Diabetes and the Feet – Part 1

Of all long-term complications of diabetes, the most preventable are foot problems. These foot problems mostly arise from how people with diabetes care for themselves and from how they are cared for by their physicians. People with diabetes have a high risk of developing ulcers (wounds) on their feet.

If these wounds are not properly cared for, they inexorably lead to gangrene and subsequent amputation (cutting off) of such feet. People with diabetes can lose the ability to feel any sensation on their feet, and as such they may have a wound from stepping on sharp objects or from blisters that form on the feet from wearing inappropriately sized shoes without their knowing that such ulcers are on their feet until they are told so.

Foot ulcers in people with diabetes are only second to road traffic accidents as a cause of amputation of the foot. Foot ulcers are common in people with diabetes; especially those with diabetes that is not well controlled who thus have a reduced wound healing ability.

Nearly one in every four persons with diabetes with ulcers in their feet will require amputation; hence the great need to prevent ulcers from forming in the first instance. Every thirty seconds a diabetic foot is amputated! Worldwide, about a million people with diabetes have one or both of their feet amputated every year.
Ulcerations and amputations have tremendous impacts on people’s lives; leading to increased dependence, psychological stress and social isolation.

The factors that when they are present alone or in combination in individuals with diabetes leads to ulcer formation on the foot includes damage to the nerves (neuropathy) of the legs by prolonged elevated blood sugar levels and reduced blood flow to the legs due to blockage of the arteries that carry blood to the legs due to diabetes and high blood cholesterol levels.

This neuropathy not only affects nerves that help us to feel, but also nerves that help the muscles to move well and the ones that keep the skin from becoming too dry. When this nerve damage is present some people may actually have no symptom at all while others may have experiences that range from lack of any feeling in the feet (numbness), to severe peppery sensation, severe pain, or sensation that is likened to walking on cotton wool or cramps on the feet.

Some may also experience unsteadiness in their walk which is worse when there is darkness, while others may experience pricking sensations on the legs and feet. When high blood sugar has led to damage of the nerves that keep the foot moist and well oiled, it leads to reduced sweating, dry skin and development of cracks and fissures and in some instances a foot that is warm.

It is necessary to reiterate that absence of any of these symptoms does not exclude the presence of diabetic foot disease. Therefore those with diabetes must have their feet examined at least once a year by their physicians apart from their own personal daily inspection of their feet.

When damaged by high blood sugars, nerves that help in movement of the muscles of the feet lead to a deformed foot, clawing of the toes, formation of callus and ulcers under the feet. In about ninety percent of cases, ulcer formation and amputations are preventable. The aphorism which states that “prevention is better than cure” holds true also as regards diabetic foot ulcers.

When allowed to develop, diabetic foot ulcers constitute a major medical, social and economic problem seen in every country and are a major cause of diabetic mortality. Treatment of diabetic foot ulcers is long and intensive and the associated costs are high, hence they are best prevented. The next part of this discourse will centre on prevention of foot ulceration and foot amputation.

Part 2 to follow

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