When asked about the consequences of having uncontrolled diabetes, most people would probably answer leg amputation. Although there is a myriad of complications associated with poor diabetic control, leg amputation is certainly one of the most horrific of it all. Yet, it was estimated that there are 1 million people got their leg amputated due to poorly controlled diabetes every year. The current data suggests there are at least 3.6 million Malaysians suffered from diabetes, the highest incidence rate in Asia and one of the highest around the world. If that isn’t scary enough, it was projected that by the year 2025, 31.3% of adults in Malaysia will have diabetes. That’s 3 diabetics out of the 10 peoples you meet.
Image credit: Cleaveland Clinic
Diabetic foot disease
Diabetic foot disease is one of the most serious complications of diabetes. It has been the source of major sufferings and financial costs for many diabetes patients. Diabetes foot disease usually starts with a minor wound on the foot, and slowly progress into bigger ulceration that is poorly healed, and eventually, leg amputation.
Diabetic foot disease frequently results from a person with diabetes simultaneously having either diabetic peripheral neuropathy and/or peripheral artery disease.
Diabetic peripheral neuropathy
Diabetic peripheral neuropathy leads to an insensitive and sometimes deformed foot that causes abnormal loading of the foot. In this case, if the patient experiences minor wound from wearing poorly fitted shoes, mechanical injuries such as stepping on sharp objects or thermal injury such as immersing foot into hot water suddenly, ulceration of foot can happen. The abnormal loading of the foot can also lead to the formation of callus, which further perpetuates the loading of the foot and increase the risk of foot ulceration. Nonetheless, whatever the cause of ulceration is, continued walking on the insensitive foot impairs healing of the ulcer.
Peripheral artery disease (PAD)
PAD is a blood vessel disease that is usually caused by atherosclerosis, i.e. deposition of plaque (cholesterol, calcium, fibrin and other substances) and clogs up your arteries. This results in ischaemia -- the lack of oxygen transport across your leg, which can impair the wound healing process.
Image credit: Southwest Regional Wound Care Center
It is a silent threat
Only a small percentage of people who have diabetic foot disease experience pain. The majority would be insensitive to pain and lost significant sensation due to damage to the nerve. The lack of pain means that the patient is less likely to seek medical advice when there is a wound on the foot, and continued to walk long distances despite the potential loading it may put on the foot.
How should people with diabetes take care of their feet?
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Carry out a diabetic peripheral neuropathy and PAD screening with your doctor at least once every year.
Half of the diabetic peripheral neuropathy patient population does not show any symptoms, hence it is crucial for you to attend the screening with your doctor annually.
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Inspect your feet regularly
Make sure you check your feet every day in a well-lit space looking at the top and bottom of the feet, heels, and between each toe. You should check on the following aspects: skin colour, the temperature of the foot, presence of callus or swelling, wound, blisters, deformities, abnormally large bony prominences and joint mobility. If you have physical limitations that hinder you from doing so, such as poor visual acuity or obesity, you may get the help from others to check them for you.
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Maintain good feet hygiene
Keep the feet clean by washing them with mild soaps and lukewarm water (37℃) and not hot water. Dry your feet by blotting or patting and carefully dry between the toes. Do not soak the feet in the water as that can dry up the skin. Cut your toenails carefully after washing your feet, but remember do not cut them too short as it can lead to ingrown nails.
It’s important that you change your socks every day and wear only clean, dry socks. Avoid socks that have seams as they can cause rubbing or irritation leading to a blister or callus.
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Protect your feet
Protect your feet from cold and hot temperature, hence you should not soak your feet into hot water. Never use hot water bottles, heating pads or electric blankets as these can cause burns. You are encouraged to not walk barefoot indoor or outdoor to avoid scratches or cuts on the feet.
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Do not self-treat corns, callus, blisters or any injuries on your feet
Visit a doctor or a pharmacist instead. Inform them that you are a diabetic patient.
Image credit: Medical News Today
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Manage your diabetes
Take your diabetes medications according to the doctor’s instructions, exercise regularly, follow the diet plan, monitor your blood sugar regularly and quit smoking if applicable. Ensure that your blood sugar level, blood cholesterol level and weight are under control.
Image credit: Clinical Excellence Queensland
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References:
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https://iwgdfguidelines.org/wp-content/uploads/2019/05/IWGDF-Guidelines-2019.pdf
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http://www.moh.gov.my/moh/resources/Penerbitan/CPG/Orthopaedics/Draft%20CPG%20Diabetic%20Foot.pdf
