Right Foot Forward

Unfortunately, he was not aware that his feet were a target of those continuous lifestyle and metabolic aberrations.

The trouble started when had tried to peel off a corn on the sole of his right foot with a knife. Soon his feet swelled and he had pain and fever. The infection rapidly spread to his calf. His right foot changed colour, becoming pinkish and then black. His blood sugars rose to more than 350 mg/dL. He had to be admitted to hospital and was started on insulin infusion and two antibiotics. But despite the interventions, he developed gangrene on the right foot which started spreading upwards. His right leg had to be amputated below the knee. RK now walks on crutches and has lost his lucrative job.

India, the diabetic capital

The story just illustrates the ravages caused by diabetes. And India has the dubious distinction of sitting on top of the diabetes map of the world. One in every 10 Indians living in cities is a diabetic.

Many of the diabetics do not have any symptoms until their blood sugar test is done, while others come with severe complications and then are diagnosed as diabetics. Any of the complications of diabetes could be deadly and devastating: heart attack, stroke, blindness and nerve damage are a few of them.

But the most distressing and damaging are lesions of the foot.

Foot ulceration, infection and amputation are dreaded by every aware diabetic patient. It is unfortunate that many diabetic patients in India do not know about it. Awareness of this dreaded complication is a must, since it is potentially the most preventable of all complications and morbidities due to diabetes.

How ‘diabetic foot’ occurs

High blood sugar, blood pressure and high cholesterol, damage to the nerves and obstruction of arteries impedes the blood flow to the foot. Patients tend to feel temperature and pain in the feet and lower leg less, increasing the possibility of an injury going unnoticed. Once an injury occurs, it rapidly gets infected because of poor blood supply. Also, Indians are more prone to it because of the practice of walking barefoot.

Infection is often difficult to control and runs and fast and deep in the tissues. Ulcers can be also be infected by various types of bacteria and lead to abscess formation. Even deep bones may be infected. The swelling in the infected area puts pressure on the damaged arteries and further compromises the blood supply.

Patients confined to bed often develop infection and blisters on the heel. Wounds and blisters in diabetes patients are difficult to heal. Tissue death occurs due to the above-mentioned combination of factors, resulting in gangrene.

The danger signals

Damage to leg nerves can be identified in the early stage by pain in calves due to walking, which is relieved by rest. In advanced stage, pain in the calves remain even during rest. Ulcers in feet do not heal. A physician can easily recognise a foot at a high risk for gangrene. It is pink, painful, pulseless, and sometimes cold. The pain is sometimes extreme and persistent throughout the day and night. If the gangrenous part is not amputated, there is danger of infection spreading all over the body.

How to tell if your leg nerves are at risk

• Tingling or numbness of toes and feet

• Burning of soles

• Feeling of “ants crawling over feet”

• Feeling of “walking over cotton wool”

• Frequent cramps of calves

• Pain in one or both feet or thigh

• Difficult to wear slippers

• Imbalance in walking, especially in dark

How to take care of your feet

• Do not walk barefoot

• Choose comfortable shoes

• Feel inside shoes with hands for stones, sharp object before you wear them

• Inspect feet daily for cuts, blisters. Check between toes. Use a mirror to inspect soles

• Check for nail infections

• Do not cut/treat corns by yourself

• When soaking feet in warm water, check temperature with hand. If the water is too hot, it may cause burns/blisters

• Keep feet dry

• In case of injuries, pains, change in colour in feet, consult a diabetologist

After a wound heals

• Use comfortable footwear

• Keep blood sugar, pressure and lipids under strict control

• Use drugs to improve circulation, e.g. aspirin

• Immediate physician consultation in case of cuts, wounds, bruises, discoloration, etc.

The writer is Director and HoD, Diabetes and Metabolic Diseases, Fortis Hospital, New Delhi