather prevention can lower the health care costs – which has high relevance in India. As currently India accounts over four crores i.e forty million diabetics, excluding many undiagnosed cases because of poor medical services to the interior community and it is estimated that there will be eight crores i.e eighty million cases by the year 2030.
In India the estimated treatment cost for foot infection, amputation and an artificial limb could be over Rs.1.50 lakhs, which does not account the emotional trauma, non productivity and the decline in quality of life, whereas the cost of detecting foot problems would be less then Rs.2500 per year.
Prevention:
In a study published in the May 2005 edition of Diabetes Care, a journal of American Diabetes Association, researchers of DRC, Chennai of India, showed in a follow up of 4800 foot infection diabetics that only 7 percent of people who understood and complied with the advice had foot ulcers, while 27 percent of those who failed to comprehend or comply developed foot ulcers. It shows that intensive treatment and education for diabetic patients and regular foot care greatly helped in preventing foot amputations.
Intensive treatment for both glycaemic control and foot complications are the corner stone for acute diabetic foot complications. Once foot problems develop, their treatment should be very prompt and aggressive.
So the main stress is on prevention of foot complications. Education for diabetic patients and regular foot care greatly helped in preventing those complications.
FOOT CARE:
Ten important tips for the patients (and foot care providers):
1. Do not walk bare foot to avoid injury. Remember your feet may be insensate.
2. Examine your feet daily for the injury, blisters, cracks, scratches, scaling or discoloration. It may be unnoticed in insensate feet. Daily foot care is ideal.
3. Avoid extremes of temperature whether hot or cold. Particularly always avoid extreme hot to avoid foot threatened blisters in insensate feet.
4. What to look for socks?
· Cotton socks are ideal.
· Padded socks are preferred.
· No tight tops.
· No rough seams.
· Knee-high stockings not advisable.
· Wet socks can cause fungal infection.
· Whether perfect to reduce friction within shoes.
· Socks should be non – constricting with no tight band around ankle / calf.
5. Shoes should be with –
· Wide toe box.
· Soft inside sole.
· Soft inner up & side covering.
· Heels should be 5 cm.
· Should fasten with lace / straps to hold foot properly.
· Whole foot should comfortably accommodate inside shoe.
· If it is CUSTOM made, both length & side to side breadth is measured while making.
· When buying shoes look for –
Ø Buy in the afternoon.
Ø Measure both feet.
Ø Stand up to fit.
Ø Wear in slowly.
Ø Never wear new shoes all day.
6. Check socks and shoes before use for any foreign objects as
it can cause injury.
7. Do not wear open tied shoes particularly sandals with tong
between the toes.
8. Do not use hot water bottles or heating pads on your feet.
9. Toe nails should not be cut too short and toe nail angels
should not be cut too deep. Use of a nail filer is safe.
10. Yearly check up of the nerves and blood vessels of the feet
by the expert are needed to prevent diabetic foot
complications.
Conclusion:
So, early identification of risk factors by seeking regular expert opinion regarding status of the nerves and blood vessels of the legs, careful and regular monitoring of the feet by the patient and aggressive treatment in acute foot complications by a team approach associated with diabetologist and surgeon should be the only approach to stop sacrificing legs at any age in diabetics. Lastly, diabetics should decide whether to keep leg or the bad habits of smoking!!
Published on 05 Feb, 2010 Readers can send their comments on this feature to : feature@tripurainfo.in