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Diabetic Foot

 
 

The Most Under-Rated yet the Most Dangerous

Diabetes: The word itself should be as scary as Cancer but unfortunately it is the most overused and under-rated word in today’s population.

Let’s talk about Bina Sengupta a 58 year old woman who is a victim of this dangerous disease for past 8 years.

She is aware about her condition but always said to everyone “it’s just diabetes. I am not having a life threatening disease.”

She thinks it only increases blood sugar so all she needs to do is to take medicines. What she never realised that the swelling that she gets every now and then is not something that is to be overlooked.

Hence every time she got a swelling she did what most of us do. “Self-Medication”. All she did is taking Ampicillin to control the swelling. Only it was December last year when she got another episode of swelling but this time her self-prescribed treatment didn’t respond.

She came to Desun Emergency department with

  • Redness of the Skin of the right foot
  • Swelling of the right foot
  • An extensive ulceration and a deep space abscess below the toes
 

Treating Diabetic Foot Ulcers

Stay off your feet to prevent pain and ulcers. This is called off-loading, and it’s helpful for all forms of diabetic foot ulcers. Pressure from walking can make an infection worse and an ulcer expand. For people who are overweight, extra pressure may be the cause of ongoing foot pain.

Your doctor may recommend wearing certain items to protect your feet:

  • Diabetic Shoes
  • Casts
  • Foot Braces
  • Compression Wraps
  • Shoe inserts to prevent corns and calluses

Doctors can remove diabetic foot ulcers with a debridement, the removal of dead skin, foreign objects or infections that may have caused the ulcer.

 

So what happened to Mrs. Sengupta?

Uncontrolled diabetes damaged her nerves. As she was having damaged nerves in her legs and feet, she was not feeling heat, cold, or pain. This lack of feeling is called "sensory diabetic neuropathy." Foot ulcers occured because of nerve damage and peripheral vascular disease.

Poor blood circulation is a form of vascular disease in which blood was not flowing to her feet efficiently. Poor circulation was also making it more difficult for ulcers to heal.

High glucose levels was slowing down the healing process of the infected foot ulcer, so blood sugar management is critical.

Ulcers can be identified by drainage from the affected area and sometimes a noticeable lump which is not always painful.

 

So what Mrs. Sengupta could have done to prevent the ulceration?

She should have visited an Endocrinologist / Diabetologist to get her foot examined atleast every 6 months.

She should have called her doctor the moment she noticed cuts or breaks in the skin, or had an ingrown nail. Also to tell her doctor if her foot got changed in colour, shape, or just felt different (for example, becomes less sensitive).

Because people with diabetes are more prone to foot problems.

 

Treatment

Your doctor may prescribe antibiotics, antiplatelets, or anti-clotting medications to treat your ulcer if the infection progresses even after preventive or anti-pressure treatments.

Talk to your doctor about other health conditions you have that might increase your risk of infections by these harmful bacteria, including HIV and liver problems.

Your doctor may recommend that you seek surgical help for your ulcers. A surgeon can help alleviate pressure around your ulcer by shaving down the bone or removing foot deformities such as bunions or hammertoes.

You will likely need surgery on your ulcer. However, if no other treatment option can help your ulcer heal or progress further into infection, surgery can prevent your ulcer from becoming worse or leading to amputation.

 

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