SK, a successful professional, felt like he had been walking on “cotton wool”. At night, he regularly experienced cramps. Plus, it felt as if “ants were crawling on his feet”. He had difficulty wearing slippers. Even a short walk brought severe pain in the calf.
He had been a diabetic for years, but had not followed his doctor’s instructions on diet, exercise and medication. His fasting blood sugars have been in the range of 180-250 mg/dL. Despite repeated advice from his doctor and friends, he remained a heavy smoker and drinker. His blood lipids cholesterol and triglycerides were high.
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
8226; Tingling or numbness of toes and feet
8226; Burning of soles
8226; Feeling of “ants crawling over feet”
8226; Feeling of “walking over cotton wool”
8226; Frequent cramps of calves
8226; Pain in one or both feet or thigh
8226; Difficult to wear slippers
8226; Imbalance in walking, especially in dark
How to take care of your feet
8226; Do not walk barefoot
8226; Choose comfortable shoes
8226; Feel inside shoes with hands for stones, sharp object before you wear them
8226; Inspect feet daily for cuts, blisters. Check between toes. Use a mirror to inspect soles
8226; Check for nail infections
8226; Do not cut/treat corns by yourself
8226; When soaking feet in warm water, check temperature with hand. If the water is too hot, it may cause burns/blisters
8226; Keep feet dry
8226; In case of injuries, pains, change in colour in feet, consult a diabetologist
After a wound heals
8226; Use comfortable footwear
8226; Keep blood sugar, pressure and lipids under strict control
8226; Use drugs to improve circulation, e.g. aspirin
8226; 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
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